Novel intervention to improve food insecurity among individuals with opioid use disorder: A randomized clinical trial

Food insecurity (FI) is 4-7 times greater among individuals with opioid use disorder (OUD) than the general population and is associated with increased risk for licit and illicit drug use, sexual and drug risk behaviors, infectious disease, and a two-fold odds of premature death. In this randomized study, we evaluated a novel, mail-based meal delivery intervention for improving household FI and other outcomes among individuals with OUD.

Fifty adults with FI and OUD were randomized to one of two 12-week experimental conditions: Nutritional Education (NE) involved brief education and assistance with contacting community-based FI-related resources. NE +  Meal Delivery (NE+MD) involved the same education plus weekly premade meals directly from a commercial service. The primary outcome of household FI was measured at monthly assessments, with secondary measures of depression symptoms, quality of life, and biochemically-verified drug use.

The NE+MD intervention was associated with significant improvements in household FI, with rates of FI significantly lower in the NE+MD vs. NE group at all post-intake timepoints (54.6-62.5 % and 90.5-95.2 % among NE+MD and NE groups, respectively; p's < .05). NE+MD participants rated the enjoyment and convenience of meals at 80.7 and 92.8, respectively (range: 0-100). Improvements in FI were also associated with improvements in depression, quality of life and illicit opioid abstinence.

This study supports the feasibility, acceptability and initial efficacy of a novel NE+MD intervention for improving household FI among individuals with OUD and provides new preliminary evidence that FI may be associated with participants' mental and physical health.