Nadia Fairbairn, MD, FRCPC, MHSc, cISAM, is an Associate Professor and holder of the Philip Owen Professorship in Addiction Medicine in the Department of Medicine at the University of British Columbia. A board-certified general internal medicine specialist and addiction medicine specialist, Dr. Fairbairn is a physician practicing at St. Paul’s Hospital, in Vancouver.

Dr. Fairbairn’s research program is focused on strategies to close the evidence-to-practice gap in addiction medicine through clinical, educational and research innovation.

We asked Dr. Fairbairn about her recent CHIR Project Grant award and her aims to improve clinical care for people with opioid use disorder.

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Q: Congratulations on your recent CIHR grant! Can you tell me a bit about this research project?

Contingency management is a well-established approach that uses positive reinforcement, usually financial incentives, to encourage healthy behaviours. It has been widely studied in addiction care, and has shown very strong results in helping people engage in treatment.

Our current project builds off a successful pilot study completed last year, in which we provided cash incentives to people living in poverty who were beginning treatment for severe opioid use disorder. The incentives were tied to engagement with a personalized treatment plan, co-developed with their healthcare team.

The pilot demonstrated that the intervention was both feasible and highly acceptable to participants and staff. With support from CIHR, we will now conduct a randomized controlled trial, the gold standard for evaluating interventions, to determine whether this approach can improve treatment engagement, reduce opioid use, and enhance broader health and social outcomes.

Q: How has your past research set you up for this new(er) line of inquiry?

One of the greatest challenges in opioid use disorder treatment is retention. We have evidence-based treatments, but many people, especially those in poverty, face significant barriers to staying engaged in care, particularly during the first few months of treatment.

My research has long focused on improving addiction care, sometimes in innovative ways, and understanding the social and structural factors that influence health outcomes. Contingency management is particularly interesting because it recognizes that practical challenges, such as poverty, unstable housing, and financial insecurity, can make treatment engagement difficult.

While only about one-quarter of people starting opioid use disorder treatment continue with treatment after three months, in our pilot study, more than 90% of participants attended at least one follow-up visit. Participants consistently described the intervention as effective and feasible for them. These findings suggested that the approach has the potential to meaningfully improve outcomes for people with opioid use disorder and provided a strong foundation for this larger trial.

Q: What are your goals with this research, and how do you hope to improve the lives of those living with substance use challenges?

Opioid use disorder continues to have devastating impacts on individuals, families, and communities across Canada. However, effective, evidence-based treatments are available, even if retention rates are low.

Our goal is to determine whether this intervention can improve treatment engagement and outcomes. Ultimately, we hope that this intervention might contribute to more effective, compassionate, and patient-centred models of addiction care and help more people access and remain connected to treatment.

Q: I understand that you have many collaborators in this area of research. Can you tell me who you are working with on this new grant and who you’d be interested in working more closely with?

We are fortunate to have an exceptional, world-class team of researchers, clinical community partners, and people with lived and living experience of substance use. The study is co-led by Dr. Lindsey Richardson, Canada Research Chair in Substance Use Work and Well-Being, who studies the link between poverty and health, and Dr. Paxton Bach, an addiction medicine specialist and holder of the UBC Diamond Foundation Professorship in Addiction Medicine and Recovery with extensive expertise in contingency management and clinical trials. Our team also includes leaders in addiction medicine, health equity, health economics, policy translation, Indigenous data stewardship, qualitative and quantitative research methods, and community-engaged research.

We are always interested in building new collaborations that can strengthen the impact of this work and help ensure that research findings translate into meaningful improvements in care and policy.