Digital health · Opioid use disorder
Ophelia
A telehealth medical practice treating opioid use disorder with medication and a care team. It has published five peer reviewed studies on its own patients, and the numbers in them moved as the cohorts grew.
What happens after someone misses a visit
A study posted online on September 22, 2026 takes up an ordinary problem in addiction care. A patient books a video visit and does not show. In most practices the next step is a rebooking queue, a wait of a week or two, and often no return.
Ophelia tried something else. It ran a recurring virtual drop-in clinic and invited people who had missed a visit to come back with no penalty and no new appointment. Over 71 sessions it sent 4,029 invitations to 2,731 unique patients, and 554 were seen. Attendees were back with a clinician a mean of 1.7 days after the missed visit, against 12.9 days for those who confirmed but did not attend and 14.4 for those who never confirmed. Among attendees, 7.8 percent left treatment without returning, against 21.4 percent of the others.
The authors work at Ophelia Health, Inc. and the University of Pennsylvania School of Nursing. They describe the design as a way to welcome patients back “without shame, penalty, or delay.” That is the company in miniature: the bet is not a new molecule, it is removing the friction that makes people stop coming.
The gap it is aimed at
Medication for opioid use disorder is established, evidence based treatment, and buprenorphine sits at the center of Ophelia’s model. The question has never been whether it works. It is that most people who would benefit never get it, and most who start stop early.
For two decades the supply of prescribers was constrained by law. The Drug Addiction Treatment Act of 2000 required a separate federal waiver, and patient counts per prescriber were capped. Ophelia built its early pitch on that scarcity, saying in 2021 that only about 5 percent of clinicians held the waiver. Then the constraint vanished. Section 1262(a)(1) of the Consolidated Appropriations Act, 2023, enacted December 29, 2022, amended the Controlled Substances Act to eliminate the waiver requirement for prescribing certain schedule III to V medications for opioid use disorder, and SAMHSA proposed removing the DATA-2000 provisions on February 13, 2023. The moat Ophelia had described was legislated away inside four years of founding.
A second rule matters less than it looks. SAMHSA’s revision of 42 CFR Part 8, released February 2024, effective April 2, 2024, compliance date October 2, 2024, governs opioid treatment programs, the certified clinics that dispense methadone. Ophelia is an office based practice, so the rule reshaped the field around it, not the company.
A founder with a specific reason
Zack Gray was finishing an MBA at Wharton in early 2019 when his girlfriend died of an opioid overdose. He had studied philosophy and astrophysics at Columbia and had no healthcare background. He started Ophelia after graduating, brought in Mattan Griffel of Columbia Business School as co-founder, went through Y Combinator, and treated a first patient in April 2020 in Pennsylvania. The clinical design came from elsewhere. Ophelia credits two academic addiction psychiatrists as co-designers: Arthur Robin Williams, later chief medical officer, and Adam Bisaga of Columbia University, co-medical director. Both are named authors on the studies and both hold disclosed financial interests.
From one state to most of them
Growth is documented mostly in company announcements, and the figures move. In December 2021 Ophelia said 27 states and payer contracts covering 75 million lives. By spring 2023 releases said 36 states and 85 million lives. In April 2024 a release said 30 or more. By October 2024 it said 49 states and D.C.
Outside markers are firmer. On April 16, 2024 Pennsylvania designated Ophelia an Opioid Use Disorder Center of Excellence, the first virtual first statewide provider in a program the state created in 2016. In October 2024 it went in network with New Jersey Medicaid plans. The payer work is the business: the chief executive says roughly 70 percent of patients use Medicaid, and that Ophelia targets about 70 percent Medicaid coverage before entering a state, so the map “starts to look less like one that is delineated by state lines and much more like one that is delineated by payer network lines.”
