Dr. Maithili Shetty, Psychiatrist and Rapid Access to Addiction Medicine (RAAM) Physician Lead at Niagara Health, will present on the connection between substance use and psychosis at this year's Psychiatry Clinical Education Day.
Dr. Maithili Shetty was drawn to addiction medicine early in her career after seeing how often substance use and mental illness intersect.
While training at St. Paul’s Hospital in Vancouver, she cared for patients in the city’s Downtown Eastside - an experience that shaped her belief that recovery depends as much on compassion and access as it does on treatment.
Now, as Rapid Access to Addiction Medicine (RAAM) Physician Lead at Niagara Health, she blends psychiatry and addiction medicine to help patients navigate both. After obtaining her methadone licence and expanding into opioid agonist therapy, she developed a passion for helping people find stability and recovery through early, evidence-based intervention.
Ahead of her presentation at Niagara Health’s Psychiatry Clinical Education Day on Nov. 5, Dr. Shetty shares insights on the connection between cannabis, stimulants and psychosis, and why early recognition and collaboration are key to improving outcomes.
We sat down with Dr. Shetty to learn more about her diverse work and perspectives.
Q: Who are the patients most affected by substance-induced psychosis, and what inspired you to focus on this topic?
A: We’re seeing more patients - especially young people - experiencing psychosis linked to cannabis and stimulant use. Today’s cannabis products are much more potent and accessible, while adolescence and early adulthood are critical periods for brain development. High-potency cannabis or stimulants like crystal meth can greatly increase the risk of prolonged psychosis. As a psychiatrist in addiction medicine, I see firsthand how early intervention can change outcomes. My goal is to help clinicians recognize and treat these patterns sooner so patients can recover more fully.
Q: What are some of the biggest challenges patients face when it comes to substance use and mental health?
A: Access remains one of the biggest barriers. Many people don’t know what services exist or feel too much stigma to reach out. That’s why our RAAM Clinics were designed as walk-in, low-barrier services - no referral needed. We now operate across three Niagara hospital sites - St. Catharines, Welland and Niagara Falls - five days a week. We’ve also strengthened inpatient RAAM services to improve access for hospitalized patients and create smoother transitions to community care.
Q: Where have you seen the most significant changes in addiction care in recent years?
A:We’ve seen a sharp rise in cannabis use disorder compared to just a few years ago. Legalization has increased accessibility, and daily use has become normalized, which raises the risk of dependence. Unlike opioid or alcohol use disorders, there’s no specific medication for cannabis or stimulant use disorders, so we focus on treating underlying conditions - like anxiety, depression or emerging psychosis- to prevent progression. Stimulant use, especially crystal meth, has also increased dramatically. These cases often involve psychosis and repeated emergency visits, but one positive encounter can still make a difference.
Q: When should healthcare providers and community partners step in, and what can early intervention look like?
A: Early recognition is key. Even subtle signs, such as paranoia or perceptual changes - should be taken seriously, especially in people with a history of cannabis or stimulant use. Those with a family history of psychosis are particularly vulnerable. Starting treatment early, even with low-dose antipsychotic medication, can stabilize mood and sleep while reducing symptoms. It’s equally important to connect patients to addiction treatment and counselling, since concurrent substance use can worsen outcomes. Collaboration between hospitals, community clinicians and addiction services gives patients the best chance at recovery.
Q: Why is this message so important for clinicians attending Psychiatry Clinical Education Day?
A: Early intervention truly saves lives. We can’t wait for symptoms to worsen before acting. Even starting outpatient treatment and counselling can help patients stabilize and recover more quickly. If we identify risks sooner, connect patients to care, and respond with compassion rather than stigma, we can change the course of illness and help people build lasting recovery.
To learn more about Psychiatry Clinical Education Day on Nov. 5, please contact Amanda.Etherington@niagarahealth.on.ca.
Due to limited capacity and CME accreditation requirements, priority for in-person attendance for this event will be for physicians and clinical staff. There is unlimited capacity for virtual attendance.
