Welcome to the sixth forum of Delivering Recovery. Today I am really excited to interview Dr. Steven Klein about why and when to start offering GLP-1s to your addiction treatment patients. So I think this is going to be a really exciting discussion because this is groundbreaking.
Things are changing by the minute here. So I want to start out, Steven, just kind of set the stage. Can you tell me what piqued your interest originally in treating addiction treatment patients? And what made you start investigating GLP-1s?
Sure. So thank you so much for having me today, Joanna. This is a large part of what I do now. So I'm super happy and very excited to talk about it.
What started me seeing addiction medicine patients is that I'm a person in long-term recovery. So I'm a triple-boarded doctor in pediatrics, genetics, and metabolism and addiction. I was kind of on a northern academic track to study genetics and metabolism and do academic research at the Children's Hospital of Philadelphia.
I climbed to the top of that totem pole and just realized that there was something missing from my career. And at the same time, I was growing my recovery network and my life in recovery. And an opportunity presented itself to train at Caron Foundation and Caron Treatment Centers in Wernersville, Pennsylvania.
And I took that opportunity to do fellowship, and it just made me fall back in love with medicine. The ability to take kind of what my training is, which is abstract molecular mechanism of disease, and start applying it to addiction is amazing and intellectually very satisfying. I think to be a person in recovery who helps treat people with addiction and substance use disorders has been incredibly gratifying.
To add on to that kind of personal spin, I'm also a person on a GLP-1 medication. So I was a medical resident in the global pandemic, and they repurposed all of us. So we went from where we were kind of assigned to be to being in emergency rooms.
And all of a sudden, stress was really, really high, and coping was really, really low. And I found myself reverting to food, which was an old coping skill, an old friend. And quickly put on weight, came out of the pandemic.
My provider at the time said, hey, do you want to try something called Mounjaro? It's, at that time, off-label for weight loss, but showing really incredible promise. And it was just transformative for me. I realized I was a food addict long before I was a drug addict.
The amount of equity and space that food was taking up in my mind was just huge. The amount of time that I was thinking about food and thinking about what I was going to eat and not going to eat and things like that was just really huge. And then starting a GLP-1 almost overnight, that all went away.
And the noise in my mind around food was quieted. And I think it helped me to go deeper into another stage of my recovery. So when I started Caron treatment centers, this was kind of the dawn of GLP-1s and the beginning of a signal.
I started prescribing them for people with other indications like obesity and type 2 diabetes. And I've now pioneered an entire project, entire initiative around bringing them to now people for all indications and the primary indication being substance use disorder. Oh, fantastic.
So that's really exciting. I know that I'm involved in this field also because of personal experience. I had a daughter who developed a really strong alcohol addiction.
And so I find that there's an awful lot of us who are in this field because of personal experience. So that's really interesting. So let's branch now and talk about some of the early research behind the effectiveness of GLP-1s.
What are you finding in the research? What does the early research show? Sure. So we have kind of two flavors of research. The first flavor is retrospective research.
So that's looking at patients who have been prescribed GLP-1s for weight loss or for type 2 diabetes, and then retrospectively seeing what the outcomes are related to substance use disorder. And on the flip side of that, we have prospective research. So we have research where we take a group of patients, hopefully they're randomized.
So they randomized to some received GLP-1s, some received placebo. And then prospectively, we're able to measure the effect that the GLP-1s have on things like alcohol consumption. In the realm of retrospective research, it's just staggering.
There is large cohort studies from around the world where patients in hundreds of thousands, 200s of thousands of patients in large EMR systems, large electronic medical record systems have reproducible signals that they decrease alcohol use disorder, they decrease alcohol related admissions, they decrease nicotine use, they decrease opioid related hospitalizations. The most recent and one of the most powerful of those studies was one that came out of the U.S., 600,000 U.S. veterans in the VA. And what it showed was a near 20% reduction in diagnosis of people who didn't previously have substance use disorder.
What's amazing about this study and what we're seeing in the field is that this was somewhat substance agnostic. So it showed a 20% reduction in alcohol use disorder, opioid use disorder, stimulants, nicotine, kind of across the board. In patients who had already had a diagnosis of a substance use disorder, what this paper showed was a 50% decrease in all-cause mortality.
So really, really big study, really well-powered, really, really big signal. Now on the prospective side, there's two large randomized control trials. One was in 2025, one in 2026.
