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Cited by 41Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesNeurotransmitter Receptor Influence on Behavior

A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health

Open access
Wiss, David A.·2019·Frontiers in Public Health
DOI 10.3389/fpubh.2019.00193PMC PMC6629782
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Abstract

The opioid crisis has reached epidemic proportions in the United States with rising overdose death rates. Identifying the underlying factors that contribute to addiction vulnerability may lead to more effective prevention strategies. Supply side environmental factors are a major contributing component. Psychosocial factors such as stress, trauma, and adverse childhood experiences have been linked to emotional pain leading to self-medication. Genetic and epigenetic factors associated with brain reward pathways and impulsivity are known predictors of addiction vulnerability. This review attempts to present a biopsychosocial approach that connects various social and biological theories related to the addiction crisis. The emerging role of nutrition therapy with an emphasis on gastrointestinal health in the treatment of opioid use disorder is presented. The biopsychosocial model integrates concepts from several disciplines, emphasizing multicausality rather than a reductionist approach. Potential solutions at multiple levels are presented, considering individual as well as population health. This single cohesive framework is based on the interdependency of the entire system, identifying risk and protective factors that may influence substance-seeking behavior. Nutrition should be included as one facet of a multidisciplinary approach toward improved recovery outcomes. Cross-disciplinary collaborative efforts, new ideas, and fiscal resources will be critical to address the epidemic.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review applies a biopsychosocial framework to the US opioid crisis, integrating social/environmental, psychosocial, biological, and nutritional/gastrointestinal factors. It argues that nutrition and GI health should be included in multidisciplinary opioid use disorder (OUD) treatment, though evidence for nutrition interventions remains limited.

Key findings

  • Between 2000 and 2014, nearly a half million people in the US died from drug overdose; opioids accounted for 61% of all drug-related overdoses in 2014, and overdose death rates are highest when opioids and benzodiazepines are combined. Relapse rates remain above 50% at 6 months, and heroin-related deaths tripled in the US between 2010 and 2014.
  • Supply-side factors are a major driver: as many as 80% of heroin users started with prescription opioids, and 2015 data showed a third of people in OUD treatment began with common prescribed opioids and progressed to heroin. Chronic pain preceding OUD was associated with high rates of mental disorders (81.7%).
  • Psychosocial risks include PTSD, trauma, and adverse childhood experiences (ACEs); PTSD increased risk of developing OUD after exposure to opioid painkillers, and ACEs were linked to opioid initiation, intravenous use, and lifetime overdose in a graded, dose-response manner.
  • Nutrition/GI findings include high preference for sugar/sweetened foods and low fiber intake during early abstinence, weight gain on methadone maintenance, opioid-induced bowel dysfunction, and animal evidence that morphine increased a particular bacterial strain (E. faecalis) 100-fold versus placebo; no human gut-based nutrition intervention for OUD has been investigated.

Methods

  • Design: comprehensive/narrative review using a biopsychosocial framework; the paper states that no datasets were generated or analyzed.
  • Data/sample: synthesis of prior human, animal, epidemiological, clinical, and theoretical literature across social/environmental, psychosocial, biological, genetic/epigenetic, microbiome, and nutrition domains.
  • Main analysis: conceptual integration and theory comparison, with discussion of policy and treatment implications; no systematic search strategy, inclusion criteria, or meta-analysis is described.

Limitations

  • Paper-stated: there is a paucity of high-quality evidence on nutrition in OUD recovery; nutrition does not easily lend itself to randomized controlled trials due to time needed for measurable outcomes and confounders; SUD research has high attrition; many nutrient-deficiency studies are retrospective and mostly conducted during methadone maintenance; no human study has tested nutrition therapy to reduce inflammation in OUD or gut-based nutrition interventions for OUD; it is unknown how nutrition might modify reward pathways over years.
  • Evident from the text: as a narrative review, it does not systematically search or appraise the literature, and many claims rely on animal models, case reports, clinical anecdote, or cross-sectional/ecological data.
  • Evident from the text: causal direction is often unclear, such as whether nutrient deficiencies are caused by poor diet, drugs, or impaired absorption, and whether low DAD2 receptor function is genetically determined or a consequence of prolonged drug abuse.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpubh.2019.00193

Cites

235 of 235 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 167 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Chronic pain preceding the onset of opioid use disorder is associated with high rates of mental disorders (81.7%).

