Bridging the gap: Dr. Monty Ghosh on innovation in harm reduction

What does winning the national CAHSPR Health Services and Policy Research (HSPR) Impact Award mean to you?

This national recognition represents vital validation for the organization's collective efforts in harm reduction rather than a personal achievement. Currently, there is deep concern regarding the closures of supervised consumption sites across Canada, particularly in Ontario and Alberta, which leaves individuals who use substances alone with fewer options for support. Receiving the Canadian Association for Health Services and, in some respects, Policy Research (CAHSPR) Impact Award provides crucial credibility, systemic backing and national validation that the National Overdose Response Service (NORS) is an effective, life-saving program.

How does this specific study bridge the gap between academic data and public policy?

This study serves as a direct bridge between a grassroots community initiative and evidence-based medicine. NORS began as a novel, untested concept—a dedicated phone line for people using substances alone. Because no data existed to back the service initially, academic researchers partnered with the community organization to build an evidentiary foundation proving its efficacy.

From a public policy standpoint, between 60% and 80% of overdose deaths occur when people are using substances alone at home. Building this academic evidence allows clinicians to confidently integrate the service into standard practice alongside traditional tools like opioid agonist treatment and naloxone kits. Ultimately, the goal is for public health sectors to adopt and promote this service through structural policies, such as displaying NORS information directly on naloxone kits and leveraging social media campaigns.

Why is it essential to co-create health services research alongside individuals who have lived experience?

NORS was entirely initiated, managed and operated by people with lived experience. Individuals on the front lines possess the most practical and creative insights to navigate the day-to-day complexities of substance use. Co-creating research with them aligns with the foundational philosophy of peer and Indigenous science: "Nothing about us without us." While academic researchers can sometimes suffer from a narrow scope of focus, collaborating directly with frontline individuals helps broaden research questions to ensure they are genuinely impactful and tailored to real-world needs.

What advice would you give to medical students or trainees who are considering entering your field?

Addiction medicine and research intersect multiple complex sectors, including healthcare, social services, the justice system, government and public policy. While navigating these overlapping fields is challenging, it offers immense opportunities for personal and professional growth. Trainees are encouraged to enter fields facing an explicit paucity of evidence. Because addiction medicine is a rapidly evolving area with significant knowledge gaps, it represents a highly rewarding frontier where new researchers can make a substantial, tangible impact.

How does your clinical work inform the academic research questions you choose to ask?

Frontline clinical work acts as a primary mechanism for identifying critical gaps in knowledge, resource allocation and systemic operations. Encountering these real-world challenges helps shape the scale of academic inquiry—whether prompting a localized clinical trial or demanding a large-scale, multi-stakeholder program. Practicing on the front lines provides the direct context and community connections needed to understand the true depth of the issues that clients and colleagues face daily.

Who were the key collaborators and community partners who were critical to the success of this publication?

The success of this research relied heavily on a broad network of community and institutional partners. The core driving forces behind the operations and research insights were NORS and Grenfell Ministries, led by Lisa Morris Miller, chief executive officer. Vital funding and infrastructure support were provided by Health Canada and the Canadian Institutes of Health Research (CIHR). Additionally, the project succeeded due to the widespread mobilization of national harm reduction community partners and individuals with lived experience.

Following this award, what is the next frontier or upcoming project for your research?

The upcoming research portfolio focuses on two primary areas:

• Wastewater surveillance and predictive modeling: Partnering on a newly awarded CIHR grant called STEPS—which was highlighted in a Government of Canada investment announcement to strengthen public health systems—to develop a national drug alert system, harmonized data dashboard and machine learning models to predict overdoses.
• Cognition and homelessness: Developing specialized screening methods to evaluate cognitive concerns among individuals experiencing homelessness and concurrent substance use challenges.

Is there anything else you would like to say about this award and your research?

It truly takes a village to get this work done. While I am receiving this individual recognition, it is entirely a reflection of a collective effort. Operating as a full-time clinician means seeing patients constantly, which can make dedicated research time incredibly difficult to carve out. The people in our lab are the true drivers who do the heavy lifting in the background, transforming high-level direction into meticulously executed research.

I want to explicitly acknowledge and thank the key members of our team:

The NORS operational team: Pamela Tapley, Lisa Morris Miller and Jody Bell

Our core lab members and researchers: Nathan Rider, Will Rioux, Dylan Vista, Avneet Dhanoa, Alice Seo, Mohammed Al Saleh, Maria Vasquez and Adrian Teare

Beyond their technical contributions, it is the spirit, enthusiasm and deep belief in the cause shown by these students and team members that keep this work alive. Researching in this field brings immense pushback and political friction. In moments where the going gets tough, and I have felt like quitting, the passion and drive of these students to do what is right are exactly what lifts me up. I owe everything to their dedication.