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Harm Reduction Spotlight: Dr. Monty Ghosh

Interview with Dr. Ghosh on drug checking and the Canadian harm reduction landscape
Dr. Monty Ghosh

Spectra had the opportunity to sit down with Dr. Monty Ghosh to discuss harm reduction and treatment programming as well as the impact of drug checking.

Dr. Ghosh is an Internist and Addiction Specialist who supports marginalized populations in Alberta, focusing on substance use, homelessness, and vulnerabilities. He holds an addiction certification, conducts research, influences policy, led the Section of Addiction Medicine at the Alberta Medical Association, and currently co-chairs the Canadian Network for the Health and Housing of People Experiencing Homelessness (CNH3).

How do harm reduction and treatment strategies differ? And do they often work well together?

The way that I look at harm reduction and treatment is it's part of the same spectrum. With harm reduction on one side and treatment on the other. The two can be complimentary. It's all about wellness and improving quality of life. If you have that focus in mind, about improving quality of life, then you can see how they interact with each other very well. It really depends on the individual. For some of them, the quality of life might be not getting infection from their substance use or not having a drug poisoning event from their substance use and that improves your quality of life. For others, it might mean getting off illicit substances altogether, which is where treatment comes into play, and giving supports around treatment. And that goes beyond just harm reduction treatment. It can also be housing, it can be income support. It can be food security, and providing them with food security, depending how vulnerable they are. There's a wide range of approaches to this. But again, I think the common theme denominator, if you may, is improving quality of life for the people that we serve.

And what challenges do harm reduction providers and treatment providers face when working with marginalized or unhoused populations?

There are a few problems that they encounter when working with these population groups. One is building trust and relationships. We know that a lot of the individuals who use substances have experienced trauma in the past, whether it was in their youth or afterwards, some of them have not, of course, but also many of them have faced mistrust with the healthcare system and healthcare providers. They've been treated poorly in emergency departments, hospitals, there's a lot of stigma towards substance use. They get treated poorly on the streets by others. And so there's this general mistrust towards healthcare providers and the justice system and other aspects as well. So how do you bridge that mistrust? Truly, it's through compassion, and showing compassion to these individuals. Being there for them, being available to them, and not being overbearing. We call this low threshold interventions. Meaning that you're always there, you're always around, you don't keep hovering around them. But you allow them to come to you and you have an open door policy, and no matter what choices they make, you are always still there. So that eventually if they do need your help, or even if they tried multiple times to utilize your help, they haven't quite followed through, there's still always that opportunity.

We talked a bit about how harm reduction treatment strategies differ but how can harm reduction services work more in harmony with treatment. Are there best practices or ideal models you've seen?

I do think that harm reduction and treatment are part of the same spectrum they can work together and they can work in unison and I think that one of the best ways to do this is through education. Increasing knowledge, awareness, I should say on both sides to the patient population. For example, in harm reduction facilities, it's important to tell them about opioid agonist treatment and treatment programs and what the options are and being available to provide those services on top of other things like housing income, support, a lot of stuff. Again, it's about building up the quality of life for those individuals but not forcing anything down on them. Just making sure that they're aware of the resources. At the treatment side of things, when people are in treatment, when they leave, it's important for them to know what harm reduction options are available in case they do relapse and saying hey, you know, you should not be using alone, you should have a naloxone kit. Being aware that sterile supplies is important to prevent infection control. So that's where I can see them working in unison. We see other models like the Insite model, where you have treatment on site with harm reduction. You have Insite, which is the supervised consumption facility, but then you have Onsite, which has the detox at the top floor and intervention shuffles people over to treatment programs.

How can drug checking data positively impact community partners beyond the harm reduction service providers themselves?

I think knowledge is power and the more we know what's going on with our toxic drug supply, I think the better informed we are and the better we can make choices around it. It's better than walking in the dark or running in the dark. If we have a better understanding of what is going on with the toxic drug supply, we can better inform people who are using substances to be aware of what's going on around them and what new substances are being put into their drug supply. And then being aware of the consequences of that and being aware of how to navigate around that. So if they are taking xylazine they don't even know it and they start to notice that their fingers are getting gangrenous, or other weird side effects, they can get themselves checked and say hey, this is what I think is going on. I was told there might be xylazine in the drug market right now. Even better yet, if they're able to test their supply and you know it's xylazine then they can then make the active choice of not having to use a potentially maybe towards the future we will go to a stage where they don't even need to use their their their toxic drug supplied off and go towards something else. In a safe and controlled environment. And maybe that's where we're going in the future with this. But again, knowledge is power. And it's important for people to be aware of what's going on with their with their supply. A good analogy is it's like looking at the ingredients when you're at the grocery store and buying a food product. You know not everyone looks at it but think it's important if you want to make the right choices for your health.

Are there any other community partners you think could be impacted by drug checking data, other than the specific individuals themselves?

For harm reduction workers, health care providers, knowing what's going on is very helpful. For example, if we know that levamisole is entering the drug supply, as healthcare providers, we can then look for things like neutropenia or pancytopenia, which are two outcomes that we see with this drug. Neutropenia is a lowering of your white blood cell count, and pancytopenia is lowering of all your blood cell counts. That is a side effect of levamisole. Iit is getting cut into people's cocaine, then that is worrisome, I need to do something about that. On the flip side of things, if you start to notice that xylazine is starting to enter the market, we can be aware of some of the effects of that such as the phase of constriction that occurs, it can cause loss of some limbs and almost frostbite like symptoms. Drug checking increases our chance of catching things and then responding to them. The other example is with benzos entering the market right now. We have many long-acting benzos that are in our drug supply. What we're noticing in acute care is that we're seeing a lot of late seizures, from opioid withdrawal, which you never usually see with opioids. So it has to be something else. It must be the benzos. As a result, we create protocols around this, to manage that and mitigate around that. The other groups this data can inform are policymakers and the justice system as well. It's important for the general population to know too. Knowing that the supply is so contaminated, hopefully people decide it's safer not to use that and try some alternatives instead.

And finally, what are some things that make you hopeful for the future in this space?

We're gaining more knowledge about how to navigate around this and there are a lot of people working on this problem. And that's hopeful to me. I think it's incredibly important that we have as many people focused on this as possible. We saw how we focused on COVID-19 when it occurred, and the entire world mobilized to deal with it. We've had more individuals who have had drug poisoning events and have died from drug poisoning events than COVID-19 in total now at this point, and so and we're seeing more and more people getting involved in this space. It makes me hopeful that we can direct our resources towards improving the health of people who are using substances.

This interview reflects personal views and in no way that of an institution or organization. Spectra Plasmonics is a Kingston-based technology company whose mission is to empower anyone to make better informed, human health related decisions by developing chemical sensing products that are high performing and simple to use.


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