Could This Device Change the Future of Addiction Treatment???

What if opioid withdrawal could visibly ease in 20 minutes and cravings could drop to near zero within days? We sit down with Net Recovery CEO Joe Winston to unpack a wearable neuromodulation device, FDA-cleared for managing opioid withdrawal, that adapts to real-world drug trends and may restore a person’s ability to choose. Joe traces an unexpected journey from aerospace and AI to building a handheld system that translates complex waveform expertise into accessible care—and shares how rigorous trials and peer-reviewed data convinced skeptics.

We dive into how the device works: gel electrodes behind the ears deliver patterned stimulation that dynamically shifts based on daily assessments of opioid, sedative, and stimulant withdrawal. As supplies change—think xylazine-adulterated fentanyl or emerging veterinary sedatives—the team retools waveforms to meet the moment. The results are striking: measurable relief within an hour, average treatment of three to four days, and early evidence that many patients reduce use of opioids and psychostimulants for months post-treatment, even without medication. That renewed agency becomes the catalyst for aftercare, longer residential stays, and more consistent engagement.

Access and scale matter as much as science. We explore delivery in jails where Medicaid interruptions worsen withdrawal, residential programs, and new office-based addiction treatment designed for privacy and minimal life disruption. We also tackle safety and harm reduction—falling tolerance raises overdose risk if someone returns to old doses—and clarify patterns of lapse versus relapse observed in follow-ups. Beyond clinics, Joe lays out a bold public-health vision: statewide jail deployments measured against overdoses, all-cause mortality, and re-arrest. It’s a practical, humane plan to meet people where they are and move addiction care forward with data, transparency, and stories of real recovery.

If this conversation resonates, follow the show, share it with a colleague, and leave a quick rating. Your support helps more people find evidence-based paths out of addiction.

To Learn More about Net Recovery: https://www.netrecovery.net

One of the studies Joe referenced in our interview: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1510428/full

To contact Dr. Grover: ammadeeasy@fastmail.com

Transcript

Host Intro And Acronym Guide

SPEAKER_02 0:00

Welcome to the Addiction Medicine Made Easy podcast. Hey there, I'm Dr. Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years, I worked in the emergency department seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started. Today's episode is an interview with Joe Winston, who is the CEO of a new company that is working on a device that uses transcranial alternating current stimulation to treat addiction. I have to admit, I didn't know this was a thing before recording this episode, but after talking to Joe, it sounds like this technology has enormous potential to change how addiction and withdrawal is treated. I put a link to Joe's company website in the show notes, as well as a link to one of the studies his group did on how effective this technology is when treating addiction and withdrawal. Now I wanted to clarify a few acronyms that Joe used during the interview. MAT is medication for addiction treatment. It used to be a medication-assisted treatment, but it's been updated to medication for addiction treatment. MOUD is Medication for Opioid Use Disorder, and OBAT or OBAT is Office-based addiction treatment. Before we start, a quick ask to leave me a rating on your Podcatcher app. I use an iPhone and use Apple Podcasts, and it's literally as fast as just scrolling down on the podcast and tapping a star rating. Getting more reviews helps more people find my podcast. And with that, let's get started. All right, happy Friday. So glad to have you on the podcast. Let's just start with having you tell us who you are and what you do.

