Pubdate: Mon, 05 Sep 2016
Source: Globe and Mail (Canada)
Copyright: 2016 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Lindsey Richardson
Page: S1

THE DOWNSIDES AND DANGERS OF 'CHEQUE DAY'

On Thursday, Aug. 25, the day after provincial income-assistance
recipients received their support payments, the sirens started:
Ambulance, police and fire engines throughout Vancouver were
responding to a spike in accidental drug overdoses. Although media
reports on overdoses have rightfully focused on the toll caused by
fentanyl, a new and more powerful opioid, that particular Thursday is
not unique.

Sirens are heard throughout Vancouver every month on the days after
"cheque day," and are part of a long-standing monthly ritual that
locals also refer to as "Welfare Wednesday" or "Mardi Gras." Drug
dealers collect outstanding debts. The hashtag #WelfareWednesday is
used to advertise drink specials. Community workers hand out fruit to
people standing in line at the bank. Thanks to quick action by first
responders, family members and health providers, almost all overdoses
do not result in death. Some, devastatingly, do.

Amidst what has now been declared an overdose epidemic and
public-health emergency, recent research conducted at the B.C. Centre
for Disease Control documented a 40-per-cent increase in fatal
overdoses on the days following assistance payments. Insite's
subsequent decision to open its doors 24 hours a day around cheque day
- - and its exceptional capacity to prevent accidental overdoses from
becoming lethal - will hopefully do something to stem the tide of
completely preventable deaths that occur at this time every month. No
one has ever died of an overdose at Insite.

However, overdose increases around cheque day do not just occur in
Vancouver. They have been documented across the province, across the
country and around the world. Insite's commendable efforts will do
little to help someone in Surrey, Prince George or Thunder Bay.

While fatal overdose is the worst of the drug-related harms that spike
around cheque day, it is not the only one. A growing list of studies
document increases in everything from people leaving hospital against
the advice of their doctors and clients being unable to access
services that are either closed or have lineups out the door, to
police being called in to assist in the ER and street-level violence.
These are things Insite cannot fix.

The rise in drug use and drug-related harm around cheque day is an
example of a logical administrative decision that has unintended yet
severe health, social and economic consequences. Yet most
jurisdictions in Canada and the United States deliver
social-assistance payments in the same way: once a month, on the same
day for everyone.

Academics, health-care practitioners and others have been calling for
the system to be changed. It seems like an intuitive next step. But is
it really that simple? The existing system already demonstrates how
what might seem like a straightforward approach might not be upon
closer examination.

Our researchers at the B.C. Centre for Excellence in HIV/ AIDS are
trying to find out whether there may be a better way. In October,
2015, we initiated an experimental study in the Downtown Eastside
testing whether not paying study volunteers at the same time each
month can do anything to reduce drug use and drug-related harms. We
are examining what happens when people get paid at a different time
than everybody else. We are also looking at what happens when they are
paid - like most people in regular jobs - twice a month instead of
monthly.

And while there are already ways to vary payment frequency in the
province (for example, "mid-month" split payments administered by the
Ministry of Social Development and Social Innovation), such setups are
often mandatory conditions resulting from some previous transgression.
Further, their impacts have not been evaluated. There is a serious
need for research evidence that examines potential health and social
policy solutions, not just health and social problems.

It is clear there are alternatives to the "once a month, all at the
same time" approach to income-assistance payments. When the study is
over, we hope we will have some sense of whether a change at the
policy level - and finding a way to give people some choice in the
matter - can help quiet the monthly chorus of sirens and keep people
alive.

Lindsey Richardson is an assistant professor of sociology at the 
University of British Columbia and a research scientist at the B.C. 
Centre for Excellence in HIV/AIDS. She is also the lead investigator of 
the TASA Cheque Day study examining whether changing the frequency and 
timing of income-assistance payments can reduce drug use and related harm.
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MAP posted-by: Matt