The connection between food and drugs is stronger than most people might think. Many negative health effects associated with the use of drugs have less to do with the drug itself, and more to do with lack of proper nutrition. For example, people dependent on opioids and alcohol have shown calcium and magnesium deficiencies due to poor diet, according to a 2014 study.

Because it takes extra effort from the body to metabolize certain drugs, heavy use—or withdrawal symptoms from stopping—can sometimes cause loss of appetite and anorexia, leading to a disruptive diet and nutrition imbalance. An overworked liver may have trouble absorbing some nutrients. This in turn increases the risks of infection and other health problems that don’t usually exist when a drug is taken under optimal nutritional conditions.

So when it comes to reducing harms from drugs, why isn’t nutrition a bigger part of the conversation?

Christiana Miewald, an adjunct professor at Simon Fraser University’s geography department, has a strong interest in this connection. In 2017, she co-authored a paper titled “Food as Harm Reduction” in the Journal of Critical Public Health, which explored the barriers to food access some drug users have in low-income communities in Vancouver, Canada.

Her team went to the Downtown Eastside, interviewed 42 people who currently or formerly used drugs, and asked them how their drug use impacted when, what and how they ate. They also spoke to 35 staff members at 27 programs that provide harm reduction services in the area.

It’s not very helpful to receive donated canned goods or fresh vegetables if you have nowhere to cook them.

They discovered several unique challenges for nutrition access in their community. Drugs can directly and indirectly impact nutrition, and improving that relationship, they wrote, “[S]hould be viewed as central to public health and harm reduction and should, therefore, be supported by the state, rather than left to ad hoc charitable providers.”

“There’s sort of this contradiction that we came across: There are a lot of food programs in Vancouver for people who are low-income, but at the same time, they also experience high levels of food insecurity,” Miewald told Filter in a call. “It ran the gamut of everything from the effects of actual drug use to the larger structural issues that some of the people that we were talking to experience on a daily basis.”

Those structural issues include income inequality and access to housing. While most of the people Miewald’s team spoke to weren’t homeless, many lived in small, single-occupancy rooms, such as hotels, without much in the way of kitchens. It’s not very helpful to receive donated canned goods or fresh vegetables if you have nowhere to cook them. For many people in this position, fast food or convenience store food is simply more accessible.

Food insecurity, or inconsistent access to food, affects more than 2 billion people globally—a number that has been rising since 2015—including approximately 40 million Americans and a similar proportion of one in eight households in Canada.

Why Harm Reduction Isn’t Centering Food

Many programs do exist to fill this gap, yet they often aren’t catered toward a demographic that uses drugs—requiring sobriety to eat at a soup kitchen, for example—while services that are focused on helping people who use drugs often ignore nutrition as a way to reduce harms.

“If we’re talking about harm reduction, then nutrition should be part of that. It’s not just about needles, it’s about a lot of other things.”

That isn’t to say that harm reduction operations, such as syringe access programs or overdose prevention sites, aren’t aware of their clients’ need to eat—it’s just that many of them don’t explicitly address nutrition as a way to offset negative drug effects.

“Even though a lot of the [harm reduction] organizations were providing food at various levels, when we asked them how does harm reduction link in with nutrition, that was like the first time they had really thought about that,” Miewald said. “There wasn’t really a philosophy. It was just more of, ‘We have people here, they’re hungry.’ But if we’re talking about harm reduction, then nutrition should be part of that … It’s not just about needles, it’s about a lot of other things.”

A 2011 report in Addiction agreed on what researchers at Oxford Brookes University called “an under-researched and frequently overlooked issue.” They challenged service providers to reconsider how they might assist heroin users more effectively with their eating practices, writing, “nutritional interventions should be part of the package of services comprising good holistic care.”

Like many issues, this problem comes down significantly to funding. Harm reduction programs often just aren’t financially equipped to be directly concerned with nutritional health. What’s more, the Canadian government doesn’t provide food stamps like in the US.

“If they’re on social assistance, they’re given a check, but that is supposed to cover everything. There’s no specific allocation for food,” Miewald says. “Food provision is really sort of devolved down to individual organizations … Relying on donations is very hard for these organizations. They’re constantly applying for grants or having to shift money around. It just puts additional burdens on them.”

That puts the duty of eating well on people who use drugs themselves, which can be difficult for those who may be struggling with an addiction that takes up their time and concentration.