From Cancer To Building The Device

Clinical Trials, FDA Clearance, Early Results

Tackling Xylazine And Emerging Sedatives

Scaling In Jails, Rehab, And OBAT

SPEAKER_01 2:08

Hey, Dr. Grover, thank you very much for letting me come and talk with you today. I really appreciate your podcast. I'm Joe Winston. I'm the CEO and co-founder of Net Recovery. I come to this industry in an unusual way. My background is very much engineering, Johns Hopkins and Penn and artificial intelligence and aerospace. But back when I was in high school, I came home from school one day, and there were three stretch limos wrapped around the curb where I live. I walked in the back door and the Rolling Stones were hanging out in my living room. I don't know what it's like for you, Dr. Grovert, but that's not normal for me. So there was Mick Jagger and Keith Richards and all these folks. And they were there because a technology called neuroelectric therapy had been jointly approved by the US government and the British government as an intervention for the Rolling Stones, who had run into a bit of trouble up in Canada. And so I was able to see for the first time this technology used to treat Keith Richards in real time. And I got to watch just this astonishing, very rapid transformation. If you fast forward maybe 20 years or so, I was diagnosed with a very aggressive cancer. They gave me 30 days to live. And when you count backwards from 30, 19, 18, 17, for me, a lot of things that I thought were very valuable did not survive that process. Equally, there are things that I took for granted that I found myself investing in. And so when I got past zero and I still hadn't died, and I was still convinced I'd be dead by the end of the year, I ended up putting together a small team and we took on this technical curiosity to see if we could turn it into a product. And the doctor who had invented it was getting old. And so we leaned into this and we figured out how to put Dr. Meg Patterson into a box. And the box looks like this. I don't think you can see it because your podcast is just audio. But we ended up figuring out, using some of our artificial intelligence background, how to do the thing that she did so well. Now, at her in her day, only maybe three or four people could do this. It required a tremendous amount of understanding of the withdrawal process and observation and then manipulation of waveforms to counter a pretty complex process. We figured out how to make it simplified. We took that process and ultimately ran what is arguably the most rigorous randomized control trial in the world of neurostimulation wearables in the addiction space. And we ran that clinical study in 2021, 2022. The outcome of that study was sufficiently compelling that the FDA granted us clearance. And we published the outcomes in Frontiers of Psychiatry. You can find that article there. It's peer-reviewed. And what that article would show, and what the FDA gave us clearance for, was the ability to manage opioid withdrawal. So for us, in the first 20 minutes or so, there's an immediate change to affect. What do I mean by that? A person who is going into withdrawal, you can see that they rub their nose with the back of their finger because their nose is running, they're sweating, they tend to bounce their leg, they're agitated. And if you watch them and you have a clock behind their head, we would often do this with their parents, 20 minutes in, they just visibly sit back. They change their posture, their legs stops moving, their nose stops running. If you go out to an hour, we found in our study that 98% of the people that we treated had a significant reduction in opioid withdrawal severity. That's pretty outstanding as an outcome. Now, I'm going to say that the principal cause for helping someone to get through withdrawal historically has been to bridge them into medication. And so we'll talk about that more as we go forward. If I think about Philadelphia today, they have a very different class of problem. They have, they had a xylosine outbreak, and now it's something called metatomidine. It's a horse tranquilizer. They call it rhino tranc. And they're not kidding, it's about 200 times more potent than xylazine, which is a horse tranquilizer. So hence rhino tranc. The difficulty is that there are not good methods for managing withdrawal from metatomidine. And so the ICUs in Philly are fairly overrun right now. In Kentucky, where we do a lot of work, we see xylosine now adulterating almost all of our fentanyl. And in the last six to eight months, we now have a suspected metatomidine showing up. It's hard to know for real because there's not a good test for metatomidine. But we've been quite successful at modifying the waveforms coming out of our device in order to handle metatomidine. And we're in fact in discussion with some folks in Pennsylvania right now about running a study, see if we can use that to ease the burden on their ICUs. So that's paper number one, and that's very interesting. And we're proceeding now to explore how to scale this nationwide. We received investment funding in a seed round about six months ago, and we're now running a number of models in the US. Uh, the model that we first ran in Kentucky was inside residential treatment providers. We then moved and made it available inside jails. So today in Kentucky, we're in 15% of the beds. The residential beds were in 10% of the jails. And in a jail is tremendous because if you're arrested and you're taking fentanyl, or frankly, if you're taking suboxone, you are not eligible for Medicaid anymore. And so your medication comes to a halt, and that puts people into withdrawal. So we've been very successful at making this available inside jails in order to handle this issue. We're now opening office-based addiction treatment in Florida to address a different population, people who might want treatment and are wanting privacy. They're not comfortable engaging with others. But Dr. Grover, maybe the more interesting thing coming out of this is having published that first paper, we recently published a second paper. And that second paper tried to examine what happens to folks after they're treated. What's the durability of this treatment? And there is an obvious outcome, which is you bridge people into medication. And it's very effective for that, frankly. But there's a non-obvious outcome. And one of the things that we see, in fact, there was a fact sheet put out by the White House this morning that said 80% of the 50 million people