'Cheque day' linked to drug overdose risk in B.C.: study

Registered nurse Sammy Mullally holds a tray of supplies to be used by a drug addict at the Insite safe injection clinic in Vancouver on May 11, 2011. (Darryl Dyck / THE CANADIAN PRESS)

Injection drug users are much more likely to overdose around the day government assistance cheques are issued in British Columbia, according to new research published in the International Journal of Drug Policy.

After studying drug use and overdose data collected at Insite, Vancouver Coastal Health’s safe injection site, researchers at the BC Centre for Excellence in HIV/AIDS found that more than twice as many overdoses occurred on or immediately after “cheque day.” In B.C., income assistance cheques are typically issued on the last Wednesday of each month.

Thomas Kerr, the senior author of the study, said the findings show a need to rethink the way assistance money is distributed.

“There is a clear pattern of elevated risk of drug overdose around cheque-issue day,” Kerr, the director of the centre’s Urban Health Research Institute, said in a statement.

“Given the impacts for individual health and related social consequences, many of which may be related to most people receiving their payments at the same time, there is a strong justification for exploring alternative approaches to how income assistance is delivered in B.C.”

The study found the overdose increase doesn’t come from a higher frequency of injections. Although the overdose rate increases by more than 100 per cent around cheque day, the average number of injections jumps only about six per cent to 513 per day, up from 483 on other days.

“What we take that to mean is that people who are injecting on or around cheque issuing day might be engaging in higher-risk drug use,” Lindsey Richardson, a researcher involved in the study, told CTVNews.ca in a phone interview.

Richardson said higher risk could come from increased dosage or using more than one type of drug at once. She said the risk increase could also be related a decreased tolerance for the drug due to the way users schedule their finances.

“As their money begins to run out, they might use less and less,” she said. “So if you combine that higher risk drug use with lower tolerance, you’re likely to see higher levels of drug overdose.”

Although Insite hasn’t had any drug overdose deaths since opening in 2003, responding to overdose situations can still be costly in terms of health and police services, said Richardson, who is also an assistant professor of sociology at the University of British Columbia.

The group will be conducting follow-up research to determine whether changing the cheque distribution schedule reduces the frequency of overdoses. The study will be voluntary, testing to see if those who agree to have their government assistance money staggered report a lower overall risk of overdose.

“What we are expecting is that it will decrease both levels of drug use, and disperse drug related harm over the month,” said Richardson.

“Our goal in doing this type of research is to try and identify things that harm and things that can promote the health of people who use drugs,” she said.

“Hopefully we can identify solutions that work both the individuals directly affected and the broader community.”