How modifying income assistance schedules impacts money-related behaviours of people who use drugs

• In Event: 50411 - Rethinking Policing and Drug Policy: Power, Surveillance, and Social Justice

Abstract

While government income assistance (IA) is critical for mitigating the health impacts of poverty, once-monthly synchronized IA payments have been linked with cyclical increases in substance use and related harms coinciding with cash transfer payments, including opioid toxicity, violence, health emergencies, and disruption of social, substance use disorder, and medical care. However, little is known about the effects of synchronized disbursement on financial management practices of marginalized IA recipients, including making, spending, borrowing, and repaying money. This secondary analysis of an exploratory, parallel group, unblinded, randomized controlled trial analyzed 194 adults who use drugs in Vancouver, Canada. Participants were randomly assigned on a 1:2:2 basis for six monthly IA payment cycles to: (1) existing synchronized government schedules (control); (2) a “staggered” single monthly payment; or (3) “split & staggered” twice-monthly payments, the latter two disbursed outside government payment weeks. Generalized linear mixed models assessed whether alternative IA schedules impacted income; material security including basic needs, economic security, housing, and overall; odds of owing and repaying debt; and odds of experiencing debt-related consequences. Models analyzed observations according to randomization per intention-to-treat (ITT) specifications, while modified-per-protocol (MPP) sensitivity analyses categorized observations according to effective arm. Between 2015-2019, 45 control, 72 staggered, and 77 split & staggered volunteers participated. Across study outcomes, ITT analyses identified no significant differences across arms. MPP analysis showed that modifying IA schedules had complex effects across treatment arm and gender: no difference in income, reduced economic resources in the staggered arm for men and women, reduced overall material security among men in the split & staggered arm, reduced odds of repaying debt on government payment days for women and men on split & staggered schedules, and no significant effects on debt-related consequences. Taken together, findings highlight income stability regardless of IA disbursement timing and frequency, and suggest that participants adapted debt management strategies to meet needs and avoid violence associated with unpaid debt when payment schedules were modified.

Authors

• Allison Laing, University of British Columbia

• Lindsey Richardson, University of British Columbia