in the United States who today have some form of addictive use disorder, some form of addiction, do not engage with healthcare and don't believe that they need any currently available intervention. In the end, that's likely that underserved population is likely to be our target population. Because what we saw in our second paper, and please understand this is not a indication from the FDA, but what we saw in that second paper, peer-reviewed, published in Frontiers of Psychiatry, is that people who received stimulation for more than 24 hours were significantly less likely to use either opiates or psychostimulants, methamphetamines or cocaine, and were doing so without any medication, without methadona, without buprenorphid. And we measured that every single day for three months. And so we saw that behavior at one month, we saw it at two months, we saw it at three months. We've now just finished a study which examines maybe a bigger question. Is that durable to three years? And that study closed in December. We're analyzing data right now. We expect to be publishing that data sometime early to mid this year. My expectation is that we're going to find that the ratio holds, that ratio being approximately 85% of folks that receive 24 hours of stimulation will go 30 days, the 30-day period, with no opiates, no laps, no redaps, no psychostimulants, and no medication to help them. And if that really is true, if it holds out at three years, that is an astonishing outcome. We are today putting together a second pivotal study to work through with the FDA to come back and talk to them about another set of indications for reducing substance use, host discharge. So that's where we sit today. Because we find that people are engaging with us who were not otherwise engaging with medication, that does seem to be the population that we tend to attract. We are now exploring avenues that would be attractive to that group of people. So I'm going to start by saying we had a gold standard treatment, and that is today MAT or MOUD. So this is methadone or buprenorphine. But 80% of folks don't believe they need that, don't engage to get that. That population for us is at the moment very receptive to receiving stimulation for an average of three and a half days and getting through their withdrawal, which is the primary barrier to entering treatment. If this research holds and we can present that data to the scientific community and to the FDA, it may be that's a durable outcome. And that also would be outstanding. So that's so that's the place we are today, and looking at what types of models might scale. We're brand new in this marketplace, Dr. Grover. We just got our funding about six months ago. And so this for us is all an exploration. And I think that our biggest goal today is to understand what would be attractive to people who know that they're struggling with substance use. I would call it problematic drug use, and find a way of becoming available to them in a manner that they would find acceptable. So that was a lot of things to talk about all at once. Do you have questions for me? How's the thing work? So there's a device that looks like this, it's handheld, it's got a nine-volt battery. That device attaches to two small surface gel electrodes behind your ears. They're like EKG electrodes, so they peel on, they peel off. The stimulation through there, you get to control how strong or how weak it is. It turns out that the amount, the loudness of the stimulation doesn't change how effective it is. But what we learn over time is that people who are feeling in distress, they want to turn it up and feel it. And as their distress drops, they tend to turn it down. There are a set of waveforms that come through there that feel like a faint buzzing behind your ears. And you would then have that faint buzzing all day, all night for between one and seven days. Our typical duration is three and a half days. The truth is that the length of time really is dependent upon the number of substances that you're taking when you come to our door. And the majority of folks are polysubstance. I think half of them are taking five or more different detectable substances in their urine. So you would then wear that 24 hours a day. It would change waveforms over time based on the substances that we told it to pay attention to. And then you come in and see us every day. And what we do is we do a quick assessment of your withdrawal using a profile that is opiate specific, combined with sedative specific, combined with stimulant specific, combined with some other things that are in there. And we would potentially change the waveforms that are coming out of the box in order to address your withdrawal profile. So if I were to give you an example of this, before we understood xylosine, we would get people that came in and they would tell us they're tanking fentanyl, and we take a urine test and we'd see fentanyl and maybe some methamphetamines, and we treat them. And in the first 24 hours, it'd be outstanding, and we'd get out to about hour 30, and they would suddenly have a spike in withdrawal symptoms that were characteristic of sedative withdrawal. And so we heard what was happening to Philadelphia. We began to use the xytozine strips, and sure enough, we had heavy prevalence of xytozine until we were able to figure out a default program that included xytozine. We would then switch somebody over to xytozine and we would toggle back and forth between principally opiates and stimulants and the sedatives in order to push back on all of those over a period of time. At some point, we got good enough at this that we had a baseline set of programs that we could address all three of those simultaneously, and it works pretty well. But because we get to see you every day, we end up often personalizing the treatment to your own withdrawal profile. It's a little tricky. And the reason it's a little tricky is that opiates are great painkillers. And so you could have hepatitis C and you wouldn't know it. Or you could have an abscessed tooth and you wouldn't know it. And I just picked kind of the number one, number two reason that people suddenly go to the hospital on the second day. You take them off of fentanyl or oxycodone or whatever they're taking, and all of a sudden, what shows up could be other withdrawal symptoms, or it could be an expression of a physical ailment that was very effectively masked by your opioid. So part of the training to our staff is how to differentiate between those two cases.