    “Recent data shows alarming rates of chronic pain preceding the onset of OUD, associated with high rates of mental disorders (81.7%), suggesting a high risk of transitioning to illicit drugs if stopped abruptly (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Hser, 2017, Chronic pain among patients with opioid use disorder: results from electronic health records data, J Subst Abuse Treat. source

      Not checked in the free run.

  • Premisecitation

    The environment in which one resides is a known predictor of consumption behavior.

    “The environment in which one resides is a known predictor of consumption behavior (39), thus behavioral economics is a conceptual system to understand how one's access and exposure will predict demand and subsequent intake (40–43).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Marinova, 2015, Biological correlates of complex posttraumatic stress disorder—state of research and future directions, Eur J Psychotraumatol source

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  • Interpretationreasoning

    Interventions focusing only on prescription opioids are unlikely to be sufficient as long as heroin and other synthetic opioids such as fentanyl and carfentanil continue to flood the market.

    “Interventions focusing only on prescription opioids are unlikely to be sufficient as long as heroin and other synthetic opioids such as fentanyl and carfentanil continue to flood the market.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Those already dependent on prescription opioids frequently transition to heroin when their supplies are cut off.

    “However, evidence suggests that those already dependent on prescription opioids frequently transition to heroin when their supplies are cut off (31).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Cicero, 2017, Increased use of heroin as an initiating opioid of abuse, Addict Behav source

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  • Premisecitation

    As many as 80% of heroin users started with prescription opioids.

    “Other research has shown that as many as 80% of heroin users started with prescription opioids (32).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Jones, 2013, Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers- United States, 2002-2004 and 2008-2010, Drug Alcohol Depend. source

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  • Classified as probably not a substantial claim. 42
  • May combine two claims. 33

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    Premisecitation

    Overdose death rates are highest when opioids and benzodiazepines are combined.

    “Overdose death rates are highest when opioids and benzodiazepines are combined (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Zoorob, 2018, Polydrug epidemiology: benzodiazepine prescribing and the drug overdose epidemic in the United States, Pharmacoepidemiol Drug Saf source

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    Premisecitation

    The number of people currently dependent on opioids or heroin is more than three times greater than the current capacity to deliver treatment.

    “According to some estimates, the number of people currently dependent on opioids or heroin is more than three times greater than the current capacity to deliver treatment (4).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Maxwell, 2015, The pain reliever and heroin epidemic in the United States: shifting winds in the perfect storm, J Addict Dis. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Opioids accounted for 61% of all drug-related overdoses in 2014.

    “Opioids accounted for 61% of all drug-related overdoses in 2014 (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Rudd, 2016, Increases in drug and opioid overdose deaths — United States, 2000–2014, MMWR Morb Mortal Wkly Rep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Behavioral economics is a conceptual system to understand how one's access and exposure predict demand and subsequent intake.

    “The environment in which one resides is a known predictor of consumption behavior (39), thus behavioral economics is a conceptual system to understand how one's access and exposure will predict demand and subsequent intake (40–43).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [40] Epstein, 2010, Food reinforcement, delay discounting and obesity, Physiol Behav source

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    • cites [41] Joynt, 2013, The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States, J Gen Intern Med source

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    • cites [42] Koob, 2018, Addiction and stress: an allostatic view, Neurosci Biobehav Rev. source

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    • cites [43] Amundsen, 2015, Drug-related causes of death: socioeconomic and demographic characteristics of the deceased, Scand J Public Health source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Relapse rates for opioid use disorder continue to be above 50% at 6 months and similarly high worldwide.

