164 - WEEKEND RAMBLE - DR. MONTY GHOSH

Chuck (00:46.294)
Hello listeners, welcome to the Ashes to Austin podcast and another episode of the Weekend Rumble. I'm your host, Chuck LaFlandre, and of course I have my lovely co-host with me today, Dr. Lisa. How you doing today?

Lisa (00:57.084)
I'm very good Chuck, how are you?

Chuck (00:59.298)
Fantastic. And Attica J is back for her first, I guess it's your first episode as a co-host, what I call a probationary co-host when I was talking to you the other day. How you doing today, Attica?

Atika (01:08.496)
I'm sorry.

Atika (01:12.165)
Good, I'm honored. And how are you doing, Chuck?

Chuck (01:16.338)
Excellent, excellent. And of course we have a guest with us today and I wrote a big long introduction for her. There we go, okay. He's a trailblazer in internal and addiction medicine from Alberta. He stands out for his unwavering advocacy for vulnerable groups including the indigenous LGBTQ refugees and those confronting addiction and homelessness. He's a respected academic at the University of Alberta.

He has pioneered vital health initiatives from virtual interventions to detox programs. He's celebrated for his published work as the President-elect of the Alberta Medical Association Addiction Section. Our guest has been instrumental in transforming healthcare perceptives and perceptives and policies. Welcome to the show, Dr. Monte Gosch. How are you doing today?

Monty Ghosh (02:05.957)
Doing well, thanks. Thanks for having me here.

Chuck (02:07.63)
Hey, thank you. That was a long intro. I guess I should have practiced it a couple times there, but that speaks to the caliber of guests, I guess. So you are, well, I mean, you're a medical doctor. You specialize in addictions, correct? Right? Yeah, yeah, okay. Why don't you just kind of give us a, how do you get here? Why is it that you ended up in addictions and became a doctor in the first place, if you want, kind of give us a short rundown of that.

Atika (02:20.627)
Thanks for watching!

Monty Ghosh (02:25.053)
Correct, yeah.

Monty Ghosh (02:37.241)
Yeah, totally. I mean, it was very much a journey and it took lots of twists and turns, if you may. But I started off wanting to do global health. So that was my big focus was to be overseas, working in communities that are under-served and under-privileged. And so that was the big goal of getting into medicine. And people who know me know I love to travel. That's like one of my big things. And so that was part of the impetus as well to do global health. And then I got into medicine.

Atika (02:54.888)
Thanks for watching!

Monty Ghosh (03:04.729)
And then I went down the rat race of medicine, which I mean, I think Lisa could probably talk about as well. And you get into this sort of rabbit hole of trying to get into the best specialty you can and whatnot. So I actually got into ENT when I matched at the U of A. So ENT is ear, nose, throat surgery. So I did three years of that. And then I remember.

Chuck (03:16.758)
which is... Okay, okay, yeah.

Monty Ghosh (03:25.785)
In my third year of ENT, I was like, okay, this is not me. This is not what I was meant to do. And this is not part of my journey. And there's different factors for that. I think, you know, like those patients were very different than what I was used to. A lot of them were doing rhinoplasties, so nose jobs, things like that. And people were never satisfied fully with what they got. And my heart was somewhere else. And so...

Lisa (03:30.883)
Hehehe.

Chuck (03:44.329)
Okay, okay, yeah.

Chuck (03:49.695)
Yeah.

Monty Ghosh (03:54.169)
I switched, I switched specialties. I was trying to get into family medicine and I couldn't get into family medicine. So it went to internal and it worked well. I think I started doing internal medicine, started going down that journey, really enjoyed it. And then I decided towards the end of my internal medicine journey that I wanted to move back to Calgary because my father was born and raised in Calgary.

Chuck (04:00.171)
Okay.

Chuck (04:18.635)
Are you from Calgary then? Yeah? Oh, okay. Yeah, okay.

Monty Ghosh (04:22.289)
And my family's still here in Calgary and my father was going through chemo at the time and so I'm like, okay You know what? I need to I need to move back and I Came back to Calgary and I couldn't find a job And and so it's easier I think for family medicine to find jobs Like you can just kind of set up shop but for internal medicine, it's mostly hospital-based

Lisa (04:22.556)
Thank you.

Chuck (04:40.594)
Okay, okay.

Chuck (04:44.94)
Yep.

Monty Ghosh (04:45.529)
and in Canada that is and so it was I couldn't get a job and so the only place that could hire me was like the Alex and the drop-in center and so I which is our shelter and so yeah I started off over there as an internist and probably the best thing that ever happened to be honest in my mind and yeah so

Atika (04:48.464)
Thanks for watching!

Chuck (05:04.919)
Wow.

Chuck (05:09.942)
No kidding, no kidding.

Monty Ghosh (05:12.921)
Yeah, it was there and then I met lots of mentors from that avenue. And I remember I just started a master's in disaster medicine. I was planning to go back overseas and work with doctors at Borders, but then with my father being sick, I decided to stick around a bit longer. And one of my mentors, Martin Labrie, was like, why do you wanna go overseas to do global health when if you look around, there's just so much need here? Right?

Lisa (05:38.116)
Hmm

Chuck (05:38.711)
Right?

Monty Ghosh (05:39.809)
And Martin's been amazing because Martin like lived through...

So he was like one of the original doctors in the early 70s before we had our not-for-profits in Calgary, that like, our not-for-profit health center, so he was walking the streets of downtown Calgary taking care of patients. He was part of the HIV epidemic, like so he was a palliative care doctor and he would take care of HIV individuals. And back then you had no treatment, all they, you know, all they would do is pass away. And so, and then they started getting treatment and Martin started prescribing it.

Chuck (06:03.726)
Okay, okay.

Chuck (06:07.491)
Yeah.

Monty Ghosh (06:13.631)
Well, he was a huge inspiration to me, to be honest with you. And so you can just Google him and find a lot about him. But yeah, so he's kind of an inspiration to me, kind of pushed me in this direction. And it's been like that ever since. I've been kind of working in this sort of area, intersection between internal medicine, vulnerable populations work, substance use concerns.

Chuck (06:16.558)
No kidding.

Monty Ghosh (06:37.329)
harm reduction, it's been kind of this sort of area, this triangle that I've worked in, and it's gotten bigger and bigger and busier and busier. But it all started off with just working in a shelter and then working with underprivileged individuals. And like, I don't know, Lisa, I don't know what your thoughts are on this, but I remember thinking that it was like not a glamorous job. You know, people when they finish internal medicine, usually like, oh, I get a big hospital job. And you know, I'm.

Chuck (06:45.619)
Yeah, no kidding, eh? No kidding.

Monty Ghosh (07:05.357)
in the thick of it and you're in an academic position but none of those opportunities were available to me at the time. It was just you work your shelter job and no academic appointments, you can't get grants, you can't get projects off the ground, you just do your thing.

Lisa (07:13.947)
Yeah.

Lisa (07:19.107)
So, yeah, and I think it's interesting because one of the things, and for me, right, I had a career pre-medicine, right? Like I worked in industry as an engineer for six years before I went to med school. And I think that in general, people have this perception that being a doctor is just a glorious job and that it's, you know, you can have whatever job you want and you make all kinds of money and that everything is really easy. And...

for me going through it, especially being older and having, I think, a different lens looking at medical school and what it takes to become a doctor, like that changed a lot. Like, A, it's a slog. Like, it is not easy. And like my background's engineering, that wasn't easy either. I can tell you medicine is not easy. And it's not just the content of the knowledge you need to learn, but it's the training that they put you through, the forcing you to be awake for 36 hours, the like...

Yeah, you know, constantly, you know, being under a spotlight, be having, you know, you haven't slept in 24 hours and you got preceptors who are coming at you with questions and you're like, I can't even remember my name right now. So it's, it's not, it's not an easy job. And then what made me think of all this is just like Monte talking about here, we have this trained internist and he can't find a job. Like people don't realize that happens a lot in medicine.

Chuck (08:16.127)
No kidding, eh?

Atika (08:26.961)
Pfft

Lisa (08:41.567)
I think a lot, especially in like surgical programs, because if there's no OR, then even if you have patients lined up for blocks, it's like there's nowhere to operate on them. And so you can be this incredibly trained specialized surgeon and you can't find a job, but it's still crazy, right? That you've got someone like Monte, who's a trained physician and he's like, walking down the street, knocking on shelter doors, looking if somebody will give him a job because he can't find work. Like, that's kind of crazy. Like, it's sad.

Chuck (08:42.135)
Kidding.

Chuck (08:56.587)
I'm kidding.

Chuck (09:07.97)
That's crazy. It really is. It really is, right? Yep.

Atika (09:10.069)
It is.

Monty Ghosh (09:10.336)
Thank you.

Lisa (09:11.799)
You know, but I have a question. So I didn't know you had done ENT. I feel like that's the first time I've heard that. So you did three years of ENT. And then when you switched to internal med, did you get any credit or did you need to start over from year one again?

Monty Ghosh (09:25.149)
I started from year one again, almost all. I think I got like a few months of credit. Yeah, like a couple months I think, and that was about it. And, but you know, I really love internal medicine and I think everything happens for a reason. Like you don't know it at the time. And, and you know, and so internal medicine was the right path for me. I do internal medicine at the U of A now at the University of Alberta Hospital.

Atika (09:27.429)
Oh my god.

Lisa (09:29.979)
That's.

Okay.

Lisa (09:36.303)
Mm-hmm.

Lisa (09:41.007)
That's true.

Lisa (09:49.499)
Okay.

Monty Ghosh (09:49.537)
which is one of our academic hospitals in Edmonton. So I do weeks of internal medicine up there. And then on the weeks that I'm not doing internal medicine, I'm in Calgary working at a few clinics. And so at the Calgary Drop-in Centre, but at other programs as well. And yeah.