SPEAKER_02 17:16

What's the brain science behind it?

Durability Of Effects And New Studies

SPEAKER_01 17:20

You have in the front part of your brain, you've got your prefrontal cortex, which is like the brakes, and that would allow you to exercise judgment over your own behavior. For people who are not addicted, that piece is very effective in saying, I don't want to do things which would harm my family, for instance. When you take addictive substances or frankly participate in addictive, repeated, repetitive behaviors, either one of those, it will hijack your reward system. And so if you go into your midbrain, you got a thing called your nucleus accumbens and your ventral tegmental area, little pieces of your brain that today they form a reward structure and they're like the accelerator in your brain. And so what your brain will do over time is if you constantly stimulate that, it will, fancy word, downregulate. It will begin to lessen the impact of that in your own self-preservation. But you do that long enough, and now you stop and you go into what we would call withdrawal. Your body is suffering from anhedonia. You're miserable. You have withdrawal symptoms, you feel terrible because you're not getting either the internal endorphins that you would be seeing, nor your normal levels of, say, dopamine and serotonin being produced or being received on the other side of that synapse. So the thing that we do pretty rapidly is no different than what your body would do naturally. If you just took heroin for a long time and you took a lot of it, and then one day you stopped, you'd be miserable, you'd be throwing up, you'd be hunched over in the corner. But after some period of time, the acute withdrawal would go away and you would still feel this what we would call post-acute withdrawal syndrome. And that can last a year, two years, but you know what? If you just you hang out long enough and you don't take any more opiates, your body will just recover. You will get back to this homeostasis, this position of equilibrium. All that we did is figure out that there are a set of waveforms that we can externally apply across your head, across that part of your head, and we can drive that homeostasis to occur much more rapidly. So rapidly that you can physically observe it in 20 minutes, that within one hour, you can measure a clinically objective withdrawal severity change that is significant. And within three to four days, on average, you can have a craving level, cow's level, if this is an opiate patient, that is either mild or at zero. And that today is the thing that we are cleared for by the FDA. The big question, the question that we're now doing research to assess, is that durable? Do we actually restore choice? And so if we talk about how your brain works, I started by saying your prefrontal cortex is because when you're addicted, your prefrontal cortex is unable to modulate your behavior. You must take an opiate. You just must. It appears at a human level that after three and a half days, what we give back to people is, frankly, the ability to choose. We've restored agency. And so it's not that you somehow are protected against the impact of an opiate. You'll still feel the impact of an opiate if you took it again. What's restored, apparently, is the ability of your prefrontal cortex, your choice, to modulate your behavior. And what we've discovered over time is at one month and at three months and at 10 months, and maybe even at three years, that if you can choose to take or not take drugs, you will choose not to take them. And this says nothing about the need for aftercare. The folks that we treat of their own choice engage aggressively in aftercare. We actually showed in that same study that people who are in residential care, they leave at the one-week period significantly less often, and they stay beyond three weeks significantly more often. People that we treat with the ability to exercise choice are choosing to engage in their own care, and they are choosing to exercise agency. And by and large, over periods of time, it appears 85%-ish will not take drugs in a 30-day given period.