And really what were shown there is that there's a profound effect on alcohol intake. So the Hendershot et al. paper showed about a 40% reduction in alcohol intake, 20% of the treatment arm had no drinking days at the end.
And the paper that followed that up earlier this year, again, recapitulated that in randomization at slightly higher doses. So I would say right now that the data is overwhelming. I would also say, I am someone who thinks a lot about the use of these medications.
And at the end of the day, obesity is likely, at least partially, an addiction to food. And what we're seeing with the success that people are having with weight loss, I think speaks volumes. So I think the fact that these people are able to break their eating habits and sustain weight loss and really be in a new lifestyle, I think all of the data for weight loss can really be applied to addiction with just a little bit of tweak in perspective.
So at this point, it's my belief that the data is overwhelming. Wow. And there was one of the studies that I saw that showed that among patients with alcohol use disorder, there was a 50% reduction in relapses during the time that they were on GLP-1s
That's astonishing too. Now, is that one of the retrospective studies you're talking about? Or was that a perspective study? There was a 40%, 45%, if that's the study that you're mentioning, that actually was looking at a comparison of GLP-1s versus the standard of care, which is now naltrexone, Campral, and Antabuse. They showed a 45% reduction in one year relapse rates.
That was a retrospective study. Wow. Fantastic.
And I think that one of the things you mentioned to me before is that another thing you're seeing is that an astonishingly high percentage of patients are staying on the GLP-1s for an extended period. Can you talk a little bit more about that? Yeah, absolutely. So now, as I was giving my kind of background, at Caron Treatment Centers, we offer these medications truly to anyone who wants to be on them.
There are exclusionary criteria. We can get into that maybe in the second half. It can be more specific.
But truly, for any indication, if someone's at Caron in a residential 3.7 or 3.5 ASAM level of care, we think they should be offered the medical management that is kind of cutting edge and also what's proving to be very efficacious. So because of that, we've prescribed to over 550 patients, GLP-1s within our treatment continuum. And we also are in a position now to look retrospectively at that data.
And some of our retrospective data shows that the 1-, 3-, and 6-month retention on these medications is incredibly high and that they're outperforming pretty much all of the medications that we use. So we're about five times the industry standard for Buprenorphine, about six times for Naltrexone at 1-, 3-, and 6-months. And that's data that we're following very closely and hoping to publish.
So why are they so effective? Can you talk just a little bit about what they do in the brain that makes them so effective for people struggling with addiction? Sure. So I think what makes them effective and also what makes people compliant with them are kind of related. So what makes them effective is I think they really get to the core of the issue.
We know from animal models that every region of the brain that's involved in the reward pathway, the mesolimbic system, or colloquially the hedonistic system, every single one of these regions has a GLP-1 receptor. So really what I kind of, to summarize lots and lots and mountains and mountains of scientific data is that really what these medications are doing is that they're separating that reward pathway from stimulus. So basically the reward pathway feels content, feels satiated without the cheeseburger, without the line of cocaine, without the alcohol, and therefore people stop seeking.
It also potentially, and this is also in animal data, makes these medications less or these substances less addictive. So in mouse models, the reinforcement effect of alcohol is diminished on mice who are receiving semaglutide. So that's, I think, really amazing in that it really makes us think about the reward system is governing so much of our behavior.
I think as an addiction medicine doctor, I explain all the time. Truly, the reward is not a glitch in the system. Reward is the entire system.
Reward is why we do everything. It's why we procreate. It's why we seek food.
It's why we seek shelter. Like reward drives everything. These are really, really central pathways.
Unfortunately, they've also been pathways that have been somewhat pirated and somewhat hijacked by lots of industry and lots of marketing and lots of very, very well-funded people to the point where I think about systems a lot as a physician. And to be morbidly obese, you actually probably have to live in a society where you can walk into a restaurant and order 5,000 calories of food on one plate. To be a drug addict, you probably come from a society that places huge amounts of stress on its populace and potentially limited resources to deal with that stress.
So I think for the first time, we're in a really interesting place to change the conversation. One, when you have a great medication for something, it makes it unthinkable that it's a biological disease and not a moral failing. So I think the conversation is changing.
But getting back to, you know, I think people just feel better. I think most people with substance use disorder relate to kind of common terminology of having some, you know, something on their back or something they've carried around or some type of burden, some type of thing that they're dealing with. And I really think this helps lighten the load and helps them move forward.
