Not a day goes by that you don’t hear about death or overdose related to opioids.

According to the CDC, “In 2016, more than 64,000 people died from drug overdoses in the U.S., the most of any year on record and a 19% increase from 2015. More than half of these were opioid-related, with especially large increases in deaths from heroin and illicit fentanyl.” On average, 90 people are killed daily in the US in deaths related to opioids. Opioids also strain the foster system, increase the risk of hepatitis and HIV related to needle use, and reduce life expectancy in the US (1).

Experts from the John Hopkins Bloomberg School of Public Health and Clinton Health Initiative advise evidence-based strategies to combat the opioid crisis from health care, advocacy, non-profit, government, academic, and business environments. Leaders in pain treatment, pharmacy benefits, health policy, law enforcement, and insurance were among the stakeholders gathered to issue a special report on the opioid crisis. The report, which was presented at a summit on October 30th, 2018, contains ten specific recommendations on ways to fight the opioid epidemic (1).

The opioid crisis (as well as other substance abuse crises) presents a unique intervention opportunity for dietitians.

Nutrition and hydration are necessary to aid in healing during substance abuse recovery, as they improve mental and physical well-being and increase the likelihood of recovery. Deficiencies in macro and micronutrients may lead to poor energy, anxiety, and symptoms of depression, which could increase the chance of drug or alcohol relapse. Individuals abusing drugs are often malnourished since stimulant drugs may reduce appetite and intake while other drugs may impair digestion, absorption, and transport of nutrients (2).

Those suffering from opioid or other addictions are often malnourished due to not eating enough, lacking finances to purchase and prepare nutritious foods, and/or choosing foods that are low in nutritional value. Poor eating behaviors may also be due to limited nutrition knowledge and education (2). Opiate addicts have been found to suffer calcium and magnesium deficits related to poor diet, and addicts generally eat less than the recommended servings of fruits, vegetables, and grains. During heroin withdrawal, weight gain can occur due to a higher intake of sweets and other “comfort foods,” which may provide similar dopamine responses in the brain. High-sugar foods should be limited as high sugar intake may lead to relapse. Carbohydrate metabolism may be altered during opiate withdrawal as well, and therefore higher protein intake is advised (3).

Another point to consider is the use of caffeine during recovery. When I was a clinical dietitian at the VA Medical Center, patients were not permitted caffeinated beverages, since caffeine could make a recovery more difficult by disrupting sleep or increasing anxiety. Caffeine is a drug that affects the central nervous system, and it can also be abused and cause withdrawal symptoms when taken away. Ironically, most AA meetings will have a full pot of coffee waiting when you arrive (4).

For dietitians working with those in recovery, here are seven steps to consider:

1. Perform a complete nutrition assessment to evaluate for nutrient deficiencies, weight changes, and/or eating disorders.

2. Help your clients maintain hydration during episodes of nausea, vomiting, or diarrhea related to withdrawal. Encourage water, juice, or milk instead of soda, sugary drinks, or caffeinated beverages.

3. Provide nutrient-dense, but palatable food during treatment, such as seasoned vegetables, fresh fruit, and whole grains.

4. Promote intake of high-calcium foods, such as low-fat cheese, cottage cheese, milk, and Greek yogurt.

5. Encourage B12, iron, and folate sources, such as lean meat, eggs, lentils, beans, and leafy greens.

6. Promote regular meal and snack times to prevent highs and lows in blood sugar.

7. Limit highly processed/high-sugar treats to aid blood sugar maintenance and weight management.

By Lisa Andrews, MEd, RD, LD

References:

1. www.newswise.com/articles/view/684090/?sc=rsla

2. Sepideh NABIPOUR,1 Mas AYU SAID,*,1 and Mohd HUSSAIN HABIL2 Burden and Nutritional Deficiencies in Opiate Addiction- Systematic Review Article. Iran J Public Health. 2014 Aug; 43(8): 1022–1032.

3. https://news.usc.edu/110112/nutritional-guidance-often-missing-from-substance-abuse-treatment/

4. https://health.usnews.com/wellness/food/articles/2017-01-09/whats-the-best-diet-for-newly-sober-alcoholics-and-addicts