SPEAKER_02 21:45

Are you studying it for things like alcohol and cannabis too?

SPEAKER_01 21:49

Yes. I'll give you a slightly more complicated answer. In our original opiate population that we presented to the FDA, 50% were taking out of methamphetamine. Or cocaine. A subset of those are also taking stimulants. The vast majority of those are taking THC. Alcohol in Kentucky was not that big of a deal. If we go geographically to Boston, it's a very different profile. Now we see opiates, but it's typically cocaine, not methamphetamines, and almost every one of them has alcohol in the mix. So we've learned over time that there's a high degree of geographic specificity to the mix of drugs that you take. We have a very good track record of dealing with alcohol comorbidity, but we today will not treat alcohol when it's a primary, principally because of the risk of DTs. And so when we train doctors how this works, we warn them and say off-label use for alcohol. If you're going to do that, you had better be in a controlled environment because of DTs. Now, THC is a different matter. So we have a very high prevalence of THC comorbidity in our populations in all of the places that we've been. We will often ignore it for the first three to four days because the withdrawal symptoms for THC are mild relative to the other classes that I've talked about. But we will often, on a day three or a day four, switch over the profile of waveforms that a patient is receiving to specifically address THC.

SPEAKER_02 23:27

So it seems as though if a person could be medically co-managed around withdrawal, alcohol could be an application in addition to the other substances you've discussed.

SPEAKER_01 23:38

Correct. And so I'm not a doctor, and I'm sure that you might, for instance, decide that you're going to taper a person down for a period of time where the risk of DTs is low, and then you might choose to treat them off label. I am not a doctor. I'm not pretending that I'm a doctor.

SPEAKER_02 23:54

You sure sound like one. You've done your research on brain science.

SPEAKER_01 23:59

You spend time at Johns Hopkins and you just can't help it seeping into your pores.

SPEAKER_02 24:04

So how do patients get access to this?

SPEAKER_01 24:08

Today we are available in two different places. And frankly, we're experimenting with delivery models because we don't yet have the ability to get reimbursement. We're driving hard for reimbursement, and that would be both with private insurance and with Medicaid. But we have an interval of time here where we're not yet approved there. And so how do we treat people? We treat of three ways. Number one, we've been very successful in Kentucky at accessing opioid abatement settlement funds. There is a national settlement, it's distributed out to the states. And Kentucky has been very forward-thinking at the county level. Frankly, the reason that we're in 10% of the jails in Kentucky is because of the forward-thinking nature of jailers in Kentucky. It's outstanding. That's way number one. Way number two is self-pay. And so today we are opening an office-based addiction treatment center south of Miami that'll open in March. I would expect that our website will start taking people that are applying for treatment by early to mid-February. And we're going to experiment with an OBAT model. And the thing about an OBAT model, why do we choose to do that? We find that many of the people who are attracted to receiving this kind of treatment, they're working and they don't wish to interrupt their job or they don't want their family to know that they're being treated. For them, the prospect of checking into residential care is an obstacle. And so we we want to go treat people where they are. And so to try to find an option, we're setting up an urgent care kind of facility where you could go in and you'd have to come back every day for three or four days. Our next move is going to be going to the home. And so we're already beginning to talk with people who deliver care in the home, whether that's home health nursing or whether that's infusion therapy. And we are looking for people that have a kind of a supra-regional footprint and see if we can't actually provide this to people in their homes. Once again, we're looking for privacy. We're looking for the ability to acknowledge to us that you have an issue, but not necessarily to the folks around you. A lot of problematic substance use does not interrupt one's ability to work or make a living or have a social life. And so trying to cater to people where we are, we're looking at those as models. By the time we get a year and a half to two years out, we will be available for reimbursement and it'll be available in the more traditional kinds of venues. But today it's in Kentucky with abatement funds. It's starting self-pay in Florida. And frankly, we also still treat a fairly large number of people for free simply because we're trying to build the largest possible body of real-world evidence that we can in parallel with our clinical studies. We are very cognizant of the fact that the thing I just told you is hard to believe. And so for us, the science has got to be excellent. And toward that end, our principal investigator is one of the top researchers in the country. It's Dr. Mark Greenwald out of Wayne State University. And he can speak for himself, but let's just say that as a person who did a substantial amount of research into buprenorphine, he did not start off as a believer or a fan. And having that kind of critical view in the construction of our randomized control trial and the interpretation of its results has been very healthy. The study I said was arguably the most robust in the kind of the wearables neuromodulation space. Our clinical trial design is peer-reviewed as a type of design, and it's available online. We did that again just to get feedback from the addiction treatment community before walking into this space. It's very important for us that our science be excellent.

