The use of illicit drugs is initially about entering an elevated state of joy, relief and power that not is accessible in other ways. Unfortunately, drug abuse also has various unintended and undesirable consequences, including withdrawal symptoms, hyperactivity, impulsivity, compulsion and loss of control with consequential relapse. Furthermore, it often leads to degrading activities such as prostitution and criminal conduct, increased susceptibility to acute and chronic infections, drug overdoses and unhealthy relationships with food, family and friends.
This cross-sectional study targeted illicit drug addicts living on the fringes of our affluent society, and aimed to explore dietary habits and nutritional status through the assessment of dietary, anthropometric and biochemical measurements. A semistructured interview covered drug habits, socio-demographic factors and living conditions assumed to influence food accessibility and infectious status. Recruitment, inclusion and examination took place at the same time at 23 different locations in Oslo. Data were collected all week days both during night and day.
The 195 respondents were regular poly drug addicts, and 87 percent of them injected the drugs. All were under the influence of illicit drugs at the time of examination, and women made up 37 percent of the total sample. All respondents were at least 18 years of age, with a mean age of about 35 years. The educational level was generally low, and social security benefits and disability pension were the most frequent sources of income. Further, most of the addicts were homeless, and all reported smoking tobacco.
Limited access to food was reported by 64 percent of the addicts, and related to heavier involvement in drug abuse, drug dealing, unstable housing, low intakes of energy and being underweight. Contentment with access to food related to receiving a disability pension, smoking hashish, recent involvement in treatment or rehabilitation, receiving additional food from providers, family and friends, cooking activity and number of eating events.
Approximately 40 percent of the drug addicts never prepared a hot meal, even though 85 percent reported access to cooking facilities and 80 percent to a refrigerator. Whereas male addicts had 2.6 (SD 1.4) daily eating events on average, the figure for females was 2.7 (SD 1.6). Men reported having dinner more frequently, while women reported a higher number of snack meals. Most meals eaten during the previous 24 hours consisted of sandwiches and snacks, which accounted for more than half of energy intake. Daily food intake varied from nothing to huge amounts – only 38 percent of the male addicts and 20 percent of the females had a homeostatic intake. The diet was quantitatively and qualitatively inadequate, and nutrient density was below that of the average Norwegian diet. Food choice was monotonous and easily chewable food items with high contents of added sugar (30 E %) were a major dietary component. Sugar-sweetened soft drinks were consumed most often. The intakes of whole grain flour, edible fats, fruit, vegetables and fish were very low.
The number of eating events associated positively with BMI, as did the number of days institutionalised (??14) in the previous 12 months, while sleeping rough had a negative association. Few respondents achieved the recommended intakes (RI) of most of the essential macro- and micro-nutrients, and between 70 percent and 100 percent of the respondents had lower intakes of the vitamins A, B1, C, D, and E, and lower intakes of selenium and iron than recommended.
Anthropometric and biochemical measurements supported the finding of poor dietary intakes. Underweight (BMI??18.5) was found in 27 percent of the women and 3 percent of the men. The high frequency of outlier values in the biochemical parameters, indicated that malnutrition and metabolic disturbances were prevalent and varied from 0–100 percent. Between 67 percent and 100 percent of the respondents did not meet the vitamin D3 and B6 reference values. Between 12 percent and 26 percent of the respondents had haemoglobin levels that fell below the reference values, while low serum-ferritin (SF) values were found in 5 percent of the men and 19 percent of the women. This indicated that iron intakes were probably sub-optimal, particularly among the women.
It is likely that the female addicts were most exposed to poor dietary intakes, heavy drug abuse and infections. In total, 90 percent of the addicts suffered from virus hepatitis infections. No association was detected between these infections and nutritional status, presumably due to the high frequency of infections. However, abscess infections, which were reported by 33 percent of the women and 19 percent of the men, were related to poorer nutritional status. Eighty per cent of respondents, who used heroin on a regular basis, reported more infections and had a further reduced nutritional status than the drug addicts who did not use heroin regularly. All but two (98 percent) injected the heroin, while 42 percent injected of those using other drugs but heroin on a regular basis.
Today, it is accepted that drug addiction is a disease due to the physical changes that occur in areas of the brain critical to judgment, decision-making, behaviour control and learning and memory. This must be kept in mind when considering problems linked to the assessment of illicit drug users’ dietary habits and nutritional status, and measures to improve these conditions. If the target for the nutritional status of drug users is to reach the average Norwegian level, dietary interventions have to be tailored to fit addicts’ particular needs, with a focus on food accessibility and the sensory and nutritional quality of the diets.
List of papers. Papers III and IV are removed from the thesis due to publisher restrictions.
Paper I Saeland Mone, Haugen Margaretha, Eriksen Frank-Leo, Smehaugen Anne, Wandel Margareta, Böhmer Thomas and Oshaug Arne (2009). Living as a drug addict in Oslo, Norway – a study focusing on nutrition and health. Public Health Nutr 12, 630-636. doi:10.1017/S1368980008002553 Copyright The Authors 2008.
Paper II Saeland Mone, Haugen Margaretha, Eriksen Frank-Leo, Wandel Margareta, Smehaugen Anne, Böhmer Thomas and Oshaug Arne (2011). High sugar consumption and poor nutrient intake among drug addicts in Oslo, Norway. Br J Nutr 105, 618-624. doi:10.1017/S0007114510003971 Copyright The Authors 2010
Paper III Saeland Mone, Wandel Margareta, Böhmer Thomas and Haugen Margaretha. Abscess infections and malnutrition – a cross-sectional study of poly drug addicts in Oslo, Norway. Under review.
Paper IV Saeland Mone, Wandel Margareta, Thomas Böhmer, and Haugen Margaretha. Heroin use and nutritional status in poly drug addicts in Oslo, Norway. In preparation.