Lindsey Richardson

Socioeconomic factors are increasingly recognized as important contributors to overdose risk (Dasgupta et al., 2018). Socioeconomic disadvantage results from systemic processes wherein a person or ...

Introduction: Due to high‐penalty lending practices, short‐term, small‐dollar payday loans can trap borrowers in cycles of debt and reinforce socioeconomic disadvantage. People with lived and living experience of substance use (PWLLE) who often contend with financial and labour market exclusion and have relatively inflexible cash flow needs may be particularly susceptible. Nevertheless, the use of payday loans among PWLLE is not well understood. Methods: Using cross‐sectional data extracted from two longitudinal cohorts of PWLLE in Vancouver, Canada, this exploratory study characterises prevalence and correlates of payday loan use. Logistic regression models explore financial, structural, and substance use dimensions of potential relevance to payday loan use. Results: Between December 2017 and June 2018, 318 (29%) of 1082 participants reported obtaining at least one payday loan within the previous six months. In multivariable analysis, engagement in employment, including full‐time, part‐time, casual, temporary or self‐employment, was associated with lower odds of payday loan use (adjusted odds ratio [AOR] = 0.65, 95% confidence interval [CI] 0.48–0.89). Conversely, average daily expenditure exceeding $50 on drug purchases (AOR = 1.41, 95% CI 1.02–1.94), and heavy alcohol use (AOR = 1.52, 95% CI 1.04–2.21) were associated with increased likelihood of payday loan use. Discussion and Conclusions: Our findings add to understandings of how income generation and higher‐intensity alcohol and drug use may shape use of high‐penalty short‐term loans, with implications for social service provision. Findings emphasise the potential role that employment programs and alternative approaches to bridging intermittent financial hardship could play in reducing socioeconomic precarity among PWLLE.

Employment is a social determinant of health, yet people who use drugs (PWUD) often face barriers to employment. To meet their financial needs, some engage in alternate income-generating activities (e.g., sex work, recycling, drug selling) that expose them to social and health-related harm. Drawing from two cohorts of community-recruited PWUD in Vancouver, Canada (n=2366, 2006–2023), we used generalized estimating equations to characterize gendered patterns of income generation among men (n=1501, 63.4%) and women (n=865, 36.6%). Employment and income assistance were similarly patterned across genders and associated with fewer structural harms (e.g., criminalization), while drug selling and illegal activities were associated with elevated risks of harms, including incarceration and violence. Gendered differences emerged in street-based and sex work—activities often segregated by gender—revealing distinct social and structural exposures. These findings emphasize the need for income generation supports that address the specific needs and social locations of PWUD.

Introduction The Road to Recovery (R2R) Initiative is an innovative model of substance use care that seeks to increase treatment capacity by creating approximately 100 new addiction treatment beds to provide on-demand addiction care in Vancouver, British Columbia, for patients with substance use disorders. The new model also coordinates the region’s existing clinical substance use services to support patients across a care continuum that includes traditional office-based addiction treatment and harm reduction services, early withdrawal management and more intensive abstinence-based treatment programming. To understand the impact of offering on-demand and coordinated substance use care, an observational cohort of individuals who access any R2R clinical service will be created to examine health and social outcomes over time. Methods and analysis This prospective mixed-methods study will invite individuals from Vancouver, Canada, who access substance use treatment through the R2R model of care to (1) complete a baseline and 12-month follow-up quantitative questionnaire that solicits sociodemographic, substance use and previous addiction treatment data and (2) provide consent to the use of participants’ personal identifiers to access health records for chart review and for annual linkage to select health and administrative databases to allow for ongoing (virtual) community follow-up over 5 years. Additionally, a purposive sample of cohort participants will be invited to participate in baseline and 12-month follow-up qualitative interviews to share their experiences accessing R2R and identify challenges and opportunities associated with the implementation of R2R. Ethics and dissemination The study was approved by the University of British Columbia Providence Health Care Research Ethics Board in September 2023. Results from the proposed study will be published in peer-reviewed journals, presented at national and international scientific conferences and disseminated through regular meetings with policymakers, individuals with lived and living experience, and other high-level stakeholders, academic presentations and lay media.

Despite mitigating severe impacts of poverty, synchronized, monthly government income assistance payments can negatively impact people who use drugs, including disrupting service utilization. This study evaluates whether changing payment timing and frequency impacts health and social service access. This secondary analysis of an exploratory, parallel, unblinded, randomized controlled trial assessed data collected between 2015-2019 from income assistance recipients who use drugs in British Columbia, Canada (n=194). Participants were randomly assigned for six monthly payment cycles to: (a) synchronized government schedules (control); (b) desynchronized "staggered" single monthly payments; or (c) desynchronized "split & staggered" twice-monthly payments. Generalized linear mixed models assessed utilization of, and barriers to, acute/emergency healthcare, community healthcare, psychosocial services and material/legal services. Mixed results showed increases in access to psychosocial services and material/legal services, but also increases in the barriers to community healthcare and material/legal services. Changing payment schedules may alter access to services in complex ways implicating practice, organizational and interagency adaptations for marginalized populations. Results support the importance of social service agency involvement in income assistance policy reform discussions to ensure effective service delivery. Further research should include perspectives from service providers and utilize agency administration data to better understand payment schedules and service provision dynamics.

Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs.