Chapter 20 - Drivers and Consequences of Food Insecurity Among Illicit Drug Users

Abstract

Research from across the globe suggests that the burden of food insecurity and hunger among illicit drug users is extremely heavy. Drug users contend with behavioral and environmental risk factors that place them at increased vulnerability to food insecurity and its adverse health consequences. Evidence-based conceptual frameworks have been developed to explain the complex interaction between drug users and their risk environments and between food insecurity and adverse health outcomes. However, the mechanisms by which drug use, food insecurity, and poor health are inter-linked remain poorly characterized. We propose a conceptual framework that describes the synergistic relationship between illicit drug use and food insecurity and the compounded impact these conditions have on adverse health outcomes. This framework posits that drug use acts as an individual-level as well as an environmental-level driver of food insecurity and that, in turn, food insecurity exacerbates illicit drug use. Drawing on existing empirical evidence, we demonstrate that food insecurity among drug users leads to poor outcomes in human immunodeficiency virus (HIV) and hepatitis C virus infections, including increased risk of transmission, poor treatment adherence and virologic response, and increased risk of mortality. We present evidence supporting possible nutritional, mental health, and behavioral pathways linking food insecurity to these adverse outcomes and propose the next steps to be taken in research and policymaking. The evidence reviewed suggests an urgent need for the development of contextually appropriate individual and environmental supports to reduce food insecurity and its adverse health consequences among illicit drug users. Our conceptual framework has relevance for clinicians, public health program managers, and policymakers in both high- and low-resource settings. Operations research is essential to identify low-threshold interventions, including dietary counseling and education, and, where necessary, pharmacologic, nutritional, and clinical interventions that can be integrated into programs and services for drug users.