Grant: Operating Grant

The synchronized monthly disbursement of social assistance in British Columbia significantly impacts the health of people who use illicit drugs (PWUD) as well as the provision of health and social services. Previous research has documented escalations in high-intensity drug use, overdose, hospital discharge against medical advice, drug and alcohol related death and public disorder that coincide with monthly cheque issue days. Service providers further report large spikes in service utilization that extend provders beyond institutional capacity, resulting in wait times, suboptimal service provision or clients leaving without accessing care. There is a therefore a pressing need to examine alternative disbursement arrangements' ability to mitigate these considerable drug-related harms. This grant proposes a 26-week, parallel, multi-armed assessor blinded randomized controlled trial to test the impact of alternative disbursement arrangements on the escalation of drug-related harms coinciding with cheque issue day in Vancouver's Downtown Eastside neighbourhood. This study will be conducted in partnership with a local credit union specifically designed to provide access to financial services for local residents. Study participants in non-control arms will have their social assistance deposited directly into a personalized account at the partner credit union and disbursed according to a schedule that varies disbursement. This trial will monitor the impact of alternative social assistance disbursement on intensified drug use (primary outcome), and other key drug use, service utilization, treatment discontinuation and public disorder-related outcomes. As a policy-focused structural intervention, the proposed study holds considerable potential to inform changes to social assistance disbursement policy that could significantly benefit individual and community health and safety.