Study: Overdose risk increases on and immediately after distribution of income assistance cheques
published on September 24, 2014
New research trial will evaluate alternative distribution options for social assistance in order to minimize health risks
Vancouver, British Columbia– Study findings released recently in The International Journal of Drug Policy reveal the risk of drug overdose among injection drug users increased dramatically on and immediately following the days income assistance cheques are distributed in BC, which is usually the last Wednesday of each month.
Researchers at the Urban Health Research Initiative (UHRI) at the BC Centre for Excellence in HIV/AIDS based at St. Paul’s Hospital, observed the risk of overdose among people injecting drugs at InSite, Vancouver Coastal’s supervised injection facility, was over two times more likely on or immediately after “cheque day.” This was not simply explained by a higher number of injections occurring, but rather riskier injections taking place at this time. (It should be noted that no overdose deaths have been recorded at InSite since the facility’s opening in 2003.)
These findings are consistent with an evaluation performed by Vancouver Coastal Health’s Public Health Surveillance Unit on overdose data from Emergency Departments and InSite, as well as Vancouver Police Department data identifying increased service demands and recipients’ vulnerability to violence around cheque issue days.
“There is a clear pattern of elevated risk of drug overdose around cheque issue day,” says senior author Dr. Thomas Kerr, director, UHRI. “Given the impacts for individual health and related social consequences, many of which may be related to most people receiving their payments at the same time, there is a strong justification for exploring alternative approaches to how income assistance is delivered in BC.”
The study is based on comprehensive drug use and overdose data collected at InSite by facility operators between March 2004 and December 2010 and income assistance issue dates provided by the province. By identifying overdose incidents on or immediately after cheque day and comparing them to incidents occurring on all other days, researchers were able to identify and examine trends in the timing of overdoses.
In response to public and community concerns regarding these and other drug-related harms coinciding with cheque day, researchers at UHRI have been funded by the Canadian Institutes of Health Research to conduct a randomized controlled trial to examine the impact of changing the timing of income assistance distribution.
“As a policy-focused structural intervention, this study holds considerable potential to inform changes to income assistance policy that could significantly benefit individual and community health and safety,” says Dr. Lindsey Richardson, assistant professor, UBC Department of Sociology, and research scientist at UHRI, who will lead the new federally-funded study. “In addition to reducing overdoses, staggering the distribution of income assistance and paying individuals on a biweekly basis may help mitigate other drug-related harms associated with cheque day and ease the significant monthly burden for health and police service providers.”
Study participants in the intervention arm of the study will volunteer to have their income assistance deposited directly into a personalized account at a partner credit union and distributed on a schedule that differs from regular income assistance issue dates. Other study participants will have their income assistance disbursed as usual, as a single monthly cheque.
These alternative disbursements have been made possible through a key study partnership with the downtown-eastside-based Pigeon Park Savings (PPS), which provides people living on low incomes in the Downtown Eastside with access to basic financial services. PPS is a collaboration between Vancity Credit Union and Portland Hotel Society Community Services, a long-time provider of community services to residents of Vancouver’s downtown eastside and operator of InSite.
Preparations for the study are underway with research partners which, in addition to the Portland Hotel Society Community Services and Vancity, include Vancouver Coastal Health, and the Vancouver Police Department. The study is scheduled to begin recruitment in Spring 2015.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including government, health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS. By developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses, the BC-CfE helps improve the health of British Columbians.
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