Seeing Beyond the Behaviour

Meaghan Thumath on providing care for people who use drugs

For Meaghan Thumath, looking beyond someone’s substance use and understanding the root cause is key in providing care for people experiencing addiction.

“I really grew up understanding that addiction was complicated, and that it was as much about your opportunities and your pain and trauma as it was [anything else],” says Thumath, a public health expert and Clinical Assistant Professor at UBC’s School of Nursing. “To me it was never a moral failure.”

Thumath started her career in healthcare by working and volunteering in HIV prevention. She saw the intersections with substance use and developed an interest in addiction medicine.

Since completing her nursing training, addiction treatment and care has been a focus in Thumath’s career. She completed the BC Centre on Substance Use (BCCSU) Addiction Nursing Fellowship in 2017. She’s also worked as Clinical Coordinator at Insite, Chief of Staff at the BC Ministry of Mental Health and Addictions, and on projects around the world with organizations such as WHO, UNAIDS, and the World Bank. She is currently pursuing a PhD as a Trudeau Scholar at the University of Oxford’s Centre for Evidence-Based Intervention.

Along the way, she’s seen how chronic pain is often at the root of substance use disorders, and how the health care system can fail to properly care for those individuals and create more harms.

“I think for many people, pain is the root in problematic substance use or substance use disorder,” Thumath says. “If you have untreated pain, it's absolutely devastating to your quality of life. If you add on top of that substance use disorder and it's not actually properly managing the pain, then it’s really debilitating for people.”

According to Thumath, a lack of clinician training creates more challenges for people seeking help with co-occurring substance use disorder and chronic pain.

“With chronic pain, particularly given the lack of training and lack of knowledge around how to manage both pain and addiction, […] we find that people may be sometimes unnecessarily cut off from an opioid that was managing their pain well, or they were never given access to it,” she explains.

As a result, “they turn to the street supply, which, particularly in Canada and the US, is toxic and poisonous.”

It’s something that Thumath hopes to bring attention to through training and education. She helped lead a BC ECHO on Substance Use session on co-occurring substance use disorder and chronic pain with Pain BC and recently facilitated a panel discussion on the subject at the 2021 BC Substance Use Conference.

Building capacity in the health care system to better care for people with substance use disorders is critical to removing barriers to treatment. However, Thumath also acknowledges how the pandemic is disproportionately impacting people who use drugs and creating more barriers. Reflecting on her experience in Ebola response, Thumath says COVID-19 presents particular challenges for people experiencing addiction:

“Lockdowns are very difficult for people who use drugs. It's disrupted the drug supply, it’s disrupted access to treatment. People have been afraid to seek care, although they've also experienced really significant service disruptions.”

She emphasizes the importance of maintaining low-barrier services where possible, and suggests carrying forward innovations as restrictions ease.

“There have been some people that have just completely been lost to care, and those people need outreach. They need evening and weekend clinics and really flexible appointment schedules and service by text.”

It all comes down to recognizing the context surrounding a person’s substance use and what their experiences have been in the health care system.