Lisa (10:07.939)
And Monte, where did the interest in addiction come into this? Cause it's like you talked about sort of that interest in global health and traveling and marginalized populations and underserved folks, but then you ended up at the shelters in Calgary. Is that when like the sort of specific addiction interest evolved or?

Monty Ghosh (10:25.209)
I mean most of the cases that we're dealing with were substance use related and it was something that we never got trained or taught in undergrad or residency. It's better now but because now there's as many of us who sort of teach residents about substance use concerns but back then there was nothing. And that's just like, I mean I just graduated from residency in 2016 so it wasn't that long ago you know. It's a...

Chuck (10:29.104)
Yeah.

Monty Ghosh (10:52.817)
Um, and so, yeah, it was, uh, it was there that I kind of got, uh, interest in addiction medicine. It was there that I started meeting connections and making connections with people like Rob Tangay and, uh, Dr. Lim and others. And, um, and so started shadowing and, um, doing sort of informal fellowships and training with them for almost over a year, long time period. And, uh, and then kind of ventured out on my own.

Chuck (11:14.882)
I think it could, Lisa, you had said there is no separate fellowship for addiction, right? Oh, there is now, okay, yep.

Lisa (11:19.383)
No, there is now. So there's, yeah, there's a one year program that you can do. And then I think right now in Calgary, at least, and correct me, Lontie, if I'm wrong, but I think it's actually through, more through family medicine, isn't it? Or there's more family med residents who go into it for whatever reason. Yeah, yeah, yeah.

Monty Ghosh (11:34.013)
Correct, yeah.

Atika (11:34.728)
Hmm.

Chuck (11:40.403)
Okay.

Monty Ghosh (11:41.902)
And there's a psychiatry one too.

Atika (11:44.561)
What do you like the most about addiction medicine in terms of the patient? Because sometimes I feel like it's, you know, correct me if I'm wrong, but you choose a specialty because the base of the science of it or the patient population that you get to deal with. So I'm curious about your thought process when you're choosing addiction medicine.

Chuck (12:10.414)
question.

Monty Ghosh (12:11.801)
Yeah, I mean, I love the breadth of patients, to be honest with you. You see everything from high socioeconomic status individuals to people who are highly, highly vulnerable living off the streets. So it's totally variable, different needs. It's very complex. And I think the most interesting part of addiction medicine is that it's this weird confluence or intersection between different...

different sectors that don't usually intersect. So you have the health sector, which is part of medicine. You've also got the social services side of things. You've also got justice often that often intersects with this too. And then you've got government policy. And so it's a very complex sort of...

intersectional of these areas and it's very sort of difficult to navigate if you may. Policy affects the system which affects the patient care. It's all intertwined.

And that's why I really love this. It's just very, you have to kind of navigate through all of these systems. Like I have to navigate through the social services sector and system all the time with not only my patients, but as an advocate, as a researcher, I have to go through the government officials all the time and understand public policy and why certain pieces of policy are made the way they are. And is it evidence-based and is it based off of research? You know, it's so important to do that as well. And then...

Lisa (13:41.672)
stigma.

Monty Ghosh (13:42.533)
our stigma, yeah, beliefs, theology. And then there's also, I mean, I also find the justice system is very much intertwined here. And so like, I have to concede, like I had meetings with the RCMP yesterday, week part of that was at the CPS group or the Calgary Police Department. You know, it...

Chuck (13:43.006)
Yeah, that's a moral model, right? Yeah, yeah, yeah.

Atika (13:43.174)
Stigma, it's a big thing.

Lisa (13:51.904)
Mm-hmm.

Chuck (13:52.044)
Oh yeah.

Chuck (14:01.302)
So speaking to that specifically, Damondi, I'm sorry to interrupt you. Have you seen, and because I feel like you started about the right time to see this is kind of an evolution in the drug economy or drug world, not evolution, but a migration maybe to a different kind of thing. Have you seen police specifically, have you seen their attitudes change across that time as well, have you, for the better, for the worse, for, right?

Monty Ghosh (14:29.665)
Yeah, you know what, I don't know if I've seen a change per se, but I've seen like them really like I've always felt they're very open. They understood that addiction wasn't a moral failing or a justice issue. They they all like the most of them feel it's a it really is a mental health concern. It's a medical condition. And so I've never felt that way.

Chuck (14:50.302)
I mean, I suppose they're stereotyped like anybody else's, right? But yeah, yeah. Okay.

Monty Ghosh (14:54.517)
Now I know there's people out there who do feel that way, for sure. Like, I strongly exactly. And then I, you know, you hear stories, you see comments being left on internet threads and stuff like that. But for the most part, the people that I work with, they're very caring, compassionate people.

Chuck (14:57.278)
Yeah, strongly, yeah, right, yeah.

Chuck (15:07.102)
Yeah, of course.

Chuck (15:11.828)
Okay.

Lisa (15:12.579)
And I think too, like, I don't know what your thoughts are on this, Monty, but like the police officers that would be engaging with you, the police officers that will be having conversations with you, they're a subset. And I think, you know, I think like in any realm of life, right, like whether we're talking about lay people, police officers, physicians, you know, clerks at a grocery store, you're going to have a gamut, like you're going to have a range of people.

Atika (15:25.572)
Yes.

Lisa (15:38.411)
Because I feel like that as well. Like I have had really great experiences with Calgary Police. I have a patient right now in the hospital who's connected to PACT because he's got a forensic history, he's got a mental health history. And there's a police officer who comes in and like this guy's, you know, not able at this time to go off unit alone. He comes in every single week. He takes this guy for burgers. They go outside the hospital and play basketball.

Um, you know, he's, he's working with our social worker to try and find this guy housing, because he's like, we cannot send this guy back to shelters in the streets. Like he's vulnerable, it's not okay. And so, you know, like he's incredible. But again, he chooses to work in a branch of the Calgary police service where I think people passionate about this would spend their time, right? So.

Monty Ghosh (16:24.785)
Mm-hmm.

Atika (16:24.884)
I've never seen a police like that. Not in Vancouver. Yeah.

Chuck (16:25.152)
Yeah.

Lisa (16:27.083)
Oh, it's amazing. Yeah.

Chuck (16:30.509)
You guys have a special situation out in Vancouver though, right? Like things are crazy out there. I mean, yeah. Yeah. Your mayor trying to defund them for a while there, right?

Atika (16:35.04)
It's a bit different. Our police is a little bit different. I'm actually quite surprised that... Yeah, I'm actually quite surprised that the police would, you know, have like an open, friendly meeting with you, Monty, because I don't know if they're gonna have a friendly meeting with healthcare professionals over here.

Lisa (16:55.651)
Really?

Chuck (16:57.104)
But the dynamic in Vancouver is individual to Vancouver though, right? Like the mayor tried to defund them by $6 million a couple years ago, right? Like he was actively a part of this whole defund the police campaign, right? The mayor of Vancouver was. Yeah, yeah, right? So they've got like a really, things are messed up out there, right? It's like, yeah.

Monty Ghosh (16:57.226)
That's too bad. And I do-

Atika (17:02.576)
Maybe.

Atika (17:16.704)
Well, because they tried to do the street sweeps. And basically, they used to do it once every day. And now they do it like three times a day. And just like, you know.

Chuck (17:22.43)
Yeah, yeah, yeah.

Lisa (17:31.643)
And what does that entail? Like what's a street sweep look like? What do they do?

Atika (17:35.144)
It's when you take away the camps and stuff. So you take away them. Yeah, so, you know, and, you know, I've heard people saying like, okay, well, but they have shelters to go. And I'm like, well, shelters aren't always the same. Like some shelters are good. Usually women's shelters are very good. I've been to the women's shelters and I would be like, you know what? You know, this is really nice, but.

Lisa (17:40.833)
Oh.

Atika (18:03.38)
most of the men like especially older men who are more vulnerable they don't have that choice and usually the shelters that uh that are mixed and um those are all shelters like lots of bed bugs and you know shared bathrooms and you know what like if someone tell me like oh well but they have shelters to go i'll be like

why don't you go into that shelter and like actually spend a night? Well, how about that? Because like I've seen those shelters and I personally cannot handle it. Like I would I would do my business outside, you know, because it's you know, it's pretty gross.

Lisa (18:46.371)
I agree. I've had that exact conversation with people who are sort of dismissive and they're like, oh, well, they can, they can just, they can just, I hate that saying, right? And it's like, yeah, if you've gone, like I went to Alpha House one time, I've been to the drop-in center. And it's like, you know, if that was all, if that was the only option available to me, like, yeah, I wouldn't be super excited about it. And the other thing with shelters for some patients is people have PTSD, they've got trauma. And for some people, shelters are terrifying.

Atika (18:51.378)
Yeah. They can just, yeah.

Chuck (18:53.623)
Oh, yeah, yeah.

Atika (19:08.357)
Mm-hmm.

Monty Ghosh (19:13.853)
Mm-hmm.

Lisa (19:16.587)
You know, the other thing I've had clients tell me or patients tell me is that like, particularly folks who are trying to abstain from substance use, they're like, it's the worst place for me to go. Like everyone there, you know, there's so much, there's so many people using around there. I've had patients tell me that like, if they're not using, people will come up and like offer to share with them or to use with them.

Atika (19:17.085)
Mm-hmm.

Monty Ghosh (19:17.294)
Thank you.

Lisa (19:40.695)
And so people are like, you know, if I'm trying to stay off drugs, like it's not a good place for me to be. And so they'll try to avoid it, which is super sad.

Chuck (19:50.546)
story.

Monty Ghosh (19:52.397)
No, indeed. And you have to be very, very like, yeah, cautious about that stuff. And, you know, it's, but I've been going back to the whole stigma and, and police, you know, I also, also feel that maybe it's because of my privilege as a physician and, uh, that, that they often are probably treating me with a bit more respect than my colleagues. Um, so I mean, that could factor in as well.