SPEAKER_02 28:14

Could you manage someone remotely through telemedicine?

SPEAKER_01 28:17

Not yet, but that would be the place that we would like to be in about two years.

SPEAKER_02 28:22

That would be amazing.

Neurobiology: Restoring Homeostasis And Choice

SPEAKER_01 28:24

Yeah. At the end of the day, Dr. Grover, we think that the real long-term future of this is going to be entirely self-directed. So today, pieces are self-directed. What is the amplitude of the signal? How long you use it? When are you perceiving the value? When you stop to perceive benefit, you as a patient stop treatment. It's not your doctor who instructs you. We found that to be very helpful. But there are still pieces of this that require some amount of feedback, that personalization piece. And so we're seeking right now to solve that personalization piece so that it can be driven by the patient themselves.

SPEAKER_02 29:01

Do you have any sense of after people do undergo treatment with your device and that desire to use drugs and alcohol is decreased and hopefully has some staying power, if they go back to their substance, what happens?

SPEAKER_01 29:17

I'm so glad you asked that question. Tolerance is an issue and represents a safety issue. And so whether you're treated with the net device or you are using any other mechanism to reduce your drug use, your tolerance will drop. And when your tolerance drops, if you take drugs at the old level, you put yourself at a risk of overdose. And so every single person that we treat gets a daily reminder to be careful of tolerance that if they're going to go back and lapse, make sure you do it at a pre-addiction dose. Don't fool yourself and take the dose that you were taking prior to treatment. And that's true of us, but frankly, it's true of any intervention that would cause a period of abstinence.

SPEAKER_02 30:00

However, if they do relapse and they do start at a low level, do they quickly go back into addiction? Or is it more like a one-time, I tried it out? Do you have a sense of what that does?

SPEAKER_01 30:14

I do. So this is now non-published material, but I'll share with you what we see when we look at the data. So we've now treated maybe 600 people since we received our clearance a little over a year ago. If I look at that population, I can tell, because we follow up with many or most of those, we can see which people will lapse versus relapse. And we could see, for instance, that a person who takes one episode of an opiate, meaning on one day they report use, the probability that they then use it again in the next two to three months is actually extremely low. And so as a layman, if I were to interpret that behavior, I see two classes. What I told you was that in any given month, 85% of people will use nothing. If we take that 58% and we zoom in on them, we see two classes, a relatively small class that fits into the pattern that you would get, for instance, with medication. They use, they go back, and they immediately return to frequent use. And for us, frequent use in the opiate space says it is more than five times per month. But in truth, it is heavily weighted at 29 to 31 times per month. When we look at their psychostimulant behavior, we also see this very big barbell distribution. They either use it once or they use it every day. And we get that split. But there is, in fact, a sizable, it's more than the majority of population who will use once in month one and zero times in month two, zero times in month three. Or they will use zero in month one, once in month two, zero in month three. I would interpret that as lapse. And when I have the rare opportunity to talk with people about that, I'll get the following kind of story. I was invited to my friend's birthday party. This they've been my friend ever since I was in high school. This is the person who introduced me to OxyContent, and we're having it's their birthday party. I can't say no. We all have something. We're she's my friend. And what we see is they take once and that's it. There is a population that they take once and they immediately take many times, but it is not the majority. What we do see is that it's almost as though you're back to a pre-addiction state by behavior. I can't speak to the what is happening in your brain, but by behavior, people can sample and not be addicted.