How People Who Use Drugs Can Take Control

Nonetheless, lack of access doesn’t equal lack of desire. People who use drugs know that the benefits of food security can be profound.

“If you don’t have to worry about where your next meal is coming from, you actually reduce anxiety,” Miewald says. “One interesting thing that we really found is that a lot of the people who had been using drugs for decades, a lot of them in their 40s and 50s, had actually learned how to manage their nutrition, had sort of internalized these messages about getting proper nutrition.”

“They had learned to try to eat, even if maybe they weren’t hungry,” Miewald goes on. “Or you know, go get a meal or a smoothie, even if it was just Gatorade or something like that, to keep up their vitamins or make sure they didn’t become dehydrated or malnourished.”

“As a person who is living with hepatitis C, I noticed a huge change in the inflammation and how I felt.”

Ria Tsinas, a Portland, Oregon harm reduction worker who has herself struggled with drugs, knows the importance of nutrition first hand. When she worked as a residential counselor at an emergency service center in downtown Seattle, she noticed that people’s diets were generally terrible and that most of the foods being offered were cheap starches and fats. At one point, she began taking her own diet more seriously—mostly eating roasted beets, sweet potatoes, kale and salmon—and found some unexpected positive changes.

“As a person who is living with hepatitis C, I noticed a huge change in the inflammation and how I felt,” Tsinas told Filter. “But also, in my viral metabolic panel, my counts were actually decreased because I was inadvertently eating a lot of foods that were really good for your liver.”

Tsinas later took a college nutrition class where she designed a diet for people who are using drugs that, critically, was accessible for people without access to a full kitchen. She argues that food can function as an intervention—but it’s not a method many are using.

“I started looking around and I noticed that there wasn’t really a lot of anything published about this, which I was really surprised about because it seems like such a no-brainer intervention,” she said. But Tsinas was able to pull data from general sources about food deficiencies—including some from scholarly sources and some from for-profit recovery centers—and she plugged this into the US Department of Agriculture’s Dietary Reference Intakes calculator.

The diet she designed called for, among other things, five servings each of fruits and vegetables, especially those high in things like omega-3s, protein and calcium—as well as recommended foods to reduce sugar cravings, because sugar can greatly damage teeth in people who use stimulants.

In her research, Tsinas found meal plans that can make withdrawals less extreme or stabilize blood sugar or regulate mood. For example, if you’re experiencing cramping, it may be due to a lack of potassium, so it can help to eat a banana, or electrolytes that don’t come from sugary energy drinks.

“There were a few holes, but for the most part it did what it was supposed to do,” Tsinas said of her diet, which Filter has published, with her permission. “Somebody can make it better, I’m sure. I would just love for somebody to use it or at least start having a conversation about how food is medicine, and it is a really important pragmatic tool in our toolkit of harm reduction.”

Obstacles and Food Empowerment

In the US, however, the idea of giving food to people who use drugs is often met with scorn. In some cases, people who sign up for food stamps are actually tested for drugs before they’re allowed to receive benefits. These demands are typically sold on the premise of somehow saving the state money, but invariably cost millions more to enforce, not reducing expenses whatsoever. They also rarely catch anyone engaging in illicit drug use. Last month, Maine repealed its urine analysis requirement for food assistance after it only detected 10 people in three years.

Being Canadian, Miewald is shocked by this idea, and says it will only put greater burdens on charitable food programs and the healthcare system. “Nutrition is part of health. It’s not a luxury,” she said. Decreasing nutrition “actually increases health costs potentially down the line. You are not saving any money by doing something like that—it’s crazy.”

“Food is one way of really harnessing control over your own situation … one last act of resistance is what you put in your body.”

Even with funding, offering healthy food options to populations that use drugs can be challenging. Some people may be reluctant to change their diets. But ultimately, Tsinas said, the people receiving the service should be the ones dictating what’s offered.

And like many aspects of harm reduction, that means providing accurate health information and meeting people where they are. Sack lunches and mobile smoothie carts have proven effective in Canada.

Tsinas also suggests providing perinatal vitamins for pregnant people, while feedback in Miewald’s research suggests that food providers who cater only to women can provide a much-needed safe space, especially for sex workers.

Ultimately, focusing on nutritional health can be an effective way to empower people who use drugs. “Food is one way of really harnessing control over your own situation,” Tsinas said. “It’s very personal, but one last act of resistance is what you put in your body.”

Photo by Vitalii Pavlyshynets on Unsplash