Chuck (20:04.694)
Yeah.

Chuck (20:09.643)
Yeah.

Lisa (20:12.027)
Yep.

Chuck (20:14.062)
Yeah, yeah. I don't hold any of those negative feelings towards the police, but well, my first co-host here with the show, Carl, we know he sure does. Hey, it's fun. Yeah, yeah, so I mean, he's an indigenous guy too, so there's that dynamic in there as well, right? So, you know, yeah. Yeah.

Lisa (20:24.932)
Yeah.

Atika (20:29.688)
Yeah, I think there's that because I do deal with a lot of indigenous and native patient population and I do see where their trauma came from, especially after they went to the jail. And it's like, it's so traumatizing and everyone who wears uniform, even if you're a healthcare professional, it's like, what are you going to do with me? It's like, are you an enemy?

torture me, you know? So it's like, yeah, I've seen quite a bit of that. And yeah, I mean, anecdotally though, from my experience, like, I haven't seen a case where like the police actually protecting, but I don't know. So I don't know. Yeah.

Lisa (21:22.298)
Yeah.

Chuck (21:24.222)
So we talked before the show, Monty, about your innovation in equity. Why don't you tell us about that? I thought that was a really great read, what I was reading there.

Monty Ghosh (21:31.029)
Mm-hmm.

Monty Ghosh (21:35.633)
Yeah, I mean I think one of the things I sort of really strongly believe in is this whole idea and concept of innovation for equity and I think we don't innovate often for the purposes of equity and that most innovation comes out of necessity sometimes often. That means that's the number one reason but also because of profits, other motivations, not really equity, right? Equity is not really that sexy.

Chuck (21:58.286)
course.

Monty Ghosh (22:04.633)
So I think that's what we really need to focus on as a society is making sure that's more equitable. And there's ways to innovate around that. Like it doesn't need to be, you know, we, you pour thousands, thousands of dollars into this, or millions of dollars, billions of dollars into this. It's, it's, you know, making innovative changes that makes the lives of people easier, and puts us all in an even place.

Chuck (22:22.858)
Can you give us an example of like just a?

Monty Ghosh (22:26.021)
So I mean in terms of some of the issues with equity in general for example, like and it happened which happens in medicine is that you know there's these medications that exist out there like anti-ritteral medications for HIV and they're incredibly expensive and in Canada we have it all paid for our population but if you go to other nations they don't.

So ensuring that the costs are down so that people can afford it would be helpful. And it actually saves the society much more costs further down the line as well, like everyone in our world.

Chuck (22:50.349)
Okay.

Monty Ghosh (23:01.025)
We saw a lot of inequity with vaccines and the distribution of vaccines, especially during the pandemic. You know, there was groups who got preference over the vaccines over others. There was groups who couldn't access the vaccines. You know, these were all big issues that were very difficult to overcome. I mean, then on the same token, equity can bring about, sorry, innovation can bring about equity. So, for example, we pivoted to a lot of virtual supports during the pandemic from a medical perspective.

Chuck (23:07.136)
Okay.

Monty Ghosh (23:31.239)
and it made the lives of a lot of our patients easier, especially those who had phones, but had other commitments. So like a lot of them have kids that they can't drop off, they couldn't make it to their clinic appointment. And so being able to actually just do a phone call or a Zoom call like made a huge difference to them.

Lisa (23:46.98)
Hmm.

Chuck (23:49.518)
Just kidding.

Monty Ghosh (23:50.669)
Or, I mean, just the fact that people didn't have to commute two hours to get to work, they could spend more time with their family, or they could, you know, pivot their work and work two jobs now, because they were able to do some stuff virtually, I think very much created a little bit of equilibrium, if you may, amongst those who were underprivileged.

Lisa (24:10.191)
So what do you think about the fact that now, I feel like what I'm seeing is that places that were using Zoom for patient care during the pandemic, some places are now wanting to stop that, and they're all wanting to go back to everything being in person. So it's almost like there was innovation that created more equity with respect to access, but now we know how to do it, we know it's doable, and yet you see it being taken away.

Monty Ghosh (24:38.825)
100%. I think it should be a patient's choice and preference. It's not really up to us as clinicians. I think it should be the patient's choice. A lot of them want to come and see us in person. Absolutely. Come and see us and talk.

Lisa (24:42.456)
Mm-hmm.

Monty Ghosh (24:52.265)
They want to see their clinician, but others are just like, you know, I am busy. Like, I've got kids to take care of. I've got, you know, work commitments or I've got other issues that are prioritizing. And so, and that's fair too. And then sometimes you need to make a negotiation. I've got patients who I do virtual clinics with. But I'm like, you know what? Yeah, I think you need to see me. I think I need to lay eyes on you. You know, we need to discuss things. We need to do a physical exam.

I'm worried about you. And so then you push the agenda of having an in-person meeting.

Lisa (25:22.451)
Yeah, yeah, at least sometimes, like you said, right, like maybe the, I do think that a bit of both is good. Like for me, I found in mental health, you would think that, like with video, that would it be the same? And it's not like in terms of, you know, in psychiatry, we have something called a mental status exam, which is kind of like

Chuck (25:23.534)
Okay.

Lisa (25:42.003)
not so much what the patient is telling you verbally, but it's our observation of the patient, their behaviors, their movements, their eye contact, their expressions, that kind of stuff. And I definitely felt like there was some of that lost when I was trying to do virtual care. So I thought that was sort of interesting. What other, yeah, oh yeah.

Chuck (26:02.955)
If you don't mind, I just want to take a quick break and then if we can, we'll come right back to it. Okay, let's be a short one. Thanks.

Chuck (27:20.726)
That's that.

Lisa (27:22.589)
Mmm. I like it, I like it.

Atika (27:23.076)
how you included the drawing. It's so cute! Is that supposed to be a sun? So cute.

Lisa (27:25.878)
Run.

Chuck (27:26.762)
Well, you know what that is, I gotta try and get this off, yes. So I asked, yeah, so I said, I want your daughter to do this, and then we can share it, right? Like, I can put it on forever, for as long as that podcast is on, we'll keep her son on there, and as she grows up, if she wants to redraw it, she can, whenever, if it's once a month, or six months, or a year, whatever, right? Just an Easter egg for her, kinda hidden inside the thing, right? So, yep, yeah.

Lisa (27:30.155)
Yeah. And I said, Ryan's daughter drew it. Aw.

Atika (27:51.936)
That's so cute.

Lisa (27:52.315)
We'll see Mackie's son evolve. We'll see her son's evolve as she gets older. Is that right?

Chuck (27:57.382)
Yeah, right. Well, that was the idea. Yeah, yeah, right. So I'm just trying to figure out how to get this commercial off of here so we can get back. What the heck's going on? Oh no, stop it. We're not gonna do that. There we go. I don't know what to do here. We'll just keep talking and then we'll figure itself out here eventually.

Atika (27:58.038)
The evolution of the sun.

Lisa (28:01.262)
Yeah.

Lisa (28:06.351)
We're just gonna keep listening to the birds.

Atika (28:12.321)
Yeah and the birds.

Lisa (28:16.692)
One of the things I was going to ask Monty to share his thoughts on, so like with Attica asking what you love about doing addiction medicine, one of the things that I have found, and again, Monty and I would work with somewhat different populations because his background's internal, mine's psychiatry. But I feel like when I work with patients suffering an addiction by

By speaking to them like a human, which sounds really ridiculous, but it's true. But by speaking to them like a human who, um, listening to what they have to say, meeting them where they're at, um, asking them what they're hoping I can do for them and then by being their advocate. And like, and I like go swinging. Like I will, you know, I have managers on my back all the time. Like, why is this person still here? And I'm like, because I need to be here.

And it's my license and so they're going to stay and we're going to help them. But they're one of the most grateful groups of people. And Monty, you probably even see this in a lot of other areas of your work because you do work with marginalized populations that are not purely just in addiction. But it's like when people have lived through suffering and trauma and stigma and then they meet somebody.

and maybe even particularly meet somebody in, you know, in the role of a physician who does want to help them and who they believe actually gives a shit, like actually does, I just find them so appreciative. Like I get, like, I get so much out of it because they end up being so grateful and so happy that you're like, and sometimes, you know, the help that they're getting is not what I want to give them.

Like I might be like, well, I think you need to go to residential treatment. And they're like, yeah, thanks for that. But I'm, I don't want to. Um, and so, you know, sometimes it's not, it's not about me forcing what I want on them or, or it's not the cases where I'm getting to do the things I think they need to do, but just by treating these people well, like they're so grateful and they're so appreciative and that is so rewarding.

Chuck (30:32.61)
And keeping in mind, the healthcare system, I mean, we can talk about police being stereotyping and the healthcare system is rough on somebody in addiction, right? For me, outside of violence, the most traumatic thing to ever happen to me was in an emergency room as a drug addict, right? It was awful. It was absolutely awful what happened there, right? Yep.

Monty Ghosh (30:42.365)
Yeah, there's lots of stigma there.

Lisa (30:42.555)
Totally.

Atika (30:44.374)
So rough.

Atika (30:51.644)
Like I would say that in my experience, just like talking to people in the alleys and just doing my work in the alleys.

I would say like over 95% of people have been kind of like not receiving care in the emergency room and actually just being forcefully dismissed like just because of the stigma or like because of foul language. And I'm like, are you serious? Duh! There will be foul language. What do you mean foul language? It's like, well, the last education they had is probably like sixth grade, you know,

uh probably like eighth grade like what do you expect like just like talk to you like phd's like you know it's like if they're it's like i think i think there's the space in medicine to kind of like

Chuck (31:39.25)
I don't know, at least it's got a trucker mouth on her sometimes.

