How to support your patients in recovery using IV nutrient therapy
Achieving recovery from drugs and/or alcohol is a noble feat. Any patient who is in recovery knows how difficult the process is. As practitioners, we should do our very best to help support these patients and help them prevent relapse. Because drugs of abuse deplete vital nutrients, intravenous (IV) nutrient therapy can be a beneficial means of optimizing nutrient status in individuals who are recovering from tobacco, alcohol, methamphetamine and related stimulants, and opioids.
How to support patients who are addicted to tobacco
Smoking increases oxidative stress within the body and damages the integrity of blood vessels. This can lead to unwanted effects, such as cerebrovascular accidents and cardiovascular disease. Research demonstrates that vitamin C, which serves as a potent antioxidant within the body, can help maintain the integrity of blood vessels.[1] To combat the effects of the large amount of free radicals generated by exposure to tobacco smoke, individuals who smoke need larger quantities of antioxidants like vitamin C.[2]
On average, smokers have lower levels of vitamin C in their plasma and in leukocytes than non-smokers.2 Research demonstrated improvement in the blood vessel integrity of smokers when vitamin C was administered intravenously. The evidence regarding oral intake of vitamin C, however, has been mixed. This is likely because absorption of even large doses of orally-administered vitamin C is limited to about 220 micromol/L, whereas intravenously administered vitamin C can result in levels as high as 26,000 micromol/L.[3] [4]
How to support patients who are dependent on alcohol
Alcohol inhibits the absorption of multiple B vitamins, including folic acid. On average, alcoholics in withdrawal who experienced delirium tremens had lower levels of folic acid in their cerebrospinal fluid compared to those who did not and compared to healthy controls.[5] This research suggests that low folic acid levels may contribute to symptoms of physical dependence on alcohol, such as delirium tremens.
Alcohol dependency leads to poor absorption of other B vitamins as well. Pantothenic acid, for example, is not well absorbed by alcoholic patients when administered orally. Instead, it is typically found in large amounts in the urine. [6] [7] [8]
How to support methamphetamine-dependent patients
Chronic use of methamphetamine (meth) can lead to cognitive impairment and other psychopathological concerns. These concerns have been linked to meth-induced vitamin B12 deficiency.[9] Specifically, meth addicts had lower serum vitamin B12 levels than healthy controls, and as the vitamin B12 levels increased, the number of relapses among recovering meth addicts decreased. Furthermore, researchers concluded that vitamin B12 levels influenced the severity of addiction among recovering meth addicts.
How to support patients who are addicted to opiates or synthetic opioids
About 27% of individuals who abuse opioid medications were prescribed them to treat chronic pain.[10] To support patients who are at risk for opioid dependency, vitamin D has been suggested as an adjunct therapy to assist with pain management. Research demonstrates that low vitamin D levels have been associated with increased pain and, consequently, higher dosages of opioid medications.[11] For our chronic pain patients, checking vitamin D levels and supplementing accordingly may be of benefit.
Opiates/opioids can lead to other imbalances as well. In fact, heroin addiction can cause hyperkalemia and morphine use can result in calcium inhibition.[12]
Conclusion
In conclusion, drug addiction commonly leads to various micronutrient imbalances. When applicable, checking for and addressing these imbalances is an extremely beneficial means of supporting our patients in recovery. IV nutrient therapy may be an effective means of improving nutritional status in these patients.
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[1] May, J. M., & Harrison, F. E. (2013). Role of vitamin C in the function of the vascular endothelium. Antioxidants & redox signaling, 19(17), 2068–2083. doi:10.1089/ars.2013.5205
[2] Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Press, 2000.
[3] Padayatty, S. J., Riordan, H. D., Hewitt, S. M., Katz, A., Hoffer, L. J., & Levine, M. (2006). Intravenously administered vitamin C as cancer therapy: three cases. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 174(7), 937–942. doi:10.1503/cmaj.050346
[4] Hoffer, L.J., Levine, M., Assouline, S., Melnychuk, D., Padayatty, S.J., Rosadiuk, K., Rousseau, C., Robitaille, L., & Miller, W.H. Jr. (2008). Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol. 19(11), 1969-1974.
[5] Nakazawa, Y., Yokoyama, T., Kurauchi, H., Ueda, S., Sakamoto, T., Imatoh, N., & Ezaki, E. (1981). Folic acid in serum and cerebrospinal fluid of chronic alcoholics and methamphetamine addicts. Drug and alcohol dependence, 7(2), 193–199. doi:10.1016/0376-8716(81)90033-8
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[6] Varela P, Marcos A, Ripoll S, Santacruz I, Requejo AM (1997). Effects of HIV infection and detoxi®cation time on anthropometric measurements and dietary intake of male drug addicts. Am J Clin Nutr, 66: 509–514.
[7] Mathews LJ, Parker RA (1987). Alcoholism Treatment with Biochemical Restoration as a Major Component. Int J Biosocial Res, 9(1): 92–106.
[8] Tao H, H Fox (1976). Measurement of Urinary Pantothenic Acid Excretion of Alcoholic Patients. J Nutr Sci, 22: 333–337.
[9] Zhai, C., Cui, M., Cheng, X., Ao, X., Zhao, T., Wu, W., … Jiao, D. (2018). Vitamin B12 Levels in Methamphetamine Addicts. Frontiers in behavioral neuroscience, 12, 320. doi:10.3389/fnbeh.2018.00320
[10] Dineen, K. K., & DuBois, J. M. (2016). BETWEEN A ROCK AND A HARD PLACE: CAN PHYSICIANS PRESCRIBE OPIOIDS TO TREAT PAIN ADEQUATELY WHILE AVOIDING LEGAL SANCTION?. American journal of law & medicine, 42(1), 7–52. doi:10.1177/0098858816644712
[11] Helde-Frankling, M., & Björkhem-Bergman, L. (2017). Vitamin D in Pain Management. International journal of molecular sciences, 18(10), 2170. doi:10.3390/ijms18102170
[12] Mohs, M.E., Watson, R.R., Leonard-Green, T. (1990). Nutritional effects of marijuana, heroin, cocaine, and nicotine. J Am Diet Assoc. 90(9):1261-1270.