    “Relapse rates continue to be above 50% at 6 months (5, 6) and similarly high worldwide (7, 8).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [5] Lee, 2016, Extended-release naltrexone to prevent opioid relapse in criminal justice offenders, N Engl J Med source

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    • cites [6] Nunes, 2018, Relapse to opioid use disorder after inpatient treatment: protective effect of injection naltrexone, J Subst Abuse Treat. source

      Not checked in the free run.

    • cites [7] Kadam, 2017, A comparative study of factors associated with relapse in alcohol dependence and opioid dependence, Indian J Psychol Med. source

      Not checked in the free run.

    • cites [8] Wegman, 2017, Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study, Lancet Glob Health. source

      Not checked in the free run.

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    Premisecitation

    Between 2000 and 2014, nearly a half million people in the US died from a drug overdose.

    “Between 2000 and 2014, nearly a half million people in the US died from a drug overdose (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Rudd, 2016, Increases in drug and opioid overdose deaths — United States, 2000–2014, MMWR Morb Mortal Wkly Rep source

      Not checked in the free run.

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    Premisecitation

    Childhood neglect increases the lifetime risk of developing a psychiatric disorder.

    “This hypothesis has also been described as “latent vulnerability,” suggesting that childhood neglect increases the lifetime risk of developing a psychiatric disorder (83).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [83] McCrory, 2015, The theory of latent vulnerability: reconceptualizing the link between childhood maltreatment and psychiatric disorder, Dev Psychopathol source

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    Premisecitation

    Opioid use plays a critical role in fueling rising suicide rates.

    “Recent data suggests opioid use plays a critical role in fueling rising suicide rates (58).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Hand, 2017, Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region, J Subst Abuse Treat. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Heroin use has significantly increased across most demographic groups.

    “Meanwhile, heroin use has significantly increased across most demographic groups (41).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Joynt, 2013, The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States, J Gen Intern Med source

      Not checked in the free run.

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    Premisecitation

    Pregnant women using opioids as their primary substance have the highest prevalence in the Southern US and are less educated.

    “Pregnant women using opioids as their primary substance have the highest prevalence in the Southern US and are less educated (43).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Amundsen, 2015, Drug-related causes of death: socioeconomic and demographic characteristics of the deceased, Scand J Public Health source

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    Premisecitation

    Individuals with a drug-related death in Norway had lower SES than the general population but overall SES situation prior to death was heterogenous.

    “Norwegian data suggests that individuals with a drug-related death had lower SES than the general population but overall SES situation prior to death was heterogenous (41).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Joynt, 2013, The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States, J Gen Intern Med source

      Not checked in the free run.

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    Premisecitation

    Adverse childhood experiences are linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner.

    “ACEs have been linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner (73).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Stein, 2017, Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder, Drug Alcohol Depend. source

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    Premisecitation

    The self-medication hypothesis suggests individuals turn to opioids to reduce stress, pain, and unresolved psychological trauma.

    “However, the more common theory is the “self-medication hypothesis” (69, 82) which suggests individuals turn to opioids to reduce stress, pain, and unresolved psychological trauma (path C–F).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Danovitch, 2016, Post-traumatic stress disorder and opioid use disorder: a narrative review of conceptual models, J Addict Dis. source

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    • cites [82] Khantzian, 1987

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Opioid misuse may be a coping mechanism for unresolved emotional pain that cannot be easily addressed in other ways.

    “In other words, opioid misuse may be a coping mechanism for unresolved emotional pain that cannot be easily addressed in other ways.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    It is possible that delayed GI transit time can increase intraluminal concentrations of toxins.

    “It is possible that delayed GI transmit time can increase intraluminal concentrations of toxins.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Chronic opioid use in cirrhosis has been associated with increased endotoxemia, gut dysbiosis, inflammation, and all-cause hospital readmission.