Atika (31:48.12)
You know, sometimes you just gotta talk the way, you know, the way you talk in the streets. And I really, I think there's that work to be done in medicine. Because we shouldn't dismiss someone for foul language. Are you serious? You know? Yeah.

Chuck (32:05.655)
So do you, Monty, do you find the same thing that Lisa's saying there, that subset of people is a little more appreciative?

Monty Ghosh (32:11.949)
You know what? It's all about treating people with respect. That's what it comes down to. And we're all people, as Lisa mentioned, and it's just about treating them with respect. They're no different than yourself or myself. And circumstances shift and change. And so like, you know, I'm very grateful to be where I'm at. Like I recognize it's a privilege. So growing up, we weren't very rich. We lived, you know, like I think, you know,

Chuck (32:14.506)
Yeah.

Chuck (32:37.846)
What part of town?

Monty Ghosh (32:39.821)
Yeah, we were immigrants. I came from an immigrant family. We lived in a small condo. And my father had worked two restaurant jobs. And then my mom was in school and he had his first bout of cancer back when I was a kid. And we were thinking of moving to the States at the time.

Chuck (32:44.59)
in the northeast then.

Chuck (32:51.096)
Wow.

Monty Ghosh (33:01.55)
And I recognize that if we had moved to the States, we would be bankrupt as a family. Because not only would he not be able to work, because he's going through chemo, but my mom, I mean, she would have to find a work, but she was in school and the private healthcare system in the States is so expensive.

Chuck (33:21.406)
Yeah, right, right.

Monty Ghosh (33:22.617)
that we would not do well as a family. And so very grateful for the Canadian system because we ended up staying and the system was able to take care of us and the community was able to take care of us. We had that sense of community. There was a lot of other South Asian.

families who were very supportive and drop off food and would babysit me and whatnot, you know, when my parents went through their situation, my father went through a situation. So I mean, it was it was that sense of community, but I think that's what's also lacking. Sometimes that's what we need to build in our society, is that sense of community for each other. You know, it's one thing for the South Asian people to get together, but yeah.

Lisa (33:56.229)
Mm.

Chuck (33:58.23)
Yeah, without a doubt.

Atika (34:02.789)
I find that what I tell to people from being in the hood or the alleys, it's people who have the least actually give the most. Isn't that really odd? But they were like, there was this one time there was an OD.

Lisa (34:15.671)
Mm-hmm.

Chuck (34:16.893)
Oh yeah.

Lisa (34:20.136)
I agree.

Atika (34:24.876)
and then like in the curb of the street, like basically because of speedballing, cocaine and alcohol mixed together. And...

after that like she cried so much and she just like I just want to go home I just want to go home I'm like okay well let's get you a bus and then and then there was someone who's like basically give like cash like ten dollars and she's like you know she doesn't have any shelters like I know her and she doesn't have any shelters she just like okay like digging into the little wallet and like that's the only cash she had and she just

Lisa (35:01.563)
Mm-hmm. Yeah.

Atika (35:03.018)
please take the bus and go back to your Airbnb." And it's just like I never I almost never gave cash actually and she just giving it away like that and it's just yeah like you said Monty that sense of community and giving away it's much more prevalent in people who have the least.

Lisa (35:25.507)
Mm-hmm. And I think too, like just to add on to what Monty said, like it's about respecting people. It's also, and I guess maybe I'm thinking more like within the health care system, like is to just care about people, which sounds obvious. And it's like, if you go into this profession, you would assume that that's what we would all do. And I always remember this particular case. I saw I was a resident and I was on call.

and somebody had come into the emerge. So my staff was at home and they had come into the emerge and it was primarily an addiction issue, but they were asking for help. And they'd been admitted a bunch of times before, right? And that's always looked at, how many times have they been admitted? Do they leave against medical advice? Do they follow through on what's recommended to them? And it's like, okay, well, they have a disease that's relapsing, remitting illness.

that has a very high relapse rate, particularly for people who don't have a lot of support when they leave hospital or they leave residential treatment. And I remember calling my preceptor up and this speaks to what I had experienced as a resident leading up to this point. And so I present the case to my staff who's at home, who's listening to this on the phone. And I was like really selling that they like, they wanted to help, they wanted to come in. And then, you know, like took a breath.

And my preceptor was like, so what you're telling me is they want help. And that's what we do. We help people. So help him. And I just remember being like, oh, like, you know, world off shoulders, right? But again, it's because I had run into cases where I would, this would get rejected. Like, no, they've been admitted 10 times. They don't follow through. They're not serious. Like kick them out of the emerge basically. And it's so simple.

this person came in, they wanted help, help them, period. You know? And it sounds so simple, but it's not always what's done, which is really, you know, it's really sad that it's not always done. And some of that is system pressure, right, Monty? Like we have limited beds. And so if you've got five people wanting the bed, who are you gonna give it to? You're not gonna give it to the person who said they wanted help five times before, and now they're there for a six times saying they want help.

Lisa (37:42.223)
they're going to go to the bottom of the list because there's not enough beds. There's, you know, there's limits on the resources we have.

Chuck (37:49.266)
Of course. Of course. Right?

Monty Ghosh (37:51.044)
Mm-hmm.

Lisa (37:51.367)
Yeah. But yeah, so Monty, tell us a little bit about what you've been up to. Like, so you kind of took us through to how you got into addiction medicine, you know, but like, what are you up to these days?

Monty Ghosh (38:04.805)
Yeah, um, you know it

Chuck (38:05.114)
What's your big project right now? I know you got something. Right?

Lisa (38:08.347)
Mm-hmm.

Monty Ghosh (38:09.469)
Yeah, so I mean, I've moved towards, you know, the whole idea of innovation, I think, is really is inspiring to me and pushing the system forward, if you may. I don't know if I'm necessarily pushing the system forward, but, you know, changing the system up. And so, yeah, I've got a few different projects I'm kind of working on, and it's really related to understanding what the scope of the problem that we're dealing with right now is in terms of the drug poisoning crisis.

And so several of the projects I'm working on are all around virtual care. So one is that we, Dr. Tang and I had started up the RAM program. It's the Rapid Access Addiction Medicine program in Alberta. So one of the big things that I always look at is what are the gaps that we see in our services, in our systems. And one of the biggest gaps we saw was that there was no outpatient-based treatment for people who had...

other substance use concerns outside of opioids. So we had no clinic that take care of alcohol or meth or cannabis or gambling or sex or whatever. And so one of our big pushes was to sort of open up a clinic under our public health care system that could provide that support. And so that was an interesting experience. We started small and.

Lisa (39:28.803)
Can you talk Monty about, and I mean, for anyone listening, this is a very Alberta specific question, but it's something that even me like working in what I do that I'm always kind of fuzzy about. So there's rapid access addiction medicine in Calgary. There's the Ram Clinic that Monty's talking about. And then there's also adult addiction services. Now they started out as two separate entities that are now sort of merged, if I understand that right, but they're still different physical locations. And so how would you,

Is there not a different physical location? Okay, and are they just kind of one and the same or is there a difference?

Monty Ghosh (40:00.378)
relocated.

Monty Ghosh (40:04.617)
They're one and the same. It's just that we're just keeping two separate names because the counselors are more at the adult addiction services side and the RAM, we try to brand it RAM because we're trying to model it after what's going on in Ontario. So in Ontario, they have numerous clinics like these rapid access addiction medicine clinics. And so they're scattered throughout Ontario. And so we really tried to sort of work.

off of using their name because we know that people move provinces, they transfer, they go back and forth. There's RAM clinics in BC, RAM clinics in Saskatchewan, so it's like, you know, why, if we're doing the same thing, why change the name? Let's keep the name as is.

Chuck (40:44.295)
So what is the concept from kind of a macro level?

Monty Ghosh (40:47.085)
It's a low threshold, like basically low barrier access to addiction medicine. So we see people within, yeah, we see people within one business day. Um, so very, very quick. Yeah.

Atika (40:53.013)
It's really good.

Chuck (40:57.83)
Okay, wow. Yeah, okay.

Lisa (41:00.451)
and you don't need a referral, right? You can just show up, can't you?

Monty Ghosh (41:03.714)
Exactly. You can just show up. Yep.

Chuck (41:06.218)
Wow, so is that, I'm not questioning, I'm just curious. As that becomes more popular, do you just get more, how can you maintain that? We'll see people in one day when, you know, it is like,

Monty Ghosh (41:19.197)
Well, I mean, we have to definitely keep our resources in check, but it's been okay so far. But should we need to have more resources, we definitely have to apply for more funding. Um, one of the things that we're trying to do is that, uh, so now that Calgary has this program, uh, we know the rest of Alberta doesn't, so we're trying to expand it province wide. And we have some federal grant funding to do that. So we're hoping that goes through. Um, Edmonton doesn't have any, so I had some phone calls like last night from clinicians in Edmonton.

Chuck (41:23.288)
Yeah.

Chuck (41:37.055)
Yeah.

Chuck (41:42.087)
Okay.

Monty Ghosh (41:48.113)
who had called me up, colleagues of mine who I went to a residency with, and they're like, okay, I've got this person, where do I send them? And I have to say, unfortunately, there's no plate clinic in Edmonton that deals with this. Like, there's opioid clinics that we can send them to, but there's really nothing else.

Atika (42:01.644)
You know, I have a question, Monty. Opioids is like, yes, it is a big problem, but I do see the emerging non-opiates, tranquilizers, downers, like benzoanalogs.

which is not reversible with Narcan. And then we have the tranquilizers like, like Silesine. And what's your experience on that? And where does the role of this low barrier care comes into play? Because now we're dealing with not only just benzo analogs, but we also deal with a lot of, you know,

Atika (42:51.562)
on psilazine and there's not a lot of literature on this in Canada. My research is trying to bring about this data on psilazine, but I think it's a really interesting topic. How do you see the innovation going forward with this non-opioid downers?