SPEAKER_02 32:47

And just to clarify on the definitions, by lapse you're saying a single use and relapse is returned to addiction-level use.

Polysubstance Nuance: Alcohol And THC

SPEAKER_01 32:55

Correct. When we looked at stimulants in order to present some data to the FDA last month, we broke people into three groups. They have zero use in 30 days, they have less than five days of use in those 30 days, and they have more than five days in those 30 days. And then we took a great big population of people that we had treated, and now this is all open label. This is no longer a study, it's real world data. And what we found is if we looked at about 10 months of data, people have been out of treatment for between two and 10 months. We found 85% of folks were in the zero use in their 30-day observation period. I think that there was less than 1% that was in the mild use category, less than 5. And then the remainder, the 15%, were in the more than five, and almost all of them were over 29 days. So we found this very rapid bifurcation of population that was relatively extreme.

SPEAKER_02 34:04

Are you also looking at behavior addictions like gambling or pornography?

SPEAKER_01 34:12

No. Only because our hands are full. And frankly, if I were to pick a second thing to look at, it probably would be Parkinson's. That's just a personal choice. At this moment in time, there are behavioral health interventions for many things. And today, if I were to pick the place where as a society our performance is the worst, I would say that it's substance use. And so the place that we're concentrating today is substance use. And I don't know if that's a good choice as a CEO, but I'll tell you that's a good choice as a guy who counted backwards from 30.

SPEAKER_02 34:47

Interesting. So your device, to speak honestly, has the potential to fundamentally change addiction treatment.

SPEAKER_00 34:56

I believe so, and we would like to demonstrate that. And our path to demonstrating that is going to be outstanding science.

SPEAKER_02 35:04

Yeah. I'm just trying to wrap my head around the potential for someone to wear a wearable device for a few days, manage their withdrawal, and then have drastically decreased levels of cravings and desire to use.

SPEAKER_01 35:19

Yes. And sufficiently decreased and sufficiently long-lasting that they have a return of agency, that they're able to actually control their own behavior.

SPEAKER_02 35:29

Can I convince you to set up a California site?

SPEAKER_01 35:33

You can. I'm actually talking to a county in mid-California next week about potentially working either in one of their hospitals or in one of their jails.

SPEAKER_02 35:42

Yes, I'm in California. I would love to have this available in California. I would send people to that county to get care.

SPEAKER_01 35:49

Hmm. We would love to be in California. I'm a California resident right now. I live down here in Southern California, and we would love to be available here.

SPEAKER_02 35:59

I think there's also an enormous potential in the correctional system, simply because you and I both know that a lot of addiction results in either charges related to drug use and possession and distribution, or the behaviors that come from active addiction and the loss of that prefrontal cortex agency, like robbery or assault or whatever it is. But it would seem as though, from what you're saying, we should put one of your devices on everyone in jail or prison with drug charges, and that might reduce recidivism.

Access Models, Funding, And Reimbursement

SPEAKER_01 36:33

Yeah. Boy, Dr. Grover, so let's dream for a minute. Let's say that our goal was actually to reduce the level of overdose, all-cause mortality, arrest in the state of California. Let's say that was our goal. So today, for us to do that in a residential rehab wouldn't work statistically because not enough people of their own choice enter into that environment. But if you were to be in every jail in the state of California, people don't choose to get arrested. You could, with that sampling method, materially impact the level of addiction in the state. So we've actually begun to model that to see if that's crazy. And we have already approached two different state governors with proposals to measure output at a statewide level. And if we were able to run one of those studies, what we'd like to show is very specifically that if you put people into a set of jails, that you can measure the impact on those things that I just said. Overdose, all-cause mortality, re-arrest.

SPEAKER_02 37:43

So that is my goal. We actually run a nonprofit here in the Central Coast of California called Central Coast Overdose Prevention. And our docs practice medicine in the jail and juvenile hall. So we are there and we are seeing these folks when they come out. And unfortunately, depending on where you are, some jails offer a lot of support and treatment around addiction, others offer essentially none. So you think about how much money we could save a state like California if we were to reduce recidivism with arrests related to drug use, it's just staggering.