    “Chronic opioid use in cirrhosis has been associated with increased endotoxemia, gut dysbiosis, inflammation, and all-cause hospital readmission (178).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [178] Acharya, 2017, Chronic opioid use is associated with altered gut microbiota and predicts readmissions in patients with cirrhosis, Aliment Pharmacol Ther source

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    Premisecitation

    OUD has been associated with bowel dysfunction including constipation while using and diarrhea during detoxification.

    “OUD has been associated with bowel dysfunction including but not limited to constipation while using and diarrhea during detoxification (172).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [172] Leppert, 2015, Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction, Drug Des Devel Ther source

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    Premisecitation

    During active heroin use, individuals report little interest in food, preferring quick and cheap convenience foods.

    “During active heroin use, individuals report little interest in food, preferring quick and cheap convenience foods (151).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [151] Neale, 2012, Eating patterns among heroin users: a qualitative study with implications for nutritional interventions, Addiction source

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    Premisecitation

    Some studies have shown elevated serum values of malondialdehyde, homocysteine, and leucocytes, all of which serve as markers of inflammation.

    “Some studies have shown elevated serum values of malondialdehyde (167), homocysteine (171), and leucocytes (171), all of which serve as markers of inflammation.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [167] Richardson, A preliminary study examining nutritional risk factors, body mass index, and treatment retention in opioid-dependent patients, J Behav Health Serv Res source

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    • cites [171] Waddington, 2015, Nutritional intake of opioid replacement therapy patients in community pharmacies: A pilot study. Nutr Diet source

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    Premisecitation

    Activation of mu-opioid receptors in the gut wall inhibits pathways within the enteric nervous system, which in turn reduce motility, delay gastric emptying, and slow intestinal transit.

    “Activation of mu-opioid receptors in the gut wall inhibits pathways within the enteric nervous system, which in turn reduce motility, delay gastric emptying, and slow intestinal transit (172).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [172] Leppert, 2015, Emerging therapies for patients with symptoms of opioid-induced bowel dysfunction, Drug Des Devel Ther source

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    Interpretationreasoning

    Given the retrospective nature of the research, it is difficult to determine if deficiencies are caused by poor dietary habits, by the drugs themselves, or possibly from impaired absorption.

    “However, given the retrospective nature of the research, it is difficult to determine if deficiencies are caused by poor dietary habits, by the drugs themselves, or possibly from impaired absorption.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    GI transit times are prolonged in the cecum and ascending colon, but not in the transverse or descending colon.

    “It has been shown that GI transit times are prolonged in the cecum and ascending colon, but not in the transverse or descending colon (175).”
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    • cites [175] Poulsen, 2016, The Impact of Opioid Treatment on Regional Gastrointestinal Transit, J Neurogastroenterol Motil source

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    Premisecitation

    Most of the opioid research has been conducted during methadone maintenance, due to the difficulties conducting research on individuals using illicit drugs.

    “Additionally, most of the opioid research has been conducted during methadone maintenance (162, 168–170), due to the difficulties conducting research on individuals using illicit drugs.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [162] Banerjee, 2016, Opioid-induced gut microbial disruption and bile dysregulation leads to gut barrier compromise and sustained systemic inflammation, Mucosal Immunol. source

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    • cites [168] Braveman, 2006, Health disparities and health equity: concepts and measurement, Public Health source

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    • cites [169] Jeynes, 2017, The importance of nutrition in aiding recovery from substance use disorders: a review, Drug Alcohol Depend source

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    • cites [170] Cunningham, 2016, The use of sobriety nutritional therapy in the treatment of opioid addiction, J Addict Res Ther. source

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  • May combine two claims.

    Premisecitation

    Several papers have addressed opioid-related GI concerns, yet no authors make any specific nutrition recommendations.

    “Several papers have addressed opioid-related GI concerns, yet no authors make any specific nutrition recommendations (174, 175).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [174] Camilleri, 2017, Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits, Clin Gastroenterol Hepatol source

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    • cites [175] Poulsen, 2016, The Impact of Opioid Treatment on Regional Gastrointestinal Transit, J Neurogastroenterol Motil source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    It is possible that altered hormones associated with heroin addiction contribute to abnormal weight changes and/or decreased bone mass.