Monty Ghosh (43:14.129)
Um, you know, it's, it's hard to say. I don't know about innovation per se, but we're trying to figure out ways to mitigate it. Uh, so for instance, um, we, right now at this moment, we're taking people off of illicit opioids and getting them onto Suboxone or methadone or whatever. Uh, we do have a benzo protocols. We'd get them onto benzo diazepines and we tapered them off knowing that they could have withdrawal seizures from the benzos.

So that's something that we sort of implemented as part of our protocol. Zylazine, there's no effective medications for that, unfortunately, but we do, I do screen for Zylazine, so I do look at wounds and whatnot and make sure that they're okay. Like, you know, we talk about Zylazine, the dangers of Zylazine. But I mean the other thing that I'm working on right now, there's a few other projects I'm working on, but we're looking at the wastewater.

and we're testing for substances in wastewater and we're seeing if there's peaks in xylazine levels one week versus the next and that could serve as sort of an early warning system to our colleagues if there's something that's worrisome.

Atika (44:17.276)
That's really interesting about Silazine is that based off the work that I do on the streets and the alleys, I've seen people can enjoy Benzo. Like, okay, yeah, I can sleep, you know? Like I can sleep much easier, it's nice. But I've never heard anyone who likes Silazine, never. Not even once.

Chuck (44:40.746)
Is it being used as a street drug onto itself or is it a cut?

Atika (44:45.108)
It's like a cutting agent, isn't it? So it's like, yeah, so it's mixed with the fentanyl. I always like when I see an OD, even though it looks like a trach, I would administer Narcan because I just assume that there is an opioid with it, especially fentanyl, because fentanyl is really short-lasting and psilazine kind of like longer that effect.

Monty Ghosh (44:45.593)
to cut.

Chuck (44:46.402)
Are they cutting the fentanyl with it now? I know that's what they're doing with the benzos. Okay.

Chuck (45:09.61)
Yeah, that's why they're using it.

Atika (45:11.076)
Yeah, but like I've never seen anyone liking psilazine. Never. Yeah, like what's your experience, huh?

Monty Ghosh (45:15.874)
Thank you.

Chuck (45:17.091)
Um, you do... Oh, okay. Go ahead. I was just gonna ask. Go ahead, though. Go ahead.

Atika (45:22.602)
What's your experience with Silazine users, Monty and Lisa?

Monty Ghosh (45:27.043)
You know what? There's not as much as I was in right now in Alberta. Uh, it comes and goes. Yeah.

Lisa (45:29.839)
Yeah, I don't see it much.

Atika (45:30.298)
Oh!

Chuck (45:31.822)
We're probably a year or two years behind Vancouver, typically for the drug scene, right? Oh yeah, okay, okay. Okay, okay.

Monty Ghosh (45:36.541)
It's mostly Ontario where you see it. So if you look at the epidemiological data, yeah, it's the 80% is in Ontario, then 10% is in BC, then the last 10% is kind of spread across the country, if you may. We're starting to see some of it though. Like we've seen spikes in xylus levels here in Alberta. And...

Atika (45:39.744)
and BC.

Chuck (45:44.63)
Wow, okay.

Chuck (45:50.131)
Okay, yep.

Chuck (45:58.577)
So you just said about testing the water.

Lisa (46:00.591)
Yeah, can you explain that? Because I don't really get what you're talking about.

Monty Ghosh (46:03.437)
Yeah, a lot of this work is built off of COVID. And so what's happening is that we've got, so one of the big things we do epidemiologically for COVID is that we monitor COVID levels in a city by testing the wastewater for the entire city. And if there's, we look for certain proteins in COVID in the water, and it's basically people peeing out COVID.

Chuck (46:03.506)
Yeah.

Chuck (46:21.75)
What do you test for?

Chuck (46:26.685)
Okay.

Atika (46:28.272)
That's interesting. Oh.

Chuck (46:31.358)
Wow, okay. And the levels would show that high inside wastewater. Well, I guess it gets concentrated at a point too in the waste, okay, yeah, yeah.

Lisa (46:32.375)
Did not know that. Okay.

Monty Ghosh (46:34.414)
And yeah.

Exactly. And so we have this thing called the COVID tracker, which we monitor the wastewater and if it does correlate with peaks, but usually a few days after. So if there's a spike in COVID cases, we see people peeing out COVID for three to four days afterwards. But it also helps to sort of plan things, we know that there's certain levels of, you know, viral infections going around, maybe we need to change our staffing, the emergency department, if we're going to be expecting a huge influx of cases.

Chuck (46:47.618)
Yeah.

Atika (46:49.576)
Thanks for watching!

Chuck (46:55.063)
Wow.

Monty Ghosh (47:09.873)
Maybe it means that like for myself personally that I'll wear a mask if I start to see that there's a spike in cases going on in the wastewater. But we're doing it for substances now too. So we're looking at...

Lisa (47:17.199)
Mm-hmm.

Chuck (47:20.831)
No kidding, eh?

Atika (47:22.42)
So what categorize as wastewater? If you want to elaborate on that. Toilet water, okay. Okay.

Chuck (47:27.65)
toilet water, right? Yeah, the black water. Yeah, yeah.

Monty Ghosh (47:28.817)
toilet water. Yeah, it's in the sewer system. So we get it from the sewer system and we test it and we can tell if there's spikes in carfentanyl versus fentanyl versus xylazine versus benzos. And so we're looking at 48 different agents and their metabolites. And you know, Europe has been doing it for a while. StatsCan was looking at five substances throughout

Atika (47:40.444)
Cartofentanil, yes. Yeah.

Chuck (47:40.863)
Really?

Chuck (47:48.33)
Is this, this is a new concept or is this, it sounds like it to me, I mean, okay, okay.

Monty Ghosh (47:57.645)
within five cities throughout the country for a while. But we've taken it another step further. And the other thing that we're looking at is how do we test for new drugs entering the market? So once a week, we do what's called a QTOF and we basically look at everything in the wastewater, whether it's new laundry detergents that are into the wastewater or whatever, but then we try to find if it correlates to new drugs that have entered the system.

Chuck (48:00.127)
Okay, okay.

Chuck (48:08.896)
Yeah.

Chuck (48:16.001)
Yeah.

Chuck (48:23.027)
Wow.

Lisa (48:23.279)
Are you involved in that, Monty? Is that something you're doing, like research? That is so interesting.

Monty Ghosh (48:27.527)
Yeah. That's a...

Atika (48:27.888)
Oh wow, that's really interesting. Yeah.

Chuck (48:29.858)
That's incredible.

Monty Ghosh (48:31.087)
Mm-hmm.

Lisa (48:31.587)
And what's the, like in terms of tracking the psilocene, like what are you gonna do about it? Like what's, is it just for knowledge to know that it's arriving in Alberta and it's something that people need to be aware of or?

Atika (48:36.296)
Thank you.

Monty Ghosh (48:43.921)
The hope is to translate this knowledge to people who can use it. So, like doing drug alerts, for example, would be key for this project. But it's also, yeah, just informing my colleagues. So like we had a spike in this drug called limimazole in April. And limimazole is a cutting agent for cocaine.

Atika (48:52.168)
drug alerts.

Monty Ghosh (49:02.297)
and it causes what we call neutropenia. So people, they lose their white blood cells, which is the main cells that fight off infection. So we're seeing, back in 2012 when I was a resident, we saw a huge spike in limousine cocaine, and we saw a spike in people who were getting admitted to hospital.

with really bad infections that they couldn't fight off, and they were on death's doorstep. And so the key for what we call febrile neutropenia is to get them on what's called empiric antibiotics or high-potency antibiotics that...

that take care of it. We only usually see this in people who are undergoing chemotherapy. We've talked a lot about chemo, I feel, today. And so people who are undergoing chemotherapy often lose their white blood cells because their bone marrow gets fried as such from chemo, and so they can't fight off infections. And so you need to get them on antibiotics ASAP. And that's exactly what's happening with some of these patients. So when we saw that three-week spike in April, we were like, uh-oh, that's something worrisome. Limimizol.

Lisa (49:38.202)
Hehe.

Atika (49:56.936)
Wow. What is it called again? The cocaine cutting? The memazole?

Chuck (49:58.018)
No kidding, eh? No kidding. Okay, we do need to take another quick break here. Sorry to interrupt again, but they're paying for their spots so I should probably take care of them, eh? Right? Yes.

Monty Ghosh (50:02.41)
Uh...

Chuck (51:21.326)
There we go. Back from the break.

Monty Ghosh (51:25.401)
Yeah, so I mean, I think it's part of, you know, understanding the problem better. Like, I think if we understand the scope of the situation better, maybe we can find a solution. And I'm not smart enough to find a solution right now. But if I can frame the problem better and have a deeper understanding of what's going on with the drug supply, maybe we can save some lives. And that's where we go.

Chuck (51:45.558)
That is always a good thing, right? Yeah.

Atika (51:46.284)
Um, how accessible it is to do like an anonymous drug test in your area. I'm talking about spectrometer.

Monty Ghosh (51:58.001)
Yeah.

Atika (51:58.34)
Because if we're doing like wastewater, presumably it has gone in, right? Like it like been, you know, metabolized and everything. But with a spectrometer, you're not necessarily have to consume it. And you kind of see the profile, how accessible it is to get that drug checking done.

Chuck (52:08.438)
Well, that's the idea, yeah.

Monty Ghosh (52:25.113)
in Alberta, so it's happening in Calgary and Edmonton. They do have the infrared spectrometers that are available for them. And so they are doing those tests right now.

Chuck (52:38.194)
When would these tests be done? Like an anonymous drug test. I'm looking for context.