SPEAKER_00 38:23

Yeah.

SPEAKER_01 38:24

Of things that are intriguing to our principal investigator, and now I will speak for him. He always says to me, Joe, there's this possibility that these outstanding results are based on self-selection, that you have a population that is going to succeed because of the same set of internal dynamics that cause them to engage in treatment in the first place. And my response to him today is that it's not the population that is currently getting arrested in Kentucky. And so it is a fascinating view of ultimately the efficacy of the net device if that level of outcome is preserved in the incarcerated population. And at this point, the data set is too small for me to say that definitively, but the leading indicator is strong.

SPEAKER_02 39:17

Let me just push back on his perspective a little bit, and I'm gonna be facetious to make a point. So presumably there's some sort of placebo effect to any wearable device, yours included. So to his point, he's saying that self-selection is doing the heavy lifting. Let's assume that the device works and there's a placebo effect. If it's the placebo effect plus self-selection that's working, if it's working, who really cares? Right? I tell my patients all the time, if I prescribed you placebo and it kept you sober, would you take it? They all say yes. So I would say I'm gonna congratulate once again, as I often do, drugs for winning the war on drugs. So it's if it's self-selection and the placebo effect, heck yes. If it's a fantastic scientific breakthrough, heck yes. Whatever we need to do better than we've been doing for decades in America with our lousy addiction treatment, I'm 100% in.

SPEAKER_01 40:15

Yeah, I feel the same way. I feel like we're stalled. I feel like we should try some new things. I'm just very excited to bring one of those possible new things out to the marketplace.

SPEAKER_02 40:25

100%. Well, as we wrap up, what did we miss that you'd like to share with my audience about your device?

Toward Self-Directed, At-Home Care

SPEAKER_01 40:32

When I started in this, I thought that people who took drugs were bad. And the evidence that they were bad is that they took drugs. And when I was working over in Scotland, I was working with a researcher there, a really a bright guy, and he commented to me one day about his own sense of hypocrisy in among himself and his colleagues. And the hypocrisy he spoke about is we're so careful not to use words that make people feel badly. And yet, when we're out together at dinner and in our own heart of hearts, I don't want my children to marry somebody who is taking opiates, whether it's prescribed or not. Okay, that cuts me to the quick. But emotionally, when I first started, I understood that because it was speaking to moral failure. So two things. One is today we understand that this is actually a biological phenomena and it applies to behaviors as well as it does to drugs. But the second thing is now it's just a story. When we kicked off our clinical study in Kentucky, the very first person to show up showed up a day too early and we could not accept her. You have to have the IRB has got to approve. And for a variety of reasons, she was one day too early and we went to tell her no. And if you ever met this particular woman, you would understand that was not an acceptable answer. In fact, this particular woman came from California. She had been living on the street for several years. She had been through, I don't know, seven or eight or nine different stints at rehab. She was so bad that her mother traveled with her thinking that she might stop breathing on the flight. And so this was really a tough case. And frankly, her brother had already died two or three years prior. So this is really tragic. We ended up treating her under compassionate care. That woman is engaged to be married. And sorry, it affects me because what that means is that someplace here is a man who looks at her and says, I want to marry her.

SPEAKER_00 42:43

That's the thing that we want to bring.

SPEAKER_02 42:47

They call it recovery because you get your life back.

SPEAKER_01 42:50

Yes, it's not just choice, it's not just agency. We get to have the splendor of the ordinary. We get to just be alive.

SPEAKER_02 43:02

If you need help networking, California, count me in.

SPEAKER_00 43:06

Thank you. I would love to do that.

SPEAKER_02 43:11

Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction. And a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses. To those healthcare providers out there treating patients with addiction, you're doing life-saving work and thank you for what you do. For everyone else tuning in, thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together, we can make it happen. Thanks for listening. And remember, treating addiction saves lives.