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| First retention study | J Gen Intern Med, online Dec 2022. 475 patients in New York and Pennsylvania. Retention at 180 days 69.1 percent (95% CI 65.0 to 73.2), against 27.0 percent in multi state Medicaid claims and 31.0 percent in commercial claims. Funded by the company. | Peer reviewed |
| Larger retention study | The American Journal of Drug and Alcohol Abuse, 2023, 49(2). 1,378 patients enrolled Apr 2020 to Sep 2021, same two states. Retention 56.4 percent at 180 days, 48.3 percent at 365 days. No significant association with sex, race and ethnicity, state or rurality. | Peer reviewed |
| Insurance and retention | Health Affairs Scholar, 2024. 3,842 patients entering care in 2022. In network patients were likelier to be retained at six months than cash pay patients, adjusted risk ratio 1.50 (95% CI 1.40 to 1.62), and beat insured out of network patients, 1.86 (1.54 to 2.23). | Peer reviewed |
| Remote drug screening | JAMA Health Forum, Jul 2023. 3,395 patients across 14 states. 83.3 percent completed a urine drug screen within 30 days. Buprenorphine positivity rose from 96.9 to 98.4 percent; opioid positivity fell from 7.9 to 3.3 percent. | Peer reviewed |
| Independent evaluation | Peterson Health Technology Institute, Sep 16, 2025, assessed 16 virtual opioid use disorder solutions including Ophelia. Medication focused ones kept patients in care about 13 more days over six months, 150 against 137, saving roughly $400 per patient, with no indication of materially expanded access. | Independent |
| Retention as marketed | The company claimed 70 percent six month and 60 percent twelve month retention in Dec 2021, and 60 to 70 percent at six months in 2024. Its own larger peer reviewed cohort reported 56.4 percent at 180 days. | Differs from the papers |
| Unsourced figures | The Y Combinator profile describes a protocol “6x more effective than most rehabs” and treatment that “increases survival rates by 600%”. Company pages put overdose reduction at 75 percent in one place and 76 percent in another. None is cited. | Company-stated |
| Federal records | No FDA 510(k) or PMA record, no registered trial, no NIH or NSF award and no enforcement matter found, as of Sep 23, 2026. | Not found |
Read plainly: Ophelia has done something rare for a venture backed clinical service, which is publish its outcomes and let reviewers see them. Every paper also carries a company disclosure, and several report numbers that undercut its own marketing. The 69.1 percent figure came from 475 early patients; 56.4 percent came from 1,378 patients over a longer window in the same two states. The larger the cohort, the lower the number. The one evaluation nobody at Ophelia wrote found virtual providers as a class beating in person care by about 13 days over six months and not expanding access at all. Both can hold: the care travels well to video, and the category has not proved it reaches people who were never in treatment.
What to watch
- The DEA telemedicine flexibilities. A fourth temporary extension runs them through December 31, 2026. Two final rules published January 17, 2025, on buprenorphine treatment via telemedicine and on continuity of care for Veterans Affairs patients, took effect December 31, 2025 with more requirements than the temporary rule.
- Medicaid. About 70 percent of patients use it, and the company’s own research ties in network coverage to whether people stay in care.
- Retention figures for the national cohort. Every peer reviewed number so far comes from New York and Pennsylvania patients treated between 2020 and 2022.
- Capital. No Form D since December 2021.
In their words
“I was a business school student at Wharton, and a former girlfriend of mine died of an overdose. I was very involved in her attempt to get help and saw a system that was poorly designed for people who need access to treatment for addiction.”
Zack Gray, co-founder and CEO, The Daily Pennsylvanian, 2023 · Independent
“Anyone who wants to stop using opioids needs this medication, but most find it easier to get from drug dealers than doctors, even if it means spending a thousand dollars per month.”
Zack Gray, Series B announcement, December 2021 · Company release
“Our job is to make it easier to choose clinicians than drug dealers.”
Zack Gray, to Fierce Healthcare, July 2022 · Independent
“Virtual solutions perform as well as or slightly better than traditional care models, but healthcare providers and digital solutions need to continue striving for interventions that deliver more substantial improvements in retention and effectiveness.”
Caroline Pearson, executive director, Peterson Health Technology Institute, September 2025 · Independent
“We’re on our way to achieving long-term profitable growth without reliance on outside investors.”
Zack Gray, to Behavioral Health Business, October 2024 · Independent
Related companies
Sources
- Public recordForm D filings, Ophelia Health, Inc., CIK 0001811186
- Public recordA Virtual-First Telehealth Treatment Model for OUD
- Public recordTelehealth for OUD: retention and rurality
- Public recordUrine Drug Screening in a Telehealth Setting
- Public recordIn-network benefits and retention
- Public recordRedesigning Access: a Drop-In Clinic
- Public recordRemoval of the DATA-2000 Waiver Requirements
- Public record42 CFR Part 8 Final Rule
- Public recordDEA Extends Telemedicine Flexibilities
- IndependentVirtual OUD Solutions Are as Effective as Usual Care
- IndependentVirtual solutions can substitute for in-person care
- IndependentEntrepreneur whose startup raised $50 million
- IndependentHow to Scale Medicaid OUD Treatment
- IndependentA virtual-first center of excellence in PA
- IndependentWharton graduate Zack Gray founds startup
- CompanyOphelia Raises $50 Million Series B
- CompanyCenter of Excellence designation
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