Monty Ghosh (52:42.141)
Oh, it's done out of a van and done out of a group called AWARE. Alberta, they've changed the name recently. It used to be Alberta Addicts who educated and advocate wisely, responsibly. Now they've changed it to Alberta Alliance who educate and advocate responsibly. Um, yeah.

Chuck (52:53.311)
Okay.

Okay.

Okay, and like what's the context for these tests? Is it just trying to keep track of the drug scene? Or what's, yeah.

Lisa (52:59.501)
anymore.

Monty Ghosh (53:05.377)
So it's informative. So it's informing the population as to what their drugs might be having and to be more careful. And so by being careful it's like not using a loan for example. Using supervised consent.

Chuck (53:10.246)
Okay, okay, yeah. Okay, okay. So you're testing the drugs, not people. I hear drug testing and I thought, okay, now it all makes more sense to me. So, yeah, yeah.

Atika (53:15.439)
Yeah.

Atika (53:20.688)
Yeah, it's like I like to explain it like spectrometer I like to like explain it people about the whole drug testing procedure to people is like this You get you get into a bar and you get a cocktail, you know exactly what's in it If you're a drug user and unhoused and you know on the streets like that

You don't know what's in it. Like imagine getting a cocktail and you don't know what's in it. You think it's a beer, but turns out it's a vodka, you know? So it's like, you don't know what's in it. And it's really dangerous that way. And so it's just kind of like knowing what's in it in the drugs that I think really important. And yeah, it's like a lot of education I find, yes. It's like, I would go into the alleys and some people like,

Chuck (53:41.686)
You don't have a clue.

Atika (54:09.1)
Okay, wait, but like how does fentanyl actually work? Like why do I get drowsy with benzodiazepine? And I think there's that space for healthcare professionals.

I want to be an MD-PhD in the future and I really can see myself just going into the alleys and still talking about all these drugs and like, okay, this is how depressant works. But yeah, there's a lot of education to be done. It's like a part of harm reduction. And now, since tranquilizers are more common, wound care is also part of the harm reduction.

Yeah, it's like a lot of people just kind of asking like, how does this work? And sometimes they'd really ask the good questions. Like I would go home and search it up. Nitazines. Oh, what does, what do nitazines do? You know, and like, how does it actually work? Like, what if you mix these things together? Like, you know, so I think, um, back to Lisa's point and Monty's point about like meeting people where they're at.

That could be like educating for the patients, but also for the healthcare professionals, for physicians, because the street, there's a lot of things to be learned on the street. And I personally learned a lot from the street. And I think...

everything is really, you know, transferring really well into medicine. Because medical literature, they don't grow, they're not as fast as the knowledge that you get from the alleys. You know, so yeah.

Monty Ghosh (55:57.221)
I was gonna say, Attica, the other project I'm working on that you would be very fascinated with is I am actually evaluating the National Overdose Response Service. Yeah, so that's one of my other roles. So I helped co-found it with Rebecca Morris Miller and others back in the day. And the service itself, yeah, from 2018, or 2018? No, 2020.

Lisa (56:06.573)
Oh.

Atika (56:06.744)
Oh my god! I mean it!

Chuck (56:06.868)
Uh oh.

Chuck (56:18.23)
You helped co-found the service itself.

Atika (56:21.957)
Oh!

Chuck (56:24.438)
Wow.

Monty Ghosh (56:25.921)
And then so.

Atika (56:26.28)
Are you also doing research in Norse?

Monty Ghosh (56:29.229)
Yeah, so I'm leading the research efforts.

Atika (56:32.004)
So you're the one in charge so that whenever I finish a call with someone, I have to do a lot of data and logging and like all these check boxes that... Okay, so...

Lisa (56:34.715)
I'm going to go ahead and turn it off.

Chuck (56:36.266)
Ha ha ha.

Monty Ghosh (56:39.84)
Yeah.

Chuck (56:40.014)
Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha

Monty Ghosh (56:43.397)
Yeah, I appreciate you doing that though, because it's so helpful. Um, it tells us like, I mean, and, and Attica, you probably know this already and you can probably share some more to more than I can, but, uh, I mean, we've had over 8,000 phone calls on the phone line. Uh, we've had 80, over 80, um, drug poisoning overdose events, if you may, zero deaths on the line and yeah, across the. Yeah.

Lisa (56:44.888)
Hahaha!

Chuck (56:44.93)
Ha ha ha!

Atika (57:07.492)
zero deaths. That's true. Even if we have to dispatch.

Lisa (57:07.707)
That's amazing.

Chuck (57:09.567)
Wow.

So there's, you know, you're innovative right there, right? That's amazing, and I can't believe you're the guy that, you know, you're a part of founding that in the first place.

Lisa (57:20.076)
And don't you love that he's like not mentioned it until now? I'm just like, just so, you know, yeah.

Atika (57:20.261)
Yeah.

Chuck (57:23.466)
Yeah, not at all, right? Yeah, yeah. Just casually, you know, saved a lot of lives over here. It was a Tuesday, you know, and that's what we do, so.

Atika (57:29.433)
Like I remember during... Yeah, like I remember like during the training and they told me to like, okay, you always have to log and there's like these questions that you have to answer every time you log in and I'm like, who is in charge of this? Like this is so much checklist and...

Monty Ghosh (57:29.573)
But I mean, it was a group effort. It's not just me, right? It's a whole group effort.

Chuck (57:32.518)
Of course, of course.

Lisa (57:47.611)
Mm-mm.

Monty Ghosh (57:49.325)
I don't know if I'm in charge of that, but it helps me out.

Chuck (57:49.534)
So... Hahaha... Yeah... Yeah, yeah, yeah...

Atika (57:52.2)
like data collection to do. I love it. I love Norse and I think the culture at National Overdose Response Service is super great. Like I love it. Cause I think I'm like the second person in British Columbia who's a responder. There's like another person, but it's just me and this guy. And that's all we have in British Columbia. And I remember.

Lisa (57:52.285)
Ugh.

Chuck (58:19.358)
So now that said, are they looking for more volunteers right now? Right? Yeah, yeah, so I think that's definitely something that we should put in the show notes and how would somebody reach out if they wanted to? Sorry, to interrupt you, Attica, but this is a great time to mention this, right? So how would they reach out if somebody wanted to volunteer and help out with this?

Monty Ghosh (58:23.445)
100% we always are. I mean, Addica, you could probably answer that better than I can.

Atika (58:24.508)
Duh, yeah.

I think so. Because...

Lisa (58:36.844)
Yeah.

Monty Ghosh (58:43.785)
I mean you can go to www.nors.ca and yeah N-O-R-S and that's it or call the hotline. And the hotline number is 1-888-688-6677.

Chuck (58:47.078)
N-O-R-S. Yep. Okay.

Chuck (58:59.126)
Perfect, perfect. Okay, and I'll put that in the show notes as well, of course, right? Yeah, yeah.

Monty Ghosh (58:59.721)
or the other way to say it is like NORS, yeah. Like 188, 688 NORS. And then, yeah, I know Attica, I appreciate all that you do because it really helps us understand what's going on with the service. And so hopefully we can publish this soon. Like it's in the publishing world, Limbo, but we've seen data that shows that...

Atika (59:02.728)
Yeah.

Lisa (59:02.754)
Mm-hmm.

Monty Ghosh (59:21.345)
that people who are using, like we've had zero deaths so far, we can sort of predict deaths. One of the big things that we've seen is that women and female, sorry, and gender minorities use the line predominantly. And we're trying to figure that out because we have the exact opposite ratios in terms of people who use the service to those who use physical surface consumption sites. So...

Atika (59:45.856)
Yeah, and I like what I really like about National Overdose Response Service Like it's free and it's anonymous like when someone calls in and I'll be like, hey, I'm Attika Like do you have a code? So we just take like the first two letters of their first name and then first two letters of their last name and then the last two digits of their Year of birth and it's 24-7. It's like McDonald's. It's like, you know It's like always open

Chuck (59:46.402)
Wow. That's an interesting thing.

Lisa (59:46.425)
Huh.

Lisa (01:00:13.43)
Mm.

Atika (01:00:15.691)
and I'm usually at night and...

Atika (01:00:21.82)
I remember bringing all these Norse stickers, the swag, the little circle sticker, and just put that everywhere in the alleys in downtown Eastside Vancouver because a lot of people don't know. But as you know, Lisa and Monty, the highest overdose deaths are when people use a loan. And what I see from the experience working at a safe consumption site is that when you're a user, sometimes it's kind of lonely.

Lisa (01:00:33.435)
Hmm.

Lisa (01:00:40.172)
Mm-hmm.

Atika (01:00:51.494)
and you just want someone to talk to and you know using can be very lonely and if we can kind of like provide companion at the same time you know preventing overdose like why not right so

Monty Ghosh (01:01:07.041)
So I was gonna say Attica, like you talked about, I think the secret sauce for the whole SIS service is the peer support. And it's that companionship, and that's what we hear over and over and over again, is that people love that aspect of it. And it's so important. And the other thing that I think was really interesting is that almost 2 3rds to 70% of our callers can't access a physical surface consumption site. And...

Atika (01:01:12.636)
peer support.

Atika (01:01:21.096)
they do.

Atika (01:01:33.252)
Yes, so even though there's like, yeah, they do exist, but they don't open 24 seven. If they do open 24 seven, you don't always, like you can't always access it. Like that's the same thing as like the clients that I've seen from the downtown East side. It's like, they can't always access that. So it's really nice to kind of like have, you know, it's like a phone call away. It doesn't eat up your internet data, you know, so yeah.

Chuck (01:01:58.85)
That's huge, absolutely. Yeah, yeah, right.

Monty Ghosh (01:02:01.607)
Yeah.

Lisa (01:02:02.075)
think, Monty, that women are using it more because, like, if you think about a female user, right, they're more vulnerable, right? Sexually vulnerable, like, abuse vulnerable. Like, do you think that in part their choice to use a loan and rather use a service like Norse is that they're less worried than about, you know, being abused or being violated or whatever?