I'm also not mystified that patients like the weight loss component of it. Right, who doesn't want to lose weight? I'm sure there are some people out there. Yeah, I mean, I practice medicine in the United States.
When I look at my cohort of 550 patients, the mean BMI is 30. Those are patients who qualify for GLP-1s for FDA-approved reasons. So I think patients just like the way they feel.
They like, you know, being in the driver's seat. The most profound thing I've ever heard a patient say to me is, my brain listens to me now. And I think that says it all.
My brain listens to me now. That's wonderful. So I assume that insurance companies are not covering the cost of GLP-1s for addiction treatment or actually probably a lot of other things also.
So if a treatment center wanted to start offering them to their patients, how do they go about finding a low-cost version that is affordable? Sure. So for everybody who's listening, I'm so happy that you're here and happy to connect and I'm going to introduce this and that I have more than enough resources. We, for the 550 patients we prescribe for, about 350 of them are on compounded versions.
We get compounded versions from a 503A pharmacy. It's completely legal. It is a completely justified reason.
We use incremental dosing that's not available commercially. There's lots of ways that the compounding makes a lot of sense for substance use disorders in treatment centers. And it's something that we're very comfortable with doing now.
Some of our patients are able to get them through insurance once they leave treatment. Sometimes that takes like very heroic efforts from PCPs and outpatient providers. We do this so much at scale that we don't do a lot through insurance just because our, when I first started for patients who met FDA criteria of BMI or type 2 diabetes, we would go through insurance.
We were getting approvals of about 50%, but if you're following the news, more and more insurance companies are dropping them in fear of truly like probably going bankrupt for having to pay for these medications for the majority of their subscribers. So we find that the compounded versions are incredibly effective. The patients really like being on them.
They like the accessibility. Most compounding pharmacies ship directly to patients. So it's something that we've kind of worked through.
And as a treatment center said, you know, this is the right thing for us to do and the right thing for us to offer. And we've actually expanded that now. And what you were mentioning earlier, I'm the chief medical officer of an entity called Quell Health, which is the first in class telemedicine delivery platform for GLP-1s for addiction medicine.
So we can take care of really all of that for outpatients. We can do the prescribing. We can see patients.
We can follow them. We do outcomes tracking and things like that as well. So I'll put some information in the chat at the end of the session.
People can get in touch with us. Super. So I know that as I was looking into this, I was seeing that, you know, the legalities that the pharmacies that have the original patents on these medications were really cracking down on compounding pharmacies.
But you explained to me why that the versions that you're using are so different from the typical ones used for weight loss, that it really hasn't been much of an issue and you don't anticipate it being an issue. So could you go into a little bit more detail for other people who might be concerned about the legalities of going the compounding route? Yeah, absolutely. So from a legal perspective, initially during the pandemic, there was a supply shortage.
So the FDA manages a supply shortage list. Anything that's on that list can be compounded kind of to make up the difference. I'm not exactly sure what the metrics are that make supply shortage lists, but like by some estimates, about 2 million Americans get their GLP-1s from a compounding pharmacy.
So there's still some gap, whether we're in a supply shortage or an accessibility shortage, compounding pharmacies are filling a role. What's no longer available and what was deemed now, you know, not inbounds by the FDA is what's called 503B formulation. So 503B is if you were a doctor's office, you wanted to prescribe GLP-1s, you could actually just acquire like an office stock supply of GLP-1s and you could give those to your patients.
That's a stock supply version. The 503A compounding pharmacies are still legal and still available. That's a prescription specific pharmacy.
So if you were my patient, Joanna, I would say Joanna needs this GLP-1 and they would then ask me why, why does she need this compounded version and not a version that's commercially available? The truth is in addiction medicine, what we're finding is the lower doses are often better for cravings. So since this may be a long-term treatment, I want to keep patients on the lowest dose possible. If I get the versions that are commercially available in the auto injectable pens, I'm confined to those dosing schema.
So in semaglutide 0.25, 0.5, 1 milligram. I very, very rarely have patients who go above 1 milligram and I use all of the, basically what I'm sending them as vials with syringes. So we can go from 0.4 to 0.45 to 0.5 to 0.6. So we're making incremental changes.
And we also, as part of the compounding kind of compliance, we compound this with another additive, which is B12, which the majority of what I treat is alcohol use disorder. B12, I think is reasonable for anyone who has that diagnosis. So those, the 0.45, the 0.6 and so forth is not available under a typical prescription.
