In the late 1990s, pharmaceutical companies made the move of declaring opioids to be non-addictive substances. The explosion in opioid prescriptions that resulted eventually led to the Department of Health and Human Services (HHS) calling the “opioid epidemic” a public health emergency in 2017. According to data collected by HHS from 2016 and 2017 , 11.4 million people misused prescription opioids and 2.1 million have an opioid use disorder.
The opioid crisis is not just a prescription problem, nor is it due to a massive increase in pain disorders. In part it’s rooted in social and economic tragedies leading to physical and psychological trauma, concentrated disadvantage, isolation, and hopelessness. Greater expectations for pain relief, increased musculoskeletal disorders, obesity, increased cancer survivorship and increased frequency of surgeries are also cited as causes for the rise in opioid use.
Opioid use can bring with it nutritional consequences, and nutritional interventions could potentially play a role in improving recovery from opioid addiction.
Dysfunctional eating habits and weight gain are commonly experienced during recovery from opioid addiction. In early recovery phases, food is often used as a substitute for drug use, to satisfy cravings, and dysfunctional eating habits may be involved, such as mood and binge eating. People recovering from addiction often choose high-fat and high-sugar foods to satisfy cravings. With its high satiety value, fat brings a sense of comfort, while sugar stimulates the same dopamine-driven reward pathways in the brain that many addictive substances activate. (There are reasons no one’s comfort food is broccoli or chicken breast.) Unfortunately, this macronutrient balance (particularly the high-sugar choices) promotes metabolic dysfunction, leading to various comorbidities.
Metabolic problems often coexist with opioid dependence and contribute to some of the nutritional problems experienced during recovery. Blood sugar dysregulation is among the most common problems. According to a systemic review of the nutritional burdens and deficiencies associated with opioid use, “fasting insulin levels were found to be four times higher in heroin addicts than in control subjects and insulin resistance stemming from opioid use may be coupled with beta cell dysfunction. Acute insulin response in heroin addicts were found 42% lower than control subjects, accompanied by an 80% lower glucose disappearance rate, when they were given intravenous glucose.”
Not only are eating disorders, obesity, and metabolic problems nutritional concerns related to opioid recovery, but nutrient deficiencies are prevalent. Opioid addicts often have calcium and magnesium deficiencies, which are factors in pain and nervous system/muscular disorders among those in recovery.
Zinc deficiency is also prevalent among opioid addicts, contributing to brain and nervous system dysfunction. Zinc is a critical player in synaptic plasticity, hormone release, and nerve impulse transmission. Zinc chloride has been used in recovery because it may reduce μ-opioid agonists’ binding to receptors and reduce the intensity of dependence. On the contrary, zinc chelators enhance the withdrawal manifestations.
Further, nutritional status has a profound influence on the success of detoxification and recovery programs. Reducing simple sugars while increasing consumption of antioxidant and nutrient-rich vegetables, fruits, and dietary protein has been shown to help manage the metabolic issues and nutritional deficiencies associated with opioid recovery. A high protein intake, providing an increased pool of amino acids, has been shown to be useful for improving the success of recovery by supporting liver detoxification.
Successful recovery from opioid addiction is critical not only to the health of affected individuals and their families but to public health as a whole. Good nutrition and targeted supplementation or repletion with specific nutrients can aid in the success of recovery. A high-protein, low-carbohydrate diet will provide substrates necessary for organ repair, while targeted nutrients such as calcium, magnesium and zinc can help in managing many of the unpleasant side effects that accompany withdrawal from opioid addiction, increasing the likelihood for a successful recovery.
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