    “It is possible that altered hormones associated with heroin addiction contribute to abnormal weight changes (157) and/or decreased bone mass (158).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [157] Housova, 2005, Adipocyte-derived hormones in heroin addicts: the influence of methadone maintenance treatment, Physiol Res source

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    • cites [158] Dursteler-MacFarland, 2011, Patients on injectable diacetylmorphine maintenance have low bone mass, Drug Alcohol Rev source

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  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    If the opioid crisis in the US is to be "solved" it will require a multilevel initiative engaging all sectors of the healthcare system.

    “If the opioid crisis in the US is to be “solved” it will require a multilevel initiative engaging all sectors of the healthcare system (186).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [186] Ali, 2017, Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: evidence from the national survey of drug use and health, Addict Behav source

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    Premisecitation

    These findings have been replicated, and certain microbial communities associated with stress tolerance are reduced in the morphine-rodent model.

    “These findings have been replicated, and it has been added that certain microbial communities associated with stress tolerance are reduced in the morphine-rodent model (181).”
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    • cites [181] Wang, 2018, Morphine induces changes in the gut microbiome and metabolome in a morphine dependence model, Sci Rep source

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    Premisecitation

    Epidemiological research suggests that nutrient imbalance is a strong predictor of substance use and may be partially mediated by depression.

    “Epidemiological research suggests that nutrient imbalance is a strong predictor of substance use and may be partially mediated by depression (202).”
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    • cites [202] Schroeder, 2017, You are what you eat: the impact of nutrition on alcohol and drug use, Subst Use Misuse source

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    Premisecitation

    Gut microbiome alterations and impulsive behaviors influenced by striatal dopamine receptor expression have reduced alcohol seeking in animal models.

    “Gut microbiome alterations and impulsive behaviors influenced by striatal dopamine receptor expression have reduced alcohol seeking in animal models (164).”
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    • cites [164] Jadhav, 2018, Gut microbiome correlates with altered striatal dopamine receptor expression in a model of compulsive alcohol seeking, Neuropharmacology source

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    Premisecitation

    Interest in reducing neuroinflammation in opioid recovery is beginning to receive considerable attention.

    “Meanwhile, interest in reducing neuroinflammation in opioid recovery is beginning to receive considerable attention (165).”
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    • cites [165] Mansouri, 2018, Venlafaxine prevents morphine antinociceptive tolerance: the role of neuroinflammation and the l-arginine-nitric oxide pathway, Exp Neurol source

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    Premisecitation

    PDMP utilization is not uniform across states and has not yet been integrated into all EMRs.

    “It has been shown that PDMP implementation is associated with reduced doctor shopping for prescription opiate painkillers, but PDMP utilization is not uniform across states, and has not yet been integrated into all EMRs (190, 191).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [190] Seymour, 2017, Leading the way to solutions to the opioid epidemic: AOA critical issues, J Bone Joint Surg Am source

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    • cites [191] Smith, 2015, How, why, and for whom do emergency medicine providers use prescription drug monitoring programs?, Pain Med source

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    Premisecitation

    Some authors have recommended dietary supplements for use in early recovery from heroin.

    “Some authors have recommended dietary supplements for use in early recovery from heroin (203).”
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    • cites [203] Chen, 2012, Neurotransmitter-precursor-supplement intervention for detoxified heroin addicts, J Huazhong Univ Sci Technol Med Sci source

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  • Classified as probably not a substantial claim.

    Premisecitation

    It has been proposed that gut bacteria can influence neurobehavior including host appetite for food.

