Assessing Food Security and Hunger in Heroin-Assisted Treatment (HAT) Participants: Insights from Norway's HAT Project

Background
Food insecurity can co-occur with drug use and may exacerbate the harm experienced by people who use drugs. This study aimed to assess food access and hunger among the participants from Norway’s first heroin-assisted treatment (HAT) project.
Methods
Norway’s HAT is a 5-year project funded by the Norwegian government. The project aims to reach individuals with severe opioid use disorder (OUD); for whom conventional opioid-agonist treatment (OAT) has not been sufficient. The objective is to assess the effect of the program across diverse domains over time. Patient recruitment began in early 2022 at OAT clinics in Oslo and Bergen. Eligibility criteria for HAT were being +18 years, having ongoing OUD, and having prior unsuccessful OAT. Questionnaires, developed based on previous OAT projects, were administered at treatment start, then subsequently at 3, 6, and 12 months, and annually until 48 months. By January 2024, 88 patients completed the baseline survey. Food access was assessed by the question: “During the last 30 days, how often have you had access to the food you need?” and responses were recoded as adequate (often/always) and limited (rarely/never). Hunger was measured by: “How often do you feel hungry?” and responses were categorized as yes (often/always) and no (rarely/never). The independent variables were age, sex, education, income, employment, country of birth, having children, and stable housing as well as the type of drugs used in the last 30 days. The Fisher’s exact test assessed the bivariate relationship between independent variables with both food access and hunger. A significant threshold was p<0.05.
Results
The mean age of participants was 46 years (SD: 10), the majority were male (81%), had at least primary education (91%), and were unemployed (95%). The main sources of income were reoccurring disability pay (54%), disability insurance (24%), and unemployment benefits (13%). Most (91%) were Norwegian-born and living in a rented place (48%), with 19% lacking stable housing. Only 44% had children. Commonly used substances were illegal heroin (55%), sedatives (52%), tobacco (48%), stimulants (47%), opioids used in OAT including methadone and buprenorphine (41%), and alcohol (27%). Limited food access was reported by 32%, and hunger by 44%. Higher hunger rates were noted in males (51% vs. 13% in females) and those with unstable housing (79% vs. 36%). Limited food access tended to be higher in those with unstable housing (54% vs. 28%). Generally, those with higher education tended to have better food availability and less often hunger. No significant links were found between other factors and food access or hunger.
Conclusions
A substantial proportion of patients enrolled in a heroin-assisted treatment program had limited food access and experienced hunger, especially among males and those with unstable housing. Monitoring HAT's impact on food insecurity and addressing it in this group is essential to reduce drug-related harms.