Drug‐related harm coinciding with income assistance payments: results from a community‐based cohort of people who use drugs

Abstract

Income assistance is critical to the health and wellbeing of socio-economically marginalized people who use illicit drugs (PWUD). However, past literature paradoxically identifies unintended increases in drug-related harm coinciding with synchronized payments that may magnify signals for drug use. The scope of such harm has not been fully characterized among non-institutionalized populations. This study examined socio-demographic, health and drug use-related correlates of payment-coincident drug-related harm. This observational study uses data from prospective community-based longitudinal cohorts of PWUD between December 2013 and May 2018. Vancouver, British Columbia, Canada. A total of 1604 PWUD receiving monthly income assistance. Our sample included 586 (36.5%) women, 861 (53.7%) non-white participants and 685 (42.7%) people living with HIV. The primary outcome was a self-reported composite measure of drug-related harm in the past 6months coinciding with income assistance, including higher-frequency substance use, non-fatal overdose and service barriers or interruptions. Subanalyses disaggregated this outcome. Payment-coincident drug-related harm was reported among 77.7% of participants during the study period. In multivariable models, key correlates positively and significantly associated with payment-coincident harm included: street-based income generation [adjusted odds ratio (aOR)=1.48, 95% confidence interval (CI)=1.26-1.74, P<0.001], sex work (aOR=1.66, 95% CI=1.35-2.04, P<0.001), illegal income generation (aOR=1.57, 95% CI=1.35-1.83 P<0.001), homelessness (aOR=1.34, 95% CI=1.13-1.58, P<0.001), exposure to violence (aOR=1.31, 95% CI=1.03-1.66, P=0.032), daily crack cocaine use (aOR=1.99, 95% CI=1.59-2.50, P<0.001), heavy alcohol use (aOR=1.64, 95% CI=1.37-1.97, P<0.001) and injection drug use (aOR=2.55, 95% CI=2.01-3.23, P<0.001). In subanalyses, specific harms were more likely among individuals reporting social, structural and health vulnerabilities. In Vancouver, Canada, people who use illicit drugs who receive income assistance report high prevalence of payment-coincident drug-related harm, particularly people experiencing socioeconomic and structural marginalization or engaging in high-intensity drug use.