The Impact of Alternative Social Assistance Disbursement on Drug-related Harm

Study Overview
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Brief Summary
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This study evaluates whether altering the timing and frequency of social assistance disbursement reduces drug related-harms that increase on the days surrounding monthly synchronized government social assistance cheque issue.

Detailed Description
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Coordinated monthly income assistance payments, while seeking to alleviate poverty, can also have negative and unintended impacts, particularly among people who use illicit drugs (PWUD). Observational research has identified escalations in drug-related harm coinciding with monthly assistance payments, such as overdose, treatment interruption, hospital admissions and public disorder. This project varies the timing and frequency of income assistance disbursement, and evaluates whether varying income assistance disbursement reduces drug-related harm coinciding with coordinated income assistance. Conducted among 273 PWUD, participants will be allocated for 6 income assistance cycles to a control or one of two intervention arms. Participants in the control arm will receive payments according to the existing monthly government schedule. Participants in the intervention arm will receive their income assistance: (1) monthly on a day different from government cheque issue; or (2) semi-monthly on days different from government cheque issue. The intervention will be evaluated using qualitative and quantitative methods for its impact on drug use and related harms.

Official Title
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The Impact of Alternative Social Assistance Disbursement on Drug-Related Harm: a Randomized Control Trial

Conditions
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Drug Use

Intervention / Treatment
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* Other: Non-synchronized social assistance receipt
* Other: cheque divided into two equal disbursements


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be ≥19 years of age or older reside in greater Vancouver, Canada report regular use of illicit drugs other than cannabis receive monthly provincial income assistance are not currently administered (where cheque issue/money is externally managed) be eligible and willing to be a client of the local credit union who will administer the intervention report intensified drug use around government cheque issue days provide written informed consent be willing to comply with study procedures Exclusion Criteria: plan to relocate outside Vancouver have plans to discontinue income assistance

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Treatment As Usual (TAU)<br>Receipt of social assistance on government cheque issue days for 6 income assistance cycles (approx 26 weeks). | |
| Experimental: Staggered Arm<br>Receipt of social assistance once monthly on a randomly assigned day that does not fall during the week of government cheque issue (Non-synchronized social assistance receipt), for 6 income assistance cycles (approx 26 weeks). | Other: Non-synchronized social assistance receipt<br>* Social assistance disbursement outside government cheque issue week<br>* Other names: Staggered;|
| Experimental: Staggered and Split Arm<br>Receipt of social assistance twice monthly on equally spaced randomly assigned days that do not fall during the week of government cheque issue (Non-synchronized social assistance receipt, cheque divided into two equal disbursements), for 6 income assistance cycles (approx 26 weeks). | Other: Non-synchronized social assistance receipt<br>* Social assistance disbursement outside government cheque issue week<br>* Other names: Staggered;Other: cheque divided into two equal disbursements<br>* Social assistance disbursement divided into two equal payments<br>* Other names: Split;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Illicit drug use on government cheque issue days | Timeline Follow Back (TLFB) assessed increase of drug use defined as an increase in the frequency of drug use of at least 40% or an increase in the number of drugs used during the 3 days beginning with government cheque issue day, compared to non-cheque issue days. | 26 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Illicit drug use on non-government cheque issue days | Timeline Follow Back (TLFB) assessed increase of drug use defined as an increase in the frequency of drug use of at least 40% or an increase in the number of drugs used during the 3 days beginning with individual cheque issue day (among intervention participants), compared to non-cheque issue days. | 26 weeks | 
| Hospital admissions on government cheque issue days | Emergency Department, Emergency Department Mental Health and substance use hospitalizations in the three days beginning with government cheque issue day compared to non-cheque issue days. | 26 weeks | 
| Overdose | Self-reported non-fatal overdose and hospital record verified fatal overdose on the three days beginning with government cheque issue day compared to non-cheque issue days. | 26 weeks | 
| Police service utilization | Self-reported and police record-verified interactions with police or use of police services on the three days beginning with government cheque issue day compared to non-cheque issue days. | 26 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Social Assistance, Drug Use, Drug-Related harm