    “It has been proposed that gut bacteria can influence neurobehavior including host appetite for food (135, 137, 182), so it is not implausible to predict associations between microbiota and all substances passing through the gut.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [135] Vanamala, 2015, Can your microbiome tell you what to eat?, Cell Metab. source

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    • cites [137] Johnson, 2018, Why does the microbiome affect behaviour?, Nat Rev Microbiol. source

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    • cites [182] Soto, 2018, Gut microbiota modulate neurobehavior through changes in brain insulin sensitivity and metabolism, Mol Psychiatry source

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    Premisecitation

    Prescription drug monitoring programs (PDMPs) share data across states and represent a policy tool targeted toward providers, the broadest level of intervention in the socio-ecological model.

    “Prescription drug monitoring programs (PDMPs) (187) share data across states and represent a policy tool targeted toward providers, the broadest level of intervention in the socio-ecological model (188, 189).”
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    • cites [187] Pauly, 2018, Features of prescription drug monitoring programs associated with reduced rates of prescription opioid-related poisonings, Drug Alcohol Depend source

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    • cites [188] Glanz, 2010, The role of behavioral science theory in development and implementation of public health interventions, Annu Rev Public Health source

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    • cites [189] McLeroy, 1988, An ecological perspective on health promotion programs, Health Educ Q source

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    Premisecitation

    Better training of pharmacists to detect and discuss drug misuse with patients is included in collaborative efforts.

    “This includes better training of pharmacists to detect and discuss drug misuse with patients (193).”
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    • cites [193] Cochran, 2015, Pharmacists who screen and discuss opioid misuse with patients, J Pharm Pract source

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    Premisecitation

    Emerging data suggests that nutrition may be a useful adjunct for biological as well as social intervention.

    “Emerging data suggests that nutrition may be a useful adjunct for biological (169) as well as social (170) intervention.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [169] Jeynes, 2017, The importance of nutrition in aiding recovery from substance use disorders: a review, Drug Alcohol Depend source

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    • cites [170] Cunningham, 2016, The use of sobriety nutritional therapy in the treatment of opioid addiction, J Addict Res Ther. source

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    Premisecitation

    A trauma-focused treatment model typically involves empathy, curiosity, and trust.

    “A trauma-focused treatment model typically involves empathy, curiosity, and trust (195).”
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    • cites [195] Borrell-Carrió, 2004, The biopsychosocial model 25 years later: principles, practice, and scientific inquiry, Ann Fam Med source

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    Premisecitation

    The trauma theory of addiction suggests that opioids are strongly reinforcing to individuals with PTSD and may initially treat the aversive symptoms.

    “The trauma theory of addiction suggests that opioids are strongly reinforcing to individuals with PTSD (69) and may initially treat the aversive symptoms.”
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    • cites [69] Danovitch, 2016, Post-traumatic stress disorder and opioid use disorder: a narrative review of conceptual models, J Addict Dis. source

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    Premisecitation

    Similar to alcohol, opioid ingestion can disrupt the intestinal epithelium leading to bacterial translocation and subsequent inflammatory cascades.

    “Similar to alcohol, opioid ingestion can disrupt the intestinal epithelium (160) leading to bacterial translocation and subsequent inflammatory cascades (161).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [160] Babrowski, 2012, Pseudomonas aeruginosa virulence expression is directly activated by morphine and is capable of causing lethal gut-derived sepsis in mice during chronic morphine administration, Ann Surg source

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    • cites [161] Meng, 2013, Morphine induces bacterial translocation in mice by compromising intestinal barrier function in a TLR-dependent manner, PLoS ONE source

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    Premisecitation

    In 2016, Ohio passed a law that requires pharmacists to review a patient's PMDP history before dispensing a new controlled substance, encouraging denial to some patients and thereby taking a more proactive role in pain management.

    “In 2016, Ohio passed a law that requires pharmacists to review a patient's PMDP history before dispensing a new controlled substance, encouraging denial to some patients and thereby taking a more proactive role in pain management (194).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [194] Penm, 2017, Strategies and policies to address the opioid epidemic: a case study of Ohio, J Am Pharm Assoc source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Failure to address nutritional conditions can severely undermine treatment.

