The Impact of Alternative Social Assistance Disbursement on Drug-related Harm

Not Applicable

Terminated

Interventions: Other: Non-synchronized social assistance receipt
Other: cheque divided into two equal disbursements

Brief Summary: This study evaluates whether altering the timing and frequency of social assistance disbursement reduces drug related-harms that increase on the days surrounding monthly synchronized government social assistance cheque issue.

Detailed Description: Coordinated monthly income assistance payments, while seeking to alleviate poverty, can also have negative and unintended impacts, particularly among people who use illicit drugs (PWUD). Observational research has identified escalations in drug-related harm coinciding with monthly assistance payments, such as overdose, treatment interruption, hospital admissions and public disorder. This project varies the timing and frequency of income assistance disbursement, and evaluates whether varying income assistance disbursement reduces drug-related harm coinciding with coordinated income assistance.

Conducted among 273 PWUD, participants will be allocated for 6 income assistance cycles to a control or one of two intervention arms. Participants in the control arm will receive payments according to the existing monthly government schedule. Participants in the intervention arm will receive their income assistance: (1) monthly on a day different from government cheque issue; or (2) semi-monthly on days different from government cheque issue. The intervention will be evaluated using qualitative and quantitative methods for its impact on drug use and related harms.

Recruitment & Eligibility

Inclusion Criteria

be ≥19 years of age or older
reside in greater Vancouver, Canada
report regular use of illicit drugs other than cannabis
receive monthly provincial income assistance
are not currently administered (where cheque issue/money is externally managed)
be eligible and willing to be a client of the local credit union who will administer the intervention
report intensified drug use around government cheque issue days
provide written informed consent
be willing to comply with study procedures

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Staggered Arm	Non-synchronized social assistance receipt	Receipt of social assistance once monthly on a randomly assigned day that does not fall during the week of government cheque issue (Non-synchronized social assistance receipt), for 6 income assistance cycles (approx 26 weeks).
Staggered and Split Arm	Non-synchronized social assistance receipt	Receipt of social assistance twice monthly on equally spaced randomly assigned days that do not fall during the week of government cheque issue (Non-synchronized social assistance receipt, cheque divided into two equal disbursements), for 6 income assistance cycles (approx 26 weeks).
Staggered and Split Arm	cheque divided into two equal disbursements	Receipt of social assistance twice monthly on equally spaced randomly assigned days that do not fall during the week of government cheque issue (Non-synchronized social assistance receipt, cheque divided into two equal disbursements), for 6 income assistance cycles (approx 26 weeks).

Primary Outcome Measures

Name	Time	Method
Illicit drug use on government cheque issue days	26 weeks	Timeline Follow Back (TLFB) assessed increase of drug use defined as an increase in the frequency of drug use of at least 40% or an increase in the number of drugs used during the 3 days beginning with government cheque issue day, compared to non-cheque issue days.

Secondary Outcome Measures

Name	Time	Method
Illicit drug use on non-government cheque issue days	26 weeks	Timeline Follow Back (TLFB) assessed increase of drug use defined as an increase in the frequency of drug use of at least 40% or an increase in the number of drugs used during the 3 days beginning with individual cheque issue day (among intervention participants), compared to non-cheque issue days.
Hospital admissions on government cheque issue days	26 weeks	Emergency Department, Emergency Department Mental Health and substance use hospitalizations in the three days beginning with government cheque issue day compared to non-cheque issue days.
Overdose	26 weeks	Self-reported non-fatal overdose and hospital record verified fatal overdose on the three days beginning with government cheque issue day compared to non-cheque issue days.
Police service utilization	26 weeks	Self-reported and police record-verified interactions with police or use of police services on the three days beginning with government cheque issue day compared to non-cheque issue days.

Locations (1): British Columbia Centre on Substance Use
🇨🇦
Vancouver, British Columbia, Canada