RAMS Alumni Spotlight: Dr. Nadia Fairbairn

For our July 2024 RAMS Alumni Spotlight, we interviewed Dr. Nadia Fairbairn, MD, FRCPC  from the 4th RAMS Cohort (2015-2017) about her background and work since completing the RAMS Program.

Nadia is an Assistant Professor and holder of the Philip Owen Professorship in Addiction Medicine in the Department of Medicine, Faculty of Medicine, at the University of British Columbia. Her research program is focused on strategies to close the evidence-to-practice gap in addiction medicine through clinical, educational and research innovation. As part of these efforts, she conducts research focused on the epidemiology of addiction, quantitative and qualitative data analyses, and clinical trials. 

Read on to learn more about Nadia!

Tell us about your clinical and research background. What led you to study substance use?

I was in undergrad at the University of British Columbia in Vancouver, Canada pursuing a science degree. I was always drawn to the helping professions, but I hadn’t had any exposure to them previously. I signed up for a volunteer program that the university offers, and I was placed at a hospice in the downtown eastside of Vancouver when I was 21 or 22. I was inspired by the nurses that ran the hospice, and also a few of the doctors that cared for the patients. The patients there had experienced poverty and sociostructural inequity. Many of them had also experienced harms from substance use or had complications of HIV and were getting secure housing and good care there in a really special environment. That inspired me to learn more about the downtown eastside community, understanding the social determinants of health, and also wanting to be a compassionate care provider, which was modeled by the folks working at that hospice.

It was also at an important time in Vancouver’s history, because I happened to be volunteering around the same time that North America’s first supervised injection facility opened as a pilot. I was able to connect with clinician scientists who were helping to lead the evaluation of this supervised consumption site through folks I knew at the hospice. It was my first exposure to harm reduction philosophy of care. I got to work with them as an undergrad directed studies student, and I was just totally fascinated by the intersection between health, justice, science, and how we can improve quality of life and outcomes for people in our own society through these types of brave innovations.

So, that was it – I knew I wanted to be a doctor and clinician scientist, and after that, I went on to apply for medical school and complete the rest of my training. I felt quite grounded in knowing that that was the type of work I wanted to return to.

In what ways did your involvement with the RAMS Program assist you with your research career?

I was fortunate to participate in RAMS as a Canadian; not all programs accept international learners, but RAMS did. Becoming an addiction medicine physician and a clinician scientist focused on substance use was new in Vancouver; there wasn’t that infrastructure yet where I worked. So, I got a lot out of RAMS by learning about what that career looks like in an applied way through connections and collaboration with other people, like my peers who were pursuing similar practice professions, and through meeting inspiring leaders in the field. But also, getting to see mentoring and teaching embodied among the experienced NAC mentors and other leaders within the RAMS program was extremely helpful for me, and came at a very pivotal time when I was just embarking on my own career.

What would you consider an interesting or surprising finding from your research so far?

I graduated from my training and became a professor the same year that, in British Columbia, a public health emergency was declared by our provincial public health officer due to escalating overdose mortality rates. Therefore, there were opportunities to expand treatment options for opioid use disorder for folks that were at risk for overdose, and ways to embed harm reduction services or the philosophy of harm reduction into our clinical care models as a way to reach a broader population in a meaningful way and provide good health services that people could access.

What I have learned the most from my research is that, unlike in other areas of medicine, we have quite a large evidence-to-practice gap in addiction medicine, where, for example, the evidence is somewhat lacking for the efficacy of certain new medications that ideally, we would have available for people. Or, we have evidence, but bringing it into actual practice so the patient can receive new services or new treatments can still remain a big barrier. I think that’s true of harm reduction, where there are some interventions like supervised consumption sites where we have really good evidence, but access to those services still remains a gap. It’s frustrating on one hand, because I want to see my patients being able to access what they should be able to access, but it also provides a lot of opportunity to help advance the field and help advance the patient experience when they are struggling with substances. We still have a long way to go from evidence generation to implementation in our field.

You will be spearheading the harm reduction component that’s included in RAMS’ next grant cycle. Can you tell us more about that?

