Grant: Project Grant

The toxic drug crisis continues to affect communities across Canada, with people in poverty facing particular challenges such as unstable housing, transportation barriers, and financial stresses that increase overdose risk and make it harder to stay engaged in care. Although medications like methadone and Suboxone are effective, many individuals stop treatment early due to social barriers. To better support people in staying connected, we are testing an approach that pairs standard opioid use disorder (OUD) treatment with a targeted financial support. This study will evaluate an intervention offering cash incentives to encourage treatment engagement. This approach, known as contingency management, has been shown to help people with substance use disorders maintain connection to care, yet access in Canada remains limited. In 2024/2025, our team completed a pilot showing high acceptability, feasibility, and promising signs of reduced opioid use. This project will test whether the intervention improves outcomes for people with OUD who are working toward stability while facing socioeconomic challenges. We will recruit adults living in poverty and not currently in treatment with moderate to severe OUD at two Rapid Access Addiction Clinics in the Lower Mainland of BC. Participants will be randomly assigned to either: (1) standard care for OUD, or (2) standard care plus a weekly cash incentive of $140 for 12 weeks contingent on engagement with care. Researchers will measure opioid use and other substance use-related outcomes; health-related quality of life; socioeconomic outcomes; durability of effect; equity-based outcome differences; operational pathways; and cost-effectiveness. By reducing financial barriers and supporting sustained engagement, this approach aims to improve health, stability, and treatment retention. If successful, the model could be widely expanded as a transformative tool to support people affected by the ongoing overdose crisis.