    “It has been argued that failure to address nutritional conditions can severely undermine treatment (197).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [197] Kaiser, 2008, Nutritional links to substance abuse recovery, J Addict Nurs source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nutritional protocols for OUD have been described elsewhere and specific group education topics for SUD treatment have also been recommended.

    “Nutritional protocols for OUD have been described elsewhere (200) and specific group education topics for SUD treatment have also been recommended (201).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [200] Wiss, 2019, The role of nutrition in addiction recovery: what we know and what we don't source

      Not checked in the free run.

    • cites [201] Wiss, 2018, Registered dietitian nutritionists in substance use disorder treatment centers, J Acad Nutr Diet source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Leading experts are consistently calling for "research into new treatments for OUD" but nutrition therapy has lagged behind.

    “Leading experts are consistently calling for “research into new treatments for OUD” (196) but nutrition therapy has lagged behind.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [196] Volkow, 2018, Prevention and treatment of opioid misuse and addiction, JAMA Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    Improving social factors that decrease trauma, stress, and pain appear to be an important goal but are unlikely to be effective without reducing the overall supply and accessibility of opioids.

    “Improving social factors that decrease trauma, stress, and pain appear to be an important goal but are unlikely to be effective without reducing the overall supply and accessibility of opioids.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Targeted treatments for individuals who are at heightened psychosocial and biological risk may benefit from the inclusion of enhanced treatment protocols such as gut-focused nutrition therapy.

    “Targeted treatments for individuals who are at heightened psychosocial and biological risk may benefit from the inclusion of enhanced treatment protocols such as gut-focused nutrition therapy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    LCP considers psychosocial mediators in the biological programing of health and is therefore a major hub for recycling predictors of health outcomes in Figure 1.

    “LCP considers psychosocial mediators in the biological programing of health (219) and is therefore a major hub for recycling predictors of health outcomes in Figure 1.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [219] Ben-Shlomo, 2002, A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives, Int J Epidemiol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Of particular importance in the opioid crisis appears to be the mediating role of life stressors, and possibly the role of gastrointestinal health.

    “Of particular importance in the opioid crisis appears to be the mediating role of life stressors, and possibly the role of gastrointestinal health.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Paramount are the social determinants of health, particularly given associations between social disadvantage and the lifetime accumulation of stress and trauma, as well as how social factors impact opioid use and nutritional status.

    “Paramount are the social determinants of health, particularly given associations between social disadvantage and the lifetime accumulation of stress and trauma, as well as how social factors impact opioid use (224, 225) and nutritional status (226, 227).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [224] Grigoras, 2018, Correlation of opioid mortality with prescriptions and social determinants: a cross-sectional study of medicare enrollees, Drugs. source

      Not checked in the free run.

    • cites [225] Dasgupta, 2017, Opioid crisis: no easy fix to its social and economic determinants, Am J Public Health. source

      Not checked in the free run.

    • cites [226] Hemmingsson, 2018, Early childhood obesity risk factors: socioeconomic adversity, family dysfunction, offspring distress, and junk food self-medication, Curr Obes Rep source

      Not checked in the free run.

    • cites [227] Hemmingsson, 2014, Effects of childhood abuse on adult obesity: a systematic review and meta-analysis, Obes Rev. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The BPS Perspective draws its conceptual roots from socio-ecological models including Ecosocial Theory.

    “This single cohesive framework considers the interdependency of the entire system, drawing its conceptual roots from socio-ecological models (188, 189) including Ecosocial Theory (23).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [188] Glanz, 2010, The role of behavioral science theory in development and implementation of public health interventions, Annu Rev Public Health source

      Not checked in the free run.

    • cites [189] McLeroy, 1988, An ecological perspective on health promotion programs, Health Educ Q source

      Not checked in the free run.

    • cites [23] Krieger, 1994, Epidemiology and the web of causation: has anyone seen the spider?, Soc Sci Med. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Authors from around the globe have suggested that nutrition interventions may be helpful in combating the opioid crisis.

    “Meanwhile, authors from around the globe have suