HARM REDUCTION
HUNGRY FOR CHANGE
Nutritional deficiency can be a serious issue for people using stimulants. Addressing it is an often overlooked but easy win for harm reduction, say Alexandre Piot, Magdalena Harris, Jenny Scott and Philippe Bonnet
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f a service provider, you are likely used to seeing people present wired, worn out, and running on empty. While the drugs they’ re using might be your immediate concern, also of importance is what’ s going on under the surface – nutritional deficiencies that are often overlooked but deeply intertwined with health and drug use. This can be a particular concern for people who use stimulants such as crack cocaine. Right now, there are limited interventions tailored for people who use stimulants, and that’ s a problem. Stimulant use is common, but support around basic needs like safe paraphernalia, drug use advice, and pharmacological interventions has not caught up or is limited by legislation. One overlooked challenge that can be addressed in the current context, however, is poor nutrition – something that’ s often rooted in a perfect storm of social marginalisation, limited financial resources, and the appetite-suppressing effects of the drugs themselves.
ESSENTIAL NUTRIENTS And this isn’ t just about being a bit peckish. Nutritional deficiency is a serious issue that can worsen both physical and mental health. Broadly, there are two main nutritional issues – eating poorly and therefore lacking essential vitamins and minerals, or having limited calorific intake, which compounded by a lack of essential nutrients can lead to malnutrition. Malnutrition can damage vital organs, and people suffering from it are at real risk of significant harm or death. If someone is malnourished, they should be referred to a GP.
Not consuming enough food can also make comedowns and withdrawals much worse. There’ s a reason for the expression hangry – hunger levels have been shown to impact mental health and can manifest in impulsivity, anger and irritability. If a skipped lunch can turn the average person into a grump, imagine how challenging navigating day-to-day life can be for someone who is chronically undernourished. Stimulant use can be a coping strategy in these circumstances, providing energy to push through – particularly for people who need to stay awake at night to stay safe on the streets.
So, let’ s dig into the problem and, more importantly, what we can do about it. Research shows that people who use drugs, especially stimulants, often have diets low in calories, protein, and essential nutrients. This isn’ t just about skipping a few meals – it’ s a sustained broader issue of food insecurity, poverty, unstable living situations, and disrupted eating patterns.
FOOD INSECURITY Data from the Safe Inhalation Pipe Provision( SIPP) study suggests that a significant proportion of people who use crack cocaine in England face food insecurity. This is no surprise, given the day-to-day realities many people experience. But even when food is accessible, appetite suppression can kick in. And here’ s where it gets interesting. It’ s not just about eating less – stimulants may actually dysregulate hunger hormones, leading people to eat at odd hours and making imbalanced dietary choices( think high fat and sugar, low protein).
These patterns may result from a combination of limited access to high-quality food and disruptions in key appetiteregulating hormones, such as
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