Atika (01:02:04.214)
Thanks for watching!

Monty Ghosh (01:02:25.925)
Yeah, so we were having, we're wrapping up a qualitative study and survey with females or gender minorities who use the service. And that's exactly what we're hearing is that it's a fear of violence, fear of being seen in terms of like running into people like you're, if you were involved in the sex trade, running into clients or your employers in the past. It's children.

And so a lot of them have children that they can't leave at home. And so they, they use the Norse line. So those are the various different factors that we're hearing from our, our respondents that they tell us that they're like, these are the reasons why we're using the service. They feel comfortable. They, they enjoy the fact that they're, they have a companion on the phone line. And

And so yeah, that's the general sense that we get. And so yeah, the vast majority, the way vast majority of our callers. And Attica, you've got first line experience in this. I mean, I read reports and you're on the front lines hearing their voices. And so you're probably able to say that, what's your take, Attica? Why do you think that they're females or most of the, or people or gender minorities are the most likely callers of the service?

Atika (01:03:46.88)
Yeah, I think that's the same of like what you said, Monty, like sometimes they have kids and like they don't want the kids to know. So when the kids go to school and she's just doesn't have access to the safe consumption set, they just call in. I've had great experiences with some of these clients, like some of them are like it's like really. Fun and engaging that I would like.

you know, have a shift for like 12 hours and it just flies by because it's like sometimes I get like, oh

I'm writing this little fiction, would you care to hear about it? And then I'm like, yeah, sure. And then it's just like listening to like, you know, some of, you know, my clients writing, writing piece and like sometimes it's like a really good way to connect in terms of like, oh, what's like a safer use and like sometimes I educate, but most of the time I'm the one getting educated by them because it's.

Lisa (01:04:28.091)
Mm-hmm.

Chuck (01:04:50.242)
Jesus. Skittish. No.

Atika (01:04:50.25)
it's like, sorry. Yeah, because it's like, oh, I didn't, like what's your take on suboxone? Like in terms, I'm the one asking those questions, like, oh, why do you choose Dilaudid instead of suboxone? What's your take on methadone? And, you know, so in terms, I just actually getting quite educated from these female clients.

Lisa (01:05:16.907)
here too, in that story Attica is that like, so a it's preventing deaths, which is, you know, prize number one, but also just that building relationships, that connection, that education piece, like that may, you know, it could be one of those conversations that triggers somebody to take the next step where it's like they're not just using safely to prevent their death, which is great. But they might even, you know, take the next steps towards recovery or which is really good.

Atika (01:05:27.92)
rapport.

Atika (01:05:43.924)
I think so.

Monty Ghosh (01:05:45.441)
So, I mean, we have a great story that we published at the Canadian Medical Association Journal around NARS. And what I'll do is I'll, like, I think people will just have to Google it if they're listening in. But it's around one of our clients named Jessica. And I, for the, I don't know, Chuck, if you could post it later.

Chuck (01:06:05.942)
Well, if you send me the link, Marty, I'll definitely put it in the show notes. Yeah.

Monty Ghosh (01:06:09.477)
Yeah, and I've posted in the chat box, but essentially Jessica was a patient who, so when Norris first started, we didn't have enough operators. And so a lot of us were operators on our own end. So I was one of the operators too. And Jessica was one of my favorite patients, like she, or clients, I should say, of the Norris lines. Like she would call, and she was involved in a lot of different things, but highly vulnerable. And I met her,

Chuck (01:06:12.813)
Okay, yep.

Monty Ghosh (01:06:38.473)
on the line for the first time and she would listen to Drake songs with me as she would use her drugs and we just talked about Drake and then and yeah I just listened to music.

Chuck (01:06:44.046)
Ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha ha

Atika (01:06:45.24)
Oh my god, I can't relate. Like, in times like, I would see patients' clients, they would like, Oh, can I put on this song? I'm like, yeah, sure. And then we just listen to it together. Or like, I remember there's one client that just like really, really like super cute. Like she would be like, I have this list of topic of conversation. Which one do you want? We can talk about you. We can talk about me. We can talk about Drake. We can talk about something else, but it's always like four or five.

Monty Ghosh (01:07:07.736)
Yes, yes, yes.

Atika (01:07:14.834)
list of conversation to have while they're using it. I like to kind of like, oh, how do you feel now? And like...

Monty Ghosh (01:07:15.613)
Mm-hmm.

What is?

Atika (01:07:24.432)
getting like tips about harm reduction because I think users are actually experts in harm reduction. They are experts. Like they know, they know how to save lives. And I learned a lot more from them than I've ever been in any hospital certifications I've had. Like, yeah.

Monty Ghosh (01:07:30.438)
Yeah.

Monty Ghosh (01:07:44.093)
I think that's great. Yeah, I mean.

Lisa (01:07:46.295)
And so did Jessica end up, because that story kind of came about talking about this, you know, beyond just saving lives. Like, so did what was the, can you give us a synopsis of her story?

Monty Ghosh (01:07:57.154)
Yeah, I mean, the bottom line is that she really enjoyed the peer support that she got on the line. And then the peer support, eventually she was ready for wanting to get onto Buprenorphine Suboxone. And so the peer support worker on the line connected her with another peer support worker at a RAM clinic. And then she connected with me and then we were able to put two and two together.

that we used to be on the line with each other. And so, and then Jessica's done well. She moved back to Ontario from Alberta and she's thriving out there. And that's her story. So she wrote that part of the story. It's from her perspective.

And so which is really cool too. So like feel free to take a read of that and see the different perspectives of her journey and but you know, like Jessica's just one of various stories that we have on the Norris line and there's so many different groups that are on there and there's so many things that Norris does so it does peer support it does mental health first aid. It does methamphetamine psychosis de-escalation like that's the other thing that we were really surprised about like you know, like there's no other service that does that where people

or an active psychosis and the nervous operators are able to de-escalate the situation. They're able to say, you know, turn off the lights.

Chuck (01:09:16.702)
So in that case, would it typically be a family member that called or a loved one that would call in or the person themselves?

Atika (01:09:20.944)
No, they person themselves using methamphetamine and they would call. I had that actually. I think people on methamphetamine can experience wide range of effects and it's really, it's really like, really heterogeneous in that sense, you know, and like you said, Monty, like some people just literally just have bad trips and like we kind of like help them, you know, stay grounded.

Monty Ghosh (01:09:21.405)
person of course.

Chuck (01:09:25.151)
Okay.

Chuck (01:09:32.69)
Oh yeah, it's all over the map, I've said that for years, but you know...

Chuck (01:09:47.35)
So where I see it, and because we focus so much on the families here on Ash is Awesome, right? What I'm thinking is this guest that I'm interviewing again this weekend, we tried last, earlier this week it didn't work out. One of the things she talks about often, her and her son were talking about is her dad, or his dad, her ex-husband, with the psychosis, right? So could they call Norris and say, hey, what do I do? Like this guy's.

Monty Ghosh (01:10:06.845)
Mm-hmm.

Chuck (01:10:12.577)
He's in early recovery, and he's a week into it, and they're still following him, under the car, and they're still whatever.

Monty Ghosh (01:10:17.929)
Yeah, I mean it's more about deescalating the situation, right? So if they're experiencing psychosis, like people like Attica would just reorient them to reality.

Atika (01:10:27.04)
Yeah, like we're not gonna be like, oh, you're in recovery. OK, bye bye. You know, like we're just going to be like, OK.

Chuck (01:10:27.187)
Okay. Yeah.

Lisa (01:10:28.208)
Mm.

Chuck (01:10:32.346)
Yeah, well, no, of course you wouldn't. Of course you wouldn't, right? Yeah, no, I just mean like how to deescalate that. And, you know, that's it's for them. I wasn't even sure what to say. Right. And, you know, Ryan has suggested, well, just let them believe what he's going to believe, because there's no point trying to tell them different. So, you know, so, yeah, but.

Lisa (01:10:39.931)
Mm-hmm.

Monty Ghosh (01:10:50.845)
Sure, but I mean the line is great. One thing we are doing is like, so we're running out of funding as of April 2024, but we're gonna try to find some more. We always have this battle, every year we have to renew our funding. And so.

Atika (01:11:03.792)
These operators gotta log in the data. God damn data. Cause data's mean funding. Ha ha ha.

Monty Ghosh (01:11:08.154)
Yeah, we have to...

Lisa (01:11:10.383)
Do you find it hard, Monty? Because I feel like it's obviously a service when you guys are saving lives, like very literally. Do you have to fight? Like, is it hard to get that funding renewed? Because it shouldn't be. Like when you're a service saving lives like that, they should be throwing money at you.

Atika (01:11:23.618)
It's hard.

Monty Ghosh (01:11:26.709)
It is a tough log to be honest with you. Every, like we talk to provinces and they're like, oh, it's a federal program, the federal government should be paying for it. And then the federal government would be like, well, you know, provinces fund healthcare, not the federal government. And therefore it should go to the provinces.

Atika (01:11:28.552)
It's hard.

Monty Ghosh (01:11:43.681)
And so that's kind of the loop that we're in as a national line is that we're this the constant situation, but I mean, I do think that like with the help of people like Attica, like the data that we're collecting, um, like I, I believe in data driven advocacy. I'm, I'm.

Atika (01:11:59.565)
Mm-hmm.

Monty Ghosh (01:12:00.025)
scientist and then so it's for that reason that I'm like you know we have the data to show it works we have the data that shows that 70% of people can't access a physical service because it's not in their city it's not it's hours of operation are off limits or they are using inhalational substances and they can't use in a physical SCS in some in some respects and so like you know these are the things that kind of come into play and that you know there's just so many different things that we're able to show with the service that

And actually, Attica, like the other thing that we're looking at right now is the benefit to the operators. And so as of next week, we're launching another study within the NOR system. You'll get an email about that Attica from Pam probably. But it'll be interviewing our operators and doing a survey with our operators to see what their experiences have been like with the service. And then on top of that, we're talking to the clients. And so we're reaching back out to the clients.

