Subreal

Subreal is creating an impact within Substance Use Disorder (SUD) treatment. SUDs are conditions in which a person is unable to control their use of drugs, alcohol or medications. It involves a harmful pattern of substance use or substance dependence.

There are currently 35 mln patients with a SUD diagnosis worldwide, with 0.5 mln deaths annually attributed to them. In the US, substance overdose has already become the leading cause of death for patients 15-49 years old. SUDs are responsible for 1.38% of the Global Burden of Disease.

When untreated, SUDs increase morbidity and mortality risk, can trigger substantial suffering, and cause impairments in personal, family, social, educational, and occupational areas of functioning. Most treatments include outpatient and inpatient rehabilitation programmes or medicine-assisted treatment.

Yet, 40-60% of patients relapse within a year of treatment discharge. This value skyrockets to 80-90% for patients affected by Opioid Use Disorders. This means that most patients go through 4-5 rehabilitation visits before a long-term recovery is reached. The full recovery time takes 2 years on average.

Why is the treatment so ineffective? Most patients receive little to no aftercare treatment. After a 6-week inpatient rehabilitation programme, patients only receive a weekly in-person psychological evaluation. Even though most relapses happen within 3-4 weeks of treatment discharge, a patient's journey usually goes from 24-hour-a-day monitoring to a weekly clinical visit immediately after leaving a rehabilitation centre. That happens despite literature showing that continuous care and monitoring improve treatment outcomes.

A significant limitation to implementing more robust aftercare treatment is cost. In the UK, the NHS offers free Substance Misuse Treatment, despite there being no such thing as an NHS residential rehab (inpatient programme). NHS buys places in private clinics, where a 6-week inpatient programme costs £20,000-30,000. Hence, both providing additional aftercare treatment on top of that or trying to be treated privately are financially unviable. There is a lack of financially accessible, and continuous care monitoring tools. That is the issue we are trying to solve.

In 2022, there were 289,215 patients in contact with the UK drug and alcohol services. Nearly half of them (49%) were in treatment due to problems with opiates, and 29% were treated for alcohol use. Only 49% have left treatment successfully. Since last year, both of these conditions can be monitored continuously with novel digital biomarkers, which just got the FDA approval and CE mark. No one has implemented them commercially in SUD treatment. We are trying to achieve that.

Subreal is developing predictive technologies for Substance Use Disorder (SUD) treatment. By predicting the risk of a patient's relapse, we can provide them with continuous care with personalized medical interventions to prevent the relapse from happening.

Continuous monitoring is achieved using digital biomarkers, gathered through video footage of the patient's face and eyes, from which we can extract medical data used to monitor the patient's psychological and physical state. This data is gathered using already FDA-approved and CE-marked technologies comparable to a clinical gold standard. With that data, we utilize a multi-marker approach to monitor the patient's condition using machine learning models and predict the risk of relapse. Based on that risk assessment, the responsible clinic can provide psychological and medical intervention to prevent the exacerbation event from happening.

Patients are supported with a Subreal app, which allows them to collect bi-daily measurements using video footage and psychiatric questionnaires, and grants them access to the backlog of their everyday results. Patients can also take additional notes dedicated to use, a note-taking habit often employed by SUD patients. Their assigned clinician, who has access to their results, can comment on things when needed.

The clinic accesses the data through a clinician's dashboard and is notified when a patient's state is deteriorating and an intervention is needed.

Subreal serves Substance Use Disorder (SUD) patients, and clinicians working in SUD treatment. Subreal currently develops solutions towards patients with opioid and alcohol problems, although long term we are trying to address all Substance Use Disorders. Currently, our solution is designed for most of the 290,000 patients in treatment in the UK, with plans to expand internationally.  Most of these patients receive limited treatment, often in the form of weekly psychological support, or residential programmes with limited aftercare.

Currently, there are very limited solutions allowing for remote continuous monitoring of SUD patients. By implementing Subreal into treatment, we are building a bridge between residential programmes and full recovery, allowing the patients to have a smoother transition where they are still receiving continuous treatment and monitoring, but remotely and with personalized interventions. That lowers the risk of relapse after discharge. Decreased relapse rates mean a lower number of rehabs needed, shorter treatment time, decreased number of deaths in treatment, and decreased economic burden on the NHS.

A significant number of SUD patients also experience economic hardship, with 16% of them experiencing a housing problem. Subreal would be an affordable solution to support conventional treatment.

The Founder and CEO of Subreal (me) has been deeply interested in Substance Use Disorders and their social impact for several years. With previous years working in NGOs, and biomedical engineering, it was always very touching to him how much SUDs influence young people, and how much potential is lost within them. Experiencing first-hand how a relative is experiencing significant hardships from SUDs has made a lasting impact on him. Substance Use Disorders have become his northern star.

