RAAM CLINIC FOUNDER BULLISH ON ADDICTIONS SUPPORT

Dr. Hasan Sheikh’s favourite definition of leadership comes from Marshall Ganz, a professor at the Harvard Kennedy School of Government who teaches community organizing: “Enabling others to achieve shared purpose in the face of uncertainty.”

By Elaine Smith

Dr. Sheikh, a faculty member in the University of Toronto’s Department of Family and Community Medicine (DFCM), says, “I don’t think you have to be in a formal position of authority to be a leader and empower others to make change. I try my best to be a leader, but as to whether or not I’m successful, you’d have to ask others.”

His colleagues are happy to praise his leadership abilities.

“Dr. Sheikh is a very effective leader,” says Dr. Jennifer Hulme, a physician in the emergency department at the University Health Network (UHN) and in the Rapid Access Addiction Medicine (RAAM) clinic he co-founded there in 2018. “He leads by example and is very inclusive, but he is good at making executive decisions when we need action.”

DFCM and the provincial government also recognize Dr. Sheikh’s leadership potential. The emergency and addictions physician is the most recent winner of DFCM’s Louise Nasmith Award, given annually to provide an early career faculty member with protected time to research, prepare, and disseminate a lecture or workshop on a change-related topic. In fall 2022, he was also named the provincial clinical lead for substance use disorders at the Mental Health and Addictions Centre of Excellence at Ontario Health.

Dr. Sheikh has been involved with public health and government policy in the past. In addition to his clinical experience, while earning a master’s degree in public administration at Harvard University, he worked with the City of Calgary on creating a municipal mental health and addiction strategy, the first city in North America to do so.

“I wanted to take a person-centered view of the addictions sector in the city, and to do that I consulted with a very diverse group,” he says. “That included many members of the community: I consulted with people who were actively using substances, those in treatment programs including the injectable Opioid Agonist Treatment (iOAT) program, and those who were in abstinence-based recovery programs. I also connected with community agencies that worked with people experiencing homelessness and with people who were using substances, and even connected with law enforcement as well to hear their perspectives.”

The Louise Nasmith Award will provide Dr. Sheikh with some protected time to do systemic work that he can bring back to DFCM.

“I’d like to develop a framework of how to reframe our most frustrating clinical experiences and redirect our attention to look at the upstream failure,” Dr. Sheikh says. “Can we create a framework to systemically figure out policy failures and where to intervene?”

“This desire is based on my clinical experiences; I want to take a step back to see how I can help others who are doing similar work. We don’t get medical school training on how to diagnose or treat policy failures, despite the fact that we are the ones who see their effects every day.”

“For example, homelessness and the lack of affordable housing is a significant challenge,” he says. “Housing first strategies have shown to improve people’s mental health and substance use. Many of my patients tell me that homelessness is a major driver of their substance use.”

One of Dr. Sheikh’s proudest achievements to date is co-founding the RAAM clinic at UHN as part of a network of such clinics across Ontario. A RAAM clinic is a low-barrier, drop-in clinic that patients can attend to get help for a substance use disorder without an appointment or formal referral. It provides time-limited substance use care that includes pharmacotherapy, brief counselling, and referrals to community services.

“META:PHI (Mentoring, Education and Clinical Tools for Addiction, Partners in Health Integration) pioneered this model and built a ton of resources and a good community of practice,” Dr. Sheikh says. “It is a complete game-changer for people. It really works for people suffering from substance use disorders. We published a study on our first six months of data and patients with alcohol use disorder that came to us from the ED did even better than those referred from primary care, even though they started with more severe illness.”

In fact, the clinic began by operating for only two half days each week and is now open five half days a week. Currently, the clinic is trying a new intervention for people with stimulant use disorder that uses the reward centre of the brain to motivate them by offering vouchers for positive steps.

“The clinic fits with a DFCM pillar that says we should integrate research into our interventions and be accountable to the people we are trying to help,” Dr. Sheikh says.

Notes his colleague Dr. Hulme, “Although RAAM is not unique, it’s unique to have emergency physicians there. Dr. Sheikh has been instrumental in changing the culture of our emergency department with continuing medical education and support to our emergency providers about which medication to start people with and how to counsel them. He’s done a lot of outreach to the family health team, because people do much better with support from their family physicians. He has also helped ensure that addiction medicine is a core rotation in a family medicine residency.”

In addition to his clinical work, Dr. Sheikh is also involved in research. He is a co-author of a study published in 2020 in the Canadian Medical Association Journal that grew out of curiosity about what happened to ED patients with repeated visits for alcohol intoxication.

“We looked a year forward from their ED visits and discovered that of those who had two visits or more in a year, one in 20 died, while among those who visited five or more times in a year, one in 10 died,” he notes. “This is comparable to the mortality after having a heart attack. We should be wrapping care around these people; but they aren’t treated with the same priority or severity as they should be.”

He is committed to helping as many people with alcohol use disorder as possible.

“We know that for some part of the emergency department population, the RAAM clinic works, but for others, it isn’t the model of care they need,” Dr. Sheikh says. “We need to determine what those supports are so we can work on the silent epidemic of alcohol-related harms. Can we move away from siloed, stigmatized care toward a more compassionate system that works with the realities people face?”

Dr. Sheikh has a long career in which to answer those questions and it’s apparent he’s off to a running start.