Challenging “Cheque Day”: How changing income assistance can change drug use

• In Event: 3129 - Section on Medical Sociology Refereed Roundtables (1 hour)
  In Refereed Roundtable 60min: Table 17. Drug Use and Abuse

Abstract

Complex public health emergencies, such as the ongoing opioid crisis, demand the urgent and critical examination whether social policies meet their objectives to promote social integration and health equity, and whether they play a role in the production of harm. For example, despite mitigating the impacts of severe poverty, synchronized income assistance payments have also been linked to monthly escalations in drug use and serious associated harms, including accidental overdose. This experimental study examines whether varying income assistance payment timing and frequency can reduce the impact of individual cues (from being paid) and social cues (from everyone being paid at the same time) that contribute to spikes in drug use coinciding with income assistance payments. We randomized research volunteers to compare the conventional monthly synchronized schedule to a monthly desynchronized “staggered” schedule, or a semi-monthly desynchronized “split & staggered” schedule. Using data from 194 people who use illicit drugs collected between November 2015 and October 2018 in Vancouver, Canada, multivariate generalized estimating equations assessed the impact of alternative schedules on escalations in drug use coinciding with government and individual payment days. Escalated drug use was predefined as a 40% increase in the three days starting with payment days of at least one of: (1) drug use frequency; (2) drug use quantity; or (3) number of substances used. Results demonstrate significant reductions in the likelihood of escalating drug use on government payment days, particularly among participants in the staggered arm, and on individual payment days, particularly among participants in the split & staggered arm. These findings point to achievable reforms that could reduce escalations in drug use coinciding with assistance payments. They additionally emphasize the considerable relevance of social policy design to critically urgent public health concerns such as the opioid epidemic.

Authors

• Lindsey Richardson, University of British Columbia

• Allison Laing, University of British Columbia

• Ekaterina Nosova, British Columbia Centre on Substance Use

• Thomas Kerr, University of British Columbia