For some time now, authorities have known that drug overdoses in Vancouver usually spike toward the end of each month.

That’s because the B.C. government distributes income assistance (welfare) on the third or fourth Wednesday of each month, researchers determined.

The solution should be easy enough: break up the date on which cheques are sent out in order to more-evenly distribute the associated rise in overdoses, authorities guessed. But a new study by the B.C. Centre on Substance Use (BCCSU) suggests the situation is not so simple, and that a one-size-fits-all approach could have unintended consequences.

“These complex findings signal the potential for the income assistance system to address the severe harm seen each month around payments,” Lindsey Richardson, a BCCSU scientist and the study’s principal investigator, said quoted in a media release. “However, changes must accommodate the complexity of people’s lives by allowing for choice in preferred schedule, providing flexibility to change as life circumstances change, and focusing on the autonomy and dignity of recipients.”

Researchers reviewed three options for how the government could distribute income-assistance cheques.

The first group followed the status quo. Participants received their entire benefit all at once and everyone received their money on the same day.

Members of the second group still received their entire monthly benefit all at once, but they were broken up into subgroups to receive those payments on different days of the month, so that not everyone received the money at the same time.

The third group of participants received their monthly benefits in two payments on two different days throughout each month. In addition, payments were staggered among subgroups so that not everyone received their cheque on the same dates.

Overall, researchers found that groups two and three were both less likely to increase their drug use upon receiving income-assistance cheques. And so the study suggests that changes to B.C.’s welfare system would help reduce overdose deaths. However, researchers also found that for some people, changing how they receive their cheques could cause them harm.

“Unexpectedly, in some analyses some risks were seen to increase,” the study reads.

Those risks included violence, negative police interactions, non-fatal overdoses, and health-care interruptions.

Sharon Buchanan is the manager of Pigeon Park Savings, a bank in the Downtown Eastside where many Vancouver residents receive their monthly welfare cheques. She’s quoted in a media release warning against reforms to the system that fail to take individual circumstances into account.

"We saw that staggering social assistance allowed some members to hit savings goals and monitor their finances more closely,” Buchanna said. “However, it presented unique challenges to others who felt intimidated by creditors if they were not able to service their debts because of the new payment schedule. It's clear there's a need to balance the nuances of different schedules while meeting the need for an individualized approach.”

The cheque-day study was conducted between 2015 and 2018, a period during which time overdose deaths skyrocketed across B.C.

According to the B.C. Coroners Service, there were 333 fatal overdoses in 2013. Five years later, in 2018, that number had increased to 1,514.

For the project, researchers consulted with welfare recipients who use drugs and included their feedback alongside the study’s findings.

Taken together, the data and opinions of drug users led researchers to recommend that the provincial government allow welfare recipients to have a say in how they receive their monthly cheques.

“Changing how and when people who use drugs receive their income assistance payments could reduce escalations in drug use around government cheque day, however, changes could also have unintended consequences that increase individual drug-related harm,” the BCCSU release concludes.

“Researchers are recommending the consideration of changes to the income assistance system that allow for individual choice about the timing and frequency of payments and avoid a one-size-fits-all approach.”

The BCCSU researchers’ findings will be presented at the University of British Columbia this week as part of the school’s 2019 “Congress of the Humanities and Social Sciences” (June 1 to 7). The session on welfare and overdoses is not open to the public but sessions on related topics can be found at UBC’s website for Congress 2019.