I’m looking forward to having the next generation of Scholars and clinician scientists come to Vancouver! We have had some opportunity for innovation in Vancouver when it comes to harm reduction services and integration into healthcare delivery for substance use. So we are hosting the Fall Retreat in Vancouver at least a couple of times, and as part of that, we’ll have some didactics with powerful speakers talking about harm reduction implementation. We’ll also lead some tours of harm reduction services so that Scholars can see what they look like and learn about them more tangibly, and hopefully provide some inspiration for opportunities in their own local jurisdictions

We’re also incorporating this component in other ways; for example, at the CPDD Scientific Meeting this year, we did a harm reduction poster walk and attended an oral presentation on safe supply implementation in Canada. There were a lot of takeaways from those activities, but the main questions that came up from the Scholars were: “What is harm reduction? What qualifies or what defines something as a harm reduction service?” Harm reduction is implemented quite differently across different jurisdictions dependent on the policy context, so we talked about that piece a lot.

One common myth they’re often trying to contend with is the distinction between harm reduction and clinical treatment for substance use and recovery; there can often be this idea that those two things can’t work together. I think we therefore have some opportunity with RAMS to show how it’s a spectrum of care ranging from harm reduction services that can help people stay alive, bridging into recovery-oriented services. It’s also important to be aware of the policy framework within which certain harm reduction interventions are or are not possible to implement, and the role that policy plays overall in how healthcare services are shaped, implemented, and delivered.

How has it felt to have transitioned from a RAM Scholar to now a leader in this realm?

I think we all to some degree struggle with imposter syndrome when we transition from trainee to faculty. But one thing that’s helped me is to see the role of mentorship through RAMS, in terms of getting to know mentors who are more established in their careers. It allows you to see yourself as you evolve through your own career and what that will look like in the future. I think through experience, and with receiving mentoring from these more senior clinician scientists, that you can move away from that imposter syndrome and work to embody yourself as a leader. I’m really pleased to host and be part of the program in this way, and hopefully I will be a mentor for people who are just starting out in their careers, and share my experience and my journey as well.

Switching gears a bit, have you ever had an experience with a revise and resubmit decision and/or a rejection for a publication, or even a particularly challenging IRB issue?

Yes, I have had experience with it all!

In terms of publications, I mentor a lot of fellows through this process. We often talk about when we get feedback as a major revise and resubmission, that it’s very positive; the peer review process is there to make your work as credible and impactful as possible, so all this feedback is important to receive. Although sometimes fellows will be disheartened when asked to do a major revision, I think they feel like at the end of the process that their manuscript has significantly improved. With rejections, I like to visualize a hot potato: take the feedback that’s provided, improve it, and resubmit as quickly as possible without becoming discouraged. Keep on going, and trust that your work will be of relevance and impactful — and will, ultimately, be published.

As for the IRB, it’s there to be a responsible steward of research and ensure that participants are not harmed. I have had lots of feedback from our IRB over time with all of my work – it’s been constructive and helpful in centering the patient experience. As one example: we, in general, remunerate participants for their time. There have been discussions over time with the IRB about whether remuneration for participation can be coercive, particularly if they’re experiencing poverty, and how remuneration that might impact informed consent. Perspectives have also emerged to support payment to economically vulnerable populations as ethically justified and desirable when certain conditions are met. It’s an appropriate question to raise and I have appreciated the IRBs role – which is ultimately to ensure highest standards are employed to when conducting research and all ethical considerations have been duly reflected on.

Tell us about some directions you see your research going in.

One area I’ve become really interested in is the intersection between personal socioeconomic challenges and healthcare engagement challenges. For example, I see people regularly who want engage in treatment and be supported in their substance use goals, but because of poverty or other structural challenges such as homelessness, they’re not able to fully participate in or adhere to treatment. We’re just getting a trial off the ground now that is looking at offering health incentive payments to patients who are experiencing socioeconomic challenges who also want to engage in addiction treatment as a way to both overcome some socioeconomic barriers, and also support them in achieving their healthcare goals. I’m quite interested in innovative strategies like this that leverage cross-sectoral collaboration in order to address complex challenges.

Tell us one thing about yourself that readers might find interesting.

I love exploring beautiful British Columbia. Recently, I came back from a back country camping trip with my 2- and 5-year old near Whistler, on the traditional territories of the Squamish Nation and Lil’wat Nation. They carried their own backpacks and we enjoyed our awe-inspiring surroundings together in the mountains by glacier-fed Cheakamus Lake.

This interview was conducted by Natalie Karter, BS.