Yeah. Now Eli Lilly and Nova Nordisk both have vials available. So you could say that like you could get it through a Nova Direct, but they're not as commercially available.
Those are actually much more expensive to get those intermediate doses and not something that is as widely kind of discussed as it is in our field because the contemporary teaching was ramp patients up to the highest dose they can tolerate as quickly as possible. We do a dosing strategy that's much different. Okay, super.
And so for a typical patient in addiction treatment, taking a GLP-1 for that purpose, roughly how much would you expect it to cost on a monthly basis? Yeah. So there's the medication itself, which will continue to kind of, there's good competition there. It keeps it down.
There's the medication plus care. So to see an addiction medicine doctor, our price point is $250 a month. That's for semaglutide, $350 a month.
That's for tirzepatide. That's with care. There are certainly not as expensive GLP-1s on the market.
There are these big telemedicine practices like HIMS and HERS and RHO. The patients have to navigate that for themselves. We kind of let them know if they find cheaper equivalents and they find a maintenance dose that works for them.
Great. But I do think there's real therapeutic value in meeting with an addiction medicine doctor and talking through your cravings and externalizing your cravings and having a treatment team that's fully transparent and not saying I'm on this for weight loss when really it's for alcohol use disorder. I think there's some transparency in that that I really like as a model.
And I also think there's buy-in. I mean, patients, these are medications they want to be on. It's an investment.
And I think overall, it really helps them in their treatment course. So were you just saying that it'd be $250 or $350 a month for the addiction treatment for the doctor and the medicine? So that's all inclusive? That's all. Yep.
So that's what's available. Those are our pricing scheme for Quell Health. We also offer something that's $149 a month.
That's for anyone who just needs telemedicine addiction, telemedicine addiction medicine services outside of compounded GLP-1s. So people who need naltrexone, SSRIs, SNRIs, off-label prescribing like topiramate for cocaine use disorder, things like that. Okay.
Wonderful. So do you recommend, because they do help people lose weight, is there a lower BMI that you don't recommend that patients go on the GLP-1s if they're below a certain BMI? Yeah. I mean, I think that's a question I get all the time.
I'm not so much of like a hard cutoff person, but I'd probably exercise extreme pause with like any BMI less than 20. Those are people who are probably malnourished kind of getting in that direction. At the same time, and this is leading into another interesting conversation, the stimulant use disorder class of medication stimulants like methamphetamine and cocaine cause weight loss and malnourishment.
So you're kind of caught in this place of, well, if I can have someone stop using methamphetamines or stop using cocaine and get that under control, will their nutrition potentially get better? That's not something that we're actively pursuing. I would say, again, the lion's share of my patients are alcohol use disorder with robust BMIs by one UPenn study that came out earlier this month. One in 10 people in the United States have alcohol use disorder and morbid obesity.
So I think like the idea of robust BMIs and alcohol use disorder is established. Again, I don't have a cutoff, but I think it's a clinical judgment. You have to be really careful.
It's a similar argument for pancreatitis. So there was a real fear that GLP-1s would cause pancreatitis. So some doctors, if you've ever had pancreatitis, do not prescribe GLP-1s to you.
Interestingly, alcohol causes pancreatitis. So if I have someone who's had recurrent bouts of pancreatitis, all while intoxicated, all after binge drinking, I actually have a case series that I'm hoping to publish. It's about six patients who've had three or four cases of pancreatitis due to alcohol started on GLP-1s and did not have rebound pancreatitis because of that.
Okay, super. So one of the things I've heard about GLP-1s is that you have to stay on them forever. That if you come off, if you're taking them for weight loss and you come off, you regain a lot or all of the weight.
What is your experience with patients taking GLP-1s for addiction treatment? Is there a point at which you think they can start tapering off? Yeah. So I think the, I actually have patients who taper off pretty frequently. It's a conversation.
I think that's also why having an addiction medicine doctor who's kind of trained in the DSM-5 criteria, and I just saw something pop up in the chat about standardized scales. So like ways that we can assess how things are going. I think like the overall description that I use is, you know, if I had a magic wand in my office at Caron, I would wish everyone who walked through our doors one year of abstinence from the substances that brought them into our treatment.