To expand our perspectives, and detach from the emotional perspective, we have conducted 15 one-on-one 1.5h-long structured interviews with patients, academics and clinicians in the US, UK, and Poland. The interviews were later analyzed to more deeply emphasize with the patients, and understand their treatment journey. Based on that the high relapse rate was identified as the biggest addressable problem within SUD treatment. We are still actively talking to these patient groups and academics both in unstructured and structured interviews to get regular feedback on what we are building, testing prototypes, and making sure that our products meet clinical standards.

Subreal is also supported by EWOR, Millenium Fellowship, and Bitelabs Fellowship, through which the founding team has received extensive support in impact founding, and access to an extensive network of clinicians, which helps us bring the vision into reality.

We have already developed several prototypes to test our key features and tested them with users through non-clinical means (patients recruited outside of official treatment). The prototypes included moving from low-fidelity (spreadsheets, paper prototypes) to high-fidelity prototypes (Figma prototypes) and machine learning models trained on synthetic data and proto apps.

We are currently looking forward to running our first clinical feasibility study in Q2 2024 with an SUD Clinic, to build clinical evidence for our solution, and expand our clinical and economic validation until the end of the year.

We are looking to gain regulatory support, network with other clinical solutions, and obtain advisory support from Solve with a focus on the implementation of digital health solutions. We would also greatly benefit from Solve's talent pool since we are in a rapid growth stage and need to source talent. Additional funding would also support us in the further development and implementation of our predictive technology for Substance Use Disorders.

Subreal utilizes digital biomarker data to provide personalized continuous care and monitoring tools for SUD treatment. Currently, patient monitoring requires in-person visits to monitor the patient's psychological state, which cannot be done constantly. With Subreal, the patient's psychological and physiological state can be monitored daily and remotely. There are currently no monitoring solutions for alcohol and opioid use which provide continuous care without specialized hardware. Most of the digital data-gathering tools which allow for continuous SUD monitoring have been FDA-approved and CE-marked just within the last year. Subreal is utilizing these technologies to fill in the gap between residential care and long-term recovery through continuous care and monitoring, and a predictive approach to aftercare treatment.

In simple terms, Subreal decreases the risk of SUD patient relapse by providing continuous care and monitoring tools to SUD patients. Subreal predicts the risk of SUD patient relapse by monitoring the patient's psychological and physiological state. When the patient's condition is deteriorating and an increased relapse risk is detected the assigned clinic is informed to provide personalized treatment to prevent the relapse from happening. Since most patients relapse within 3-4 weeks of treatment discharge, preventing a relapse in that period has a positive effect on the success of the patient's long-term recovery. Through that, the overall relapse risk is decreased.

Subreal's mission is to decrease the relapse rate of SUD patients after a year of treatment discharge by at least 10% and increase the coverage of SUD interventions to at least 50% of 290,000 treated SUD patients in the UK. That aligns with SDG goal 3.5.1 to increase coverage of treatment interventions for substance use disorders. These two goals are measured by monitoring the patient outcomes of patients using Subreal. The relapse rate is tracked using electronic health records to see how many patients go back to treatment after a residential (inpatient) programme. Coverage is measured by the number of clinics in the UK offering Subreal as a part of their treatment.

Subreal utilizes digital biomarkers to create multimarker machine-learning models, which track patient's psychological and physiological state. Data gathering is done using digital biomarker tools for smartphones and wearables, which collect medical data comparable to a clinical gold standard. Subreal is accessed through a smartphone app to create an engaging 'Bereal'-like experience where the data is collected through short videos of the patient's face. That footage is used to extract the medical data using FDA-approved and CE-marked technologies, which are later analyzed using a machine learning model, and sent to the clinic with the NHS electronic health record APIs.

I am the sole founder and CEO of Subreal.

6 months on this solution, 12 months with structured customer discovery and ideation.

Our current talent sourcing looks for diverse backgrounds to increase the number of perspectives and experiences in the team.

Subreal creates value by improving the quality of SUD treatment, through continuous care and monitoring tools, which allow for personalized treatment and a decrease in relapse rates. 

Our solution is monetized through selling to insurance innovation units and, later, to the NHS. By providing a 10% decrease in SUD patients' relapse rates within a year of treatment discharge, the amount reimbursed by the insurance companies is lower, as opposed to the full-length treatment of patients not using Subreal. A part of the generated savings covers the costs of continuous treatment and monitoring provided by Subreal on annual contracts. Therefore, the value proposition provided to the clinics and patients is additional aftercare treatment allowing for constant monitoring and constant treatment. For the insurance companies and the NHS, Subreal decreases the costs needed for full patient recovery and improves the quality of clinical care.

Subreal long-term financial sustainability will come from long-term contracts with the insurance companies and the NHS. The product will be offered as a part of the treatment provided by the rehabilitation centres and recovery clinics in the UK, with later expansion to the US market. 

Our development is financed through grants, and we are looking to raise pre-seed venture funding in Q3, 2024. To achieve this, we will increase our clinical validation through feasibility and development studies, and start testing the economic validation in a clinical setting through multi-facility studies.