There’s a lot related to healthcare that Dr. Karim Ali sees in a hospital.
There’s also a lot he doesn’t see.
It wasn’t until Dr. Ali, Medical Director of Infection Prevention and Control, and Director of the Infectious Diseases Division, stepped outside his roles at Niagara Health that he began to see the whole picture, particularly related to addiction.
Dr. Ali spends one day a week volunteering with Positive Living Niagara’s StreetWorks Program, a free and confidential harm reduction program that offers sterile injection supplies and disposal, and provides supervision to people who inject drugs. It’s something he’s been doing in his spare time since late 2018 before also joining Positive Living’s board of directors last year.
“In the hospital, I only saw one aspect of the opioid crisis: the infections,” Dr. Ali says. “I didn’t know about the countless folks who passed away. I didn’t know about the countless folks living with this over their heads, the countless families being destroyed.”
Niagara consistently ranks in the top five regions in Ontario for opioid-related deaths. Between January and May this year, Niagara Region Emergency Medical Services responded to 259 suspected opioid overdoses. Grimmer numbers reported by Niagara Region Public Health show that between January and June 2022, the region was averaging about 11 opioid-related deaths a month.
Dr. Ali was given a glimpse into the complexity of this reality by a young woman he treated at Niagara Health, who eventually died of an overdose.
She told him she came from a well-to-do family. She talked about her siblings; about the stigma attached to her addiction and how people treated her differently for it. In the process, she shifted Dr. Ali’s perspective.
“She made me see this is an issue that does not affect ‘other people.’ It affects all of us,” Dr. Ali says. “I came full circle because this is a population that’s very, very marginalized, not just what happens to them socially but also what happens within the healthcare system. This has enlightened me that every patient we see with these complicated infections, there is a lot that happens that brought them to our door.”
In 2018, Dr. Ali met Talia Storm, Positive Living’s director of StreetWorks Services, who taught him about what was happening in Niagara, convincing him to volunteer. She remains one of his biggest influences and educators about the opioid crisis with her impact carrying over into his work at Niagara Health.
“It’s treating people who use substances with respect, as humans. This can happen to anybody,” Dr. Ali says. “As a society, this has become a moral argument. Substance using is seen as a moral issue. As a physician, I don’t see it that way. It has multi-facets.”
While on a StreetWorks shift, Dr. Ali and a team from Positive Living travel throughout the region to areas challenged by drug use. Together, they provide clean needles and inhalation kits, dispose of used equipment, provide free sexual health items, and connect people with community resources.
Meeting people where they are, as Dr. Ali describes it, helps to prevent them from seeing him in the hospital with complicated illnesses, including spinal infections, multiple skin and soft tissue infections, and endocarditis (heart valve infections) that can result from opioid use. HIV and Hepatitis B and C transmission, which are also risks, are managed in the community.
“Healthcare is more than just the hospital,” Dr. Ali says. “Providing harm reduction supplies is a life-saving measure in the opioid crisis.”
Another influence in Dr. Ali’s work is Brenda Yeandle, Niagara Health Clinical Manager of Addiction Services, who co-chairs OPENN — Overdose Prevention and Education Network Niagara – with Storm.
OPENN formed in 2016, consisting of members from 30 prevention, harm reduction, treatment and enforcement agencies, including Niagara Health, alarmed by the rising number of people dying from toxic substance overdose.
From left: Talia Storm, Director of Positive Living Niagara’s StreetWorks Program, Brenda Yeandle, Niagara Health Clinical Manager of Addiction Services, and Dr. Karim Ali, Niagara Health Medical Director of Infection Prevention and Control, and Director of the Infectious Diseases Division.
Yeandle has dedicated her career as a social worker to helping people with addictions and is buoyed by Dr. Ali’s involvement, including his willingness to shoulder the moral arguments lobbed against users and those who help them.
“The importance in addictions of resources working together, that need for collaboration with community partners to be able to provide a continuum of services – Dr. Ali has been that link,” Yeandle says. “We would benefit from having more Dr. Alis and having more people helping, not just because we need boots on the ground but because of the credibility it adds. People need assistance and they need access to medical assistance, too. I admire him a lot because of his contributions.”
More recently, Dr. Ali started helping with a federally funded, multi-agency substance use assistance program that provides safer supply. Safer supply is a strategy where people at high risk of death or who have tried other therapies, such as methadone, without success, are prescribed a defined – and clean – dose of opioids.
By accessing safer supply, individuals avoid toxic street drugs, which are increasingly cut with lethal amounts of synthetic opiods. They also don’t need to partake in harmful activities to support their habit, allowing them to focus on finding adequate housing, getting their lives back on track and “wherever that leads you,” Dr. Ali explains.
“People can function normally. They can get their lives together once they’re on safer supply,” he says.
They can also benefit from more compassion, he and Yeandle stress.
“Addiction hits everyone,” Yeandle says. “That could be my daughter, my mom. Certainly, someone working in this field is someone’s daughter. Could we just be kinder?”
If you or someone you know is struggling with addiction, recovery services are offered across Niagara. Learn more at niagarahealth.on.ca/site/addictionrecoveryservices