title: Protocol of the impact of alternative social assistance disbursement on drug-related harm (TASA) study: a randomized controlled trial to evaluate changes to payment timing and frequency among people who use illicit drugs.
abstract: Government social assistance payments seek to alleviate poverty and address survival needs, but their monthly disbursement may cue increases in illicit drug use. This cue may be magnified when assistance is disbursed simultaneously across the population. Synchronized payments have been linked to escalations in drug use and unintended but severe drug-related harms, including overdose, as well as spikes in demand for health, social, financial and police services.
  
  
  
  The TASA study examines whether changing payment timing and frequency can mitigate drug-related harm associated with synchronized social assistance disbursement. The study is a parallel arm multi-group randomized controlled trial in which 273 participants are randomly allocated for six assistance cycles to a control or one of two intervention arms on a 1:1:1 basis. Intervention arm participants receive their payments: (1) monthly; or (2) semi-monthly, in each case on days that are not during the week when cheques are normally issued. The study partners with a community-based credit union that has developed a system to vary social assistance payment timing. The primary outcome is a 40 % increase in drug use during the 3 days beginning with cheque issue day compared to other days of the month. Bi-weekly follow-up interviews collect participant information on this and secondary outcomes of interest, including drug-related harm (e.g. non-fatal overdose), exposure to violence and health service utilization. Self-reported data will be supplemented with participant information from health, financial, police and government administrative databases. A longitudinal, nested, qualitative parallel process evaluation explores participant experiences, and a cost-effectiveness evaluation of different disbursement scenarios will be undertaken. Outcomes will be compared between control and intervention arms to identify the impacts of alternative disbursement schedules on drug-related harm resulting from synchronized income assistance.
  
  
  
  This structural RCT benefits from strong community partnerships, highly detailed outcome measurement, robust methods of randomization and data triangulation with third party administrative databases. The study will provide evidence regarding the potential importance of social assistance program design as a lever to support population health outcomes and service provision for populations with a high prevalence of substance use.
  
  
  
  NCT02457949 Registered 13 May 2015.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada.
authors.forename: Lindsey
authors.identifier: 0000-0001-6376-8891
authors.initials: L
authors.lastname: Richardson
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Laing
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 1Y6, BC, Canada.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; PHS Community Services Society, 20 Hastings Street W, Vancouver V6B 1G6, BC, Canada.
authors.forename: Russ
authors.initials: R
authors.lastname: Maynard
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A1S6, BC, Canada.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Nosyk
authors.affiliation: Department of Epidemiology, School of Public Health, Brown University, 121 South Main Street, Providence 02912, RI, USA.
authors.forename: Brandon
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 910 West 10th Ave, Vancouver V5Z 1 M9, BC, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.affiliation: Vancouver Coastal Health, 601 West Broadway, Vancouver V5Z 4C2, BC, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Daly
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada; Faculty of Medicine, Division of AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 1Y6, BC, Canada.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada.
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver V6Z 7Y6, BC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001955:British Columbia; D016527:Drug Costs; D004335:Drug and Narcotic Control / Q000191:economics; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000600:supply & distribution*; D008297:Male; D011632:Public Assistance; D019966:Substance-Related Disorders / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D055815:Young Adult
chemical_list: D013287:Illicit Drugs
keywords: Drug use; Drug-related harm; Social assistance; Structural intervention