HOW ‘CHEQUE DAY’ IS LINKED TO DRUG OVERDOSE RISK
Staggered payments under consideration
Researchers in British Columbia are urging authorities to explore new ways to dispense welfare cheques, after concluding the current, once-a-month payments trigger more than 15 preventable drug-overdose deaths a year — in just one province.
The deaths are striking evidence of the so-called “cheque effect,” dangerous bingeing among drug abusers and alcoholics believed to occur after the monthly dump of social-assistance money, say the scientists’ new study.
They urge provinces to consider distributing smaller amounts more frequently, or staggering payments so not everyone gets paid at the same time.
“These are preventable deaths … what ends up being more than a death a day following each cheque issue,” said Michael Otterstatter, the B.C. Centre for Disease Control epidemiologist who spearheaded the research. “It would be warranted to look at methods … to try to reduce this avoidable mortality.”
Although his work in the International Journal of Drug Policy examined only illicit drug use, Otterstatter said it’s possible the same issue is exacerbating the current epidemic of Fentanyl abuse and death.
Meanwhile, a study released earlier this year by Toronto scientists suggests the phenomenon extends to other people who get paid once a month, and to alcohol as well as illicit-drug use.
One advocate for the poor said the issue is not the timing of welfare hand-outs, but their size, noting that single recipients in B.C. receive just $610 a month — when even a room in Vancouver’s depressed Downtown Eastside averages over $500 monthly.
Evidence indicates that improving income and housing quality tends to lessen rates of addiction and mental illness, said Trish Garner of the B.C. Poverty Reduction Coalition.
“You’ve been in a state of stress and survival and hunger and cold for the whole month and you get this (welfare payment),” added Garner. “I think anyone’s reaction would be to spend a little on what gives you enjoyment.”
B.C.’s Ministry of Social Development and Social Innovation said in an emailed response to questions that it will review the study, and is awaiting other research on the issue, too.
It notes that most provinces and the federal government also send assistance once a month on the same day, reflecting the need to pay rent and other monthly bills. It said it tries to ensure the money is used properly by, for instance, urging recipients to set up direct deposits into bank accounts, which “helps keep cash off the street.”
Regardless, researchers in Canada, the U.S. and elsewhere have for several years been citing evidence of the cheque phenomenon, including increased emergency-department visits, overdoses and mortality.
The theory is not just that individual drug abusers receive a small windfall, but that money flows into whole communities of users, said Otterstatter.
Still, past studies have tended to be less-than rigorous in establishing the link, he said.
Seeking more clarity, he and colleagues obtained data on illicit-drug overdose deaths — an unambiguous, “hard” event — and exactly when they happened from the provincial coroner’s office, then overlayed the dates of social-assistance payments.
The coroner’s data did not actually specify whether the victims were on welfare. But statistical analysis showed an unwavering trend over the 2009 to 2013 period studied: versus other weeks, there were nearly twice as many fatal overdoses on the Thursday and Friday after Wednesday cheque days.
“You see this chequeweek after cheque-week, month after month, year after year,” said Otterstatter. “The pattern is so consistent.”
Overall, 77 out of the 1,343 deaths — an average of 15 a year — appeared to occur because of the timing of payments, he said.
The Ontario study published in May looked at ambulance calls related to licensed establishments in the Toronto-area’s Peel region between 2005 and 2014.
It found four times as many drunkenness-related calls to a bar and almost three times as many assaults on the last day of the month — cheque day — or the next day, compared to the previous week.
Dr. Joel Ray, the internalmedicine specialist at St. Michael’s Hospital who led that research, cautioned that the new B.C. study could not definitively link the extra 77 deaths to welfare recipients.
But he agreed there is enough evidence of a cheque effect now that governments should consider changes.
“Most Canadians would argue that their investment in social assistance programs should be for the assistance of that individual’s well-being, rather than harming them,” said Ray. “And alcohol … and illicit drugs harm people.”