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Dan Stadt, centre, at a safe injection site that he and advocate Ann Livingston, right, setup in the Downtown Eastside.

DARRYL DYCK/The Globe and Mail

The average number of people who died of drug overdoses in B.C. over the past five years was 40 per cent higher during weeks when social-assistance payments were distributed than during the rest of the month, according to a study published in the International Journal of Drug Policy.

Additionally, an estimated 77 avoidable deaths over the five-year period can be attributed to the timing of income-assistance cheques, the study concluded – underscoring a phenomenon that has led public-health advocates to push for the system to be changed.

That study, published in July, adds to a growing body of research that links the timing of social assistance payments to drug overdose deaths and other effects, including emergency room visits. And as service providers, police and hospitals brace for a potential surge in overdoses on what is commonly referred to as "welfare Wednesday," researchers are investigating whether changing how social assistance is handed out could save lives.

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Read more: Police move to treat fentanyl overdoses as homicides

Read more: How a B.C. couple's struggle with addiction ended in deadly fentanyl overdoses

Read more: A rescue mission on the Downtown Eastside: Meet the firefighters battling B.C.'s fentanyl crisis

"There is sort of a laundry list of harms that spike around cheque day," says Lindsey Richardson, one of the authors of the July study and a research scientist with the B.C. Centre for Excellence in HIV/AIDS.

As a follow-up to that study, Dr. Richardson is now working on a project to help determine whether harms associated with "cheque day" – including police service calls, emergency room visits and overdose deaths – can be reduced by changing payment schedules to other days of the month or every two weeks.

"Rather than document more harm – we know that's happening, we know it's a problem – I wanted to see if we could do some research that supported a more solutions-oriented perspective," Dr. Richardson said on Wednesday.

That study – the impact of Alternative Social Assistance disbursement of drug-related harm, or TASA – got under way last year. Participants are volunteers who are on social assistance and are split into groups: a control group that will get their cheques on government-issue days and two intervention groups that will receive their cheques on a different day or in portions.

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According to a briefing note provided by the researchers, "provisions are being undertaken to ensure that research participants' housing stability is not jeopardized by changes in their social assistance schedule and that they are able to withdraw from the study at any point without penalty."

Preliminary results are expected in late 2018.

Michelle Stilwell, Minister of Social Development and Social Innovation, was not available for an interview.

But an e-mailed statement provided by her office noted that many people on social assistance opt to have the rental portion of their cheques go directly to their landlord. In Vancouver's Downtown Eastside, 76 per cent of people on social assistance use that option.

Cheque-issue dates "reflect the need to pay rent and monthly bills" and monthly issue dates are also common in other provinces and for federal programs such as Canada Pension Plan and Old Age Security, the statement said.

Having said that, "the ministry is always looking at ways to improve the services we provide to ensure that our clients are getting the support they need in the best way possible," the statement said, adding that the ministry is also waiting for conclusion of other research.

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Along with the TASA study, researchers at Simon Fraser University are reviewing emergency department admissions at two Lower Mainland hospitals over an eight-year period to better understand the "cheque effect."

B.C. declared a public health emergency this past April in response to a surge in overdoses and overdose deaths. This week, the Vancouver Police Department said carfentanil, an opioid believed to be 100 times more toxic than fentanyl, was detected in drugs seized in September and subsequently tested by Health Canada.

In the Downtown Eastside, activists have set up unsanctioned injection sites in an effort to help people at risk of overdosing.

The TASA study should help determine whether changing payment schedules would make a difference to overdose statistics, said Dr. Bonnie Henry of the B.C. Centre for Disease Control.

"The challenge is, that there are often unintended consequences if you change things – and we may not know about them," added Dr. Henry. "This is a way of trying to get a handle on whether there are other impacts of changing cheque day."

Dr. Richardson, meanwhile, worries when the end of the month comes around.

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"Every month it is in the back of my mind," Dr. Richardson said. "I hope there is a way to do this that is less harmful, and every day that is a cheque day, I think of what we could be avoiding."

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