I think a year is a really good amount of time to build what others in the field have called recovery capital. So how are you connected to community? What's your personal therapist like? What is your, just kind of like medication regimen, medical team? I think about all of these things as capital that can help keep people away from drugs. I don't think GLP-1s are the cure for addiction.
I think recovery is. I think GLP-1s are a tool to help people stay and hopefully get into recovery a little bit more deeply. So it's a case-by-case basis.
I think it's probably very similar to weight loss. So if you're on a GLP-1 and all you do is take the medication and you're less hungry, so you eat less and you do nothing else, it'll probably come back on when appetite suppression goes away. But if you use that time of weight loss to eat higher protein, to exercise, to teach yourself lifestyle redesign, then that's really good.
And I think you could probably keep the weight off. I think what also enters the conversation at this point, though, is those wraparound services are not equally distributed and not available to all patients. So the idea that someone has access to personal therapy and has access to the time to get to AA meetings and has childcare so that someone can watch their children and they can have an hour to go engage in therapy is something that there's a huge disparity around.
And I think for the people who need these medications most and are struggling with addiction, this may be their lifeline out to start rebuilding their lives and then get to some of that capital, maybe three years, not in the first year. Yeah, that makes a lot of sense. So let's step back a little bit and talk about if we have addiction treatment centers that are on this call that might be interested in offering GLP-1s to their patients.
Can you talk about some of the different ways that Quell Health could work with them to help them start up a program? Yeah, absolutely. So we really offer everything. And this spans from Caron Treatment Centers into Quell Health.
But from my position at Caron Treatment Centers as an addiction physician who's really kind of done this day and night for the past 18 months, we're happy to consult and help you build a program under your own roof. That involves training, consenting, things with compliance, making sure that you have standard protocols for receiving shipments of medications, medication tracking, quality tracking, things like that. That's a big lift.
So that's not going to be right for every treatment center. What we're also offering now, and we actually just started a collaboration with Hope House in Boston, is that we'll do what's called teleportation. So we will teleport into your treatment center.
We'll help you set up an area where basically your patients can meet with Quell physicians and we'll prescribe. The medications will arrive to the treatment center. What's really nice about that model is we follow them once they leave your doors.
So they're enrolled in the Quell ecosystem. They meet with a provider once every three months. We're doing outcomes tracking, and we're very, very happy to share that outcomes data with the treatment center that referred them.
And then the last thing is, if even that's too much, we can just be your partner at discharge. So we can just be a resource. We're happy to take referrals.
We have a referral portal on our website. Patients can be referred directly to us, and we can engage them once they leave treatment. And I actually think that's an incredible model as well.
You know, I think in a perfect world, I would love to see patients start the medication before they leave treatment because I think it's a nice runway to then have a little bit more craving suppression as they transition to their next level of care or to back to the reality of their world and their lives. But I think, you know, if that's not doable for a treatment center, I think getting them plugged in with us, we can also take over, like I said, the prescribing of their naltrexone, Campral, Antabuse, whatever other forms of non-controlled MAT they're on. Hopefully in the near future, we'll be doing buprenorphine as well.
That would be really helpful also, because I mean, we see a lot in our outcomes research where people said they just couldn't find they were on this medication that really made a difference during treatment, and then they left treatment and they had real problems finding it. So that would be a tremendous help for a lot of those patients. Yeah, that's really why Quell was born.
You know, I guess four years ago, I never saw myself in addiction. And two years ago when I started this, I never saw myself as like a telemedicine founder. But, you know, it's just kind of following what's needed by the patients.
I think like it's been really some of the most amazing patient experiences. It's like I work with the return to use population at Caron, and these are people who have been in multiple treatment centers, who have tried multiple rounds of naltrexone, camperol, additions of those. And I think, you know, for this field specifically, it's really important for patients to have faith and buy in for the medications that they're taking.
And when someone loses faith in naltrexone, I think it's challenging to get them to reinitiate that. But what's been really great is we have really impressive data that, you know, the idea that now we're combining naltrexone with another medication that could potentially work synergistically. Patients are really, really into that.
And they're really, really on board with that. I think they start feeling better sooner on the GLP-1s, and it keeps kind of everything that they're doing and working so hard with while in treatment going. So you're putting people on naltrexone and GLP-1s at the same time? Oh, yeah.
Oh, I didn't realize that. That's my favorite. I also do a lot of buprenorphine plus GLP-1s.
Wonderful. So we do have a couple of questions coming in. One was, would Quell work with referrals from private non-medical licensed professionals? Absolutely.
So Quell works with everybody. Quell is also a direct-to-consumer. So people can just come to our website and click, and without any payment or anything like that, they will see an addiction medicine doctor.
Only if they want to enroll after that do they get charged. So that's the idea. And I think that's the moment that we're in as a field.
My hope is that GLP-1s will start not only helping people that are being served in treatment centers and by addiction medicine licensed providers, but also people who are curious. There's a whole Reddit forum called DryZempik, so people who have started taking Ozempik and stopped drinking and now find community on Reddit and talk about their experience. So my hope is that, you know, we start reaching only a small, small percentage of patients with SUD who will ever make it into a treatment center. So I'm a real believer and a real student of the idea that there's no wrong door to addiction treatment.
And my hope is that we start seeing patients sooner in the continuum or sooner in their journey. And that also that Quell can serve as a referral pipeline, not only in downstepping, but if we have someone in our continuum who's not doing well, that we can step them up into a treatment center in their region. Fantastic.
Another question came in. Can you speak to any side effects or potential negative outcomes? Yeah, absolutely. So I would say like our early experience was definitely like what I call pathologic slash unintended weight loss.
So that was something that we had to be really careful of, especially like in the beginning. I think everyone was like, we have two choices, semaglutide and tirzepatide. Everyone was like tirzepatide causes more weight loss.
So it's probably superior for cravings. We found that patients on low dose tirzepatide were losing too much weight. So we stopped using that.
We use almost entirely semaglutide. The other thing is that we, as is reported, the common side effects, although honestly, like I can tell you from our month to month data, the number of patients who stop because of side effects is the vast minority. The most common side effects are nausea and vomiting.
These tend to be very self-limited, especially at the low doses. I mean, now we have Wegovy HD or high dose. That's seven milligrams.
I very rarely go above 0.6 milligrams for this. So it's almost an order of magnitude less than the highest dose. So I think that's helpful for a side effect mitigation.
When talking about negative outcomes, something that we screen for is previous history of eating disorder, especially restrictive type eating disorder. So I would say that's a feared complication, but something you can screen around would be triggering someone to have a restrictive type eating disorder relapse. I think binge eating disorder, there's a whole conversation there about these medications may help to treat that, but that's not backed by anything besides kind of anecdotal experience at this point.
So really, I mean, what we navigate is very, very, I would say very, very manageable. The side effect profile, especially at the low dose, most patients have very transient side effects, maybe for the first week where they increase their dose and they seem to abate. Wonderful.
Well, unfortunately, we're going to have to wrap this up. Can you talk about if a treatment center owner or medical professional is interested in considering working with you to start offering GLP-1s to their patients, what should they do next? What's the next step? Yeah, I'm going to put three things in the chat. The first is my email at Caron.
The second is my email at Quell. And the third is the Quell website. And you can get in touch with me truly any way that you'd like to.
I am very available. I would love to talk to you about what you're thinking, about what your reservations are, about how we either at Caron or at Quell or at both can help you in the journey. I think, you know, this is something that I talk about a lot and that I'm kind of on the forefront of.
We've been in the New York Times, the Washington Post, the Boston Globe. We're going to be on PBS and NPR the next month and Dr. Drew in two months. So there's just a lot of energy around this.
I think this is something that patients are going to hear, at least at Caron, where we're now seeing patients come in the door almost expecting to be on or expecting to be offered because they want something different and they want something that maybe hasn't been offered to them before because they're in that state of really kind of like hopelessness and things haven't worked for them. So I'm very, very passionate about this. I think, you know, we're just at the beginning of what's going to be a tidal wave that sweeps through addiction medicine.
And I think we're just starting to understand the impact that these medications will have on our patients and likely the generation to come. Fantastic. So one last question.
That was a great wrap up. So you mentioned Caron. How are Caron and Quell Health? How are they associated? Sure.
So the easiest answer is me. So I work at both. Caron, Pennsylvania, is inpatient.
And this is basically allowing us to get into and follow patients into the outpatient world. Caron has financial interest in Quell as well. Oh, fantastic.
All right. Well, I thank you so much, Steve. This has been incredibly informative.
I'm sure you'll get a lot of people reaching out to you. And congratulations on the incredibly groundbreaking work that you're doing. Thank you.
Thank you so much. And thank you for your attention to the topic. Thank you.