Atika (01:12:43.54)
I will and I'll be doing the data logging again.

Atika (01:12:53.81)
Yeah.

Monty Ghosh (01:12:59.049)
and doing another survey and also another qualitative study with them to see what their experiences are like and asking them a whole new range of different questions than we've asked before. We've published quite a bit on this already, but there's just more that needs to come and things that we need to show and demonstrate to Health Canada. That's the biggest thing is that...

Atika (01:13:16.944)
Yeah, and-

Lisa (01:13:17.448)
So who is funding it now? Is it federally funded or is it provincially funded? Okay.

Monty Ghosh (01:13:21.785)
It's Health Canada. And Attica, if I had to show you, so Lisa Morris Miller is one of the other leads of the program and her and I have to fill out, I think a 50 page document once every three months that we have to send to them with all the data, all the stats, what's happened with the line. It was.

Atika (01:13:39.812)
Oh, I think, I think like my logging was bad. Like, I have to like do this question there every time. And then I think about you, Monty. And I, okay, I feel better now that you're doing that too. You're doing that Monty.

Monty Ghosh (01:13:45.501)
Thanks for watching!

Monty Ghosh (01:13:49.249)
I appreciate it.

Monty Ghosh (01:13:53.429)
Yeah, it takes a long time and we have to write stories and what's happened and it's a long document. It comes back and forth and do we have to analyze all of our statistics? And so it's a process, but it's going to be worth it, honestly.

Chuck (01:13:53.973)
I think it.

Chuck (01:14:10.466)
I think maybe some public awareness might help, you know, get kind of the campaign behind you. I think I'll commit to it even right now, as we're recording it, you know, we'll certainly throw in an episode or a commercial for it, you know, if we can work together and figure something out in our episodes, you know, and keep trying to get the word out. Absolutely, we can do that, yeah.

Atika (01:14:22.876)
and like what i like also about norse yeah what i like about norse also it's like

Monty Ghosh (01:14:27.357)
Thank you.

Atika (01:14:31.356)
there are some times where I would respond to someone witnessing an overdose or after witnessing an overdose. Like, oh my God, like I just witnessed an overdose and it like sometimes can be really stressful. Like I've seen enough overdoses that I'm kind of like, okay, you know, like I can like kind of compartmentalize but I think us as peers, it's like, like you said, Monte, about that peer support, supporting someone who just witnessed an overdose the first time, kind of like debrief.

about the user can be family. It could be someone who just witnessed an overdose. Can be someone who's like, I'm not sure if this is an overdose. Is this an overdose? And we will go through the whole process with them. And the thing about NORS is like, if we have to dispatch, there's like a NORS.

a line of it that they know exactly. It's like 911 for overdose. Like we know exactly it's an overdose and what I experience from consumption sites, it's like we call 911 and I'll be like responding to an overdose and they'll be like, do you need a police, firefighters or healthcare? And I'm like, dude, okay, this person is overdosing, okay? Like I just

Lisa (01:15:49.603)
Yeah.

Atika (01:15:50.366)
like as a responder, it's really, really frustrating to just like be on the line for like 30, 40 minutes. And they're going to say like, your emergency is very important to us. Please stay on the line. You know, like, you know, so I think having that access at North that we can just dispatch and they know exactly we're dealing with an overdose. They know exactly where to go. It's super helpful. Super helpful. It does. It does bring me sanity in that case.

Chuck (01:16:00.974)
Hmm.

Lisa (01:16:06.742)
Yeah.

Lisa (01:16:17.114)
Yeah.

Atika (01:16:20.767)
That's for your study, Monty. Operators, right?

Chuck (01:16:21.09)
No kidding. Hehehehe.

Monty Ghosh (01:16:22.469)
Yeah, sounds good. Well, let's mention that because it will be interviewing you. We have a whole group of interviewers who will be interviewing all the operators and you can share your thoughts and be open about it. Like because I think that's the key thing that we have to show is that because like they're honestly like I hear it from other operators too, Attica, like your colleagues that they tell us that it helps them as well with their own wellness and they enjoy it. And there's this culture, as you mentioned, Attica, that just really permeates through the service that.

Lisa (01:16:23.515)
Hmm.

Chuck (01:16:28.924)
Ah.

Atika (01:16:33.153)
Yeah.

Chuck (01:16:33.163)
Perfect.

Atika (01:16:44.197)
Yeah.

Lisa (01:16:44.239)
Hmm.

Monty Ghosh (01:16:52.157)
that they're all there for each other. And so it's amazing to see. And I feel very privileged to be a part of the project and to be able to work with everyone there. So it's super cool.

Chuck (01:17:07.158)
No kidding, no kidding. Well, I think that gets us towards the end of it here, Monty, is there anything that you'd like to say on the way out here?

Monty Ghosh (01:17:16.357)
Uh, no, I mean, I had a great conversation today and it's great to meet Attica. Like it's great to meet one of the operators. So thank you. And then, I mean, I met Lisa before and you're so Chuck, it's great.

Chuck (01:17:22.73)
That's crazy, it's funny you two didn't even know about each other, eh? Yeah, yeah, yeah. I really gotta thank you for coming on. We're not done with you, because well, we've got this daily gratitude thing that we do every day that I forgot to tell our guests about again, so you know, that happened. Lisa, I feel like that's gonna go under your purview from now on, right? Yes. All right. So we'll do our little thing here. That brings us to my favorite part of the show, and that's the daily gratitude. Do this first.

Atika (01:17:24.125)
Thanks for watching.

Lisa (01:17:34.545)
Hahaha!

Lisa (01:17:38.481)
Okay.

Chuck (01:18:03.094)
So every day we do some daily gratitudes, every episode, Monty, and whenever we have a guest, of course we get at least a couple out of you. If we could, that'd be great. I'm sure you got something to be grateful for.

Monty Ghosh (01:18:14.026)
Oh, 100%. I mean, I think I just said it a couple seconds ago that I'm grateful to be able to work with Norris and the team there.

and learn off of all my colleagues there. I mean, it's been a great experience and I'm grateful for all the opportunities that have come my way. And as Lisa knows, it started off that there's no jobs, but things happen for a reason and grateful for those opportunities. And actually, I think that's the biggest thing that I've learned kind of starting from that place was that every opportunity that came by was a bonus. And I'm grateful for that.

Chuck (01:18:45.886)
Excellent, excellent. Bojuhwaka, you got a couple for us?

Atika (01:18:49.32)
I am so grateful to talk to Monty, Lisa, and Chuck. And now I am so even grateful that I know who it is behind the North other than Rebecca. And I know who to blame if I'm frustrated about.

Lisa (01:18:53.019)
I'm going to go to bed.

Lisa (01:19:05.316)
Hahaha

Atika (01:19:05.428)
doing the little questionnaire every time I finish with a client. But I'm really grateful for Nors and I love every single one of whoever is the other side of the phone because harm reduction comes down to love at the end of the day. And we're here to save lives and it's really fun to save lives. So yeah, that's what I'm grateful for.

Chuck (01:19:32.555)
Lisa, what you got for us?

Lisa (01:19:36.543)
Every single week, I'm grateful that my brother is still sober. My brother is going on five, over five and a half months now on this particular journey and he's, I spoke to him just a few nights ago and he's doing well and I'm grateful for that. I'm also going to say today, so my little one went back to school this week, right, so everyone's back to school now. And it was really funny because throughout the week it was a bit of a hectic week, right, like she's back to all her activities, she's back to school and

Chuck (01:19:38.528)
every week.

Lisa (01:20:05.803)
And I was working in Emerge this week, which I do every other week, and those are always busy work weeks for me. And so I was kind of feeling sorry for myself the other night. And then I stopped and thought about the fact that, you know, I have friends who've lost kids, you know, to various things. And it kind of just popped into my head and made me stop and realize how lucky I am to have a healthy little girl going back to school who's busy and vibrant.

And so it was just a good shift in perspective that I'm lucky that I've got her. So yeah, so I'm choosing to be grateful for my busy week that I had this week.

Chuck (01:20:45.55)
Good stuff, good stuff. You got to be busy as Carl would say, right? Yes, yes, yeah, absolutely, absolutely. And for myself, I'm grateful for another excellent guest introduced to us through Lisa, of course. Thank you so much for coming on, Monty. That's a big deal. We really do appreciate it. And what a great conversation at that, right? And my final gratitude will go out to you, the listeners, whatever you guys are doing, please keep doing it. We're still growing somehow. It's kind of amazing right now. And...

Lisa (01:20:48.672)
Yeah, exactly. I didn't have to be. I got to be.

Chuck (01:21:14.634)
If you see our logo on any of the socials, I'm not even gonna list them all anymore because there's so damn many. We are literally all of them. Drop us some comment, like, share, do whatever you gotta do because every time you do any one of these things, you're getting me a little bit closer to living my best life. My best life will be to make a humble living spreading the message. The message is this, if you are in active addiction right now, today could be the day. Today could be the day that you start that lifelong journey. Reach out to a friend, reach out to a family member, call into detox, go to a meeting, do whatever the hell it is you need to do to get that journey started because it is so.

much better than the alternative. And if you have a loved one who's suffering, yes, if you have a loved one who's suffering an addiction right now, you're just taking the time to listen to the weekend ramble. If you could just take one more minute out of your day and text that person, let them know they are loved. Use the words.

Lisa (01:22:00.192)
You are love.

Atika (01:22:00.24)
You are loved.

Chuck (01:22:02.658)
That little glimmer of hope just might be the thing that brings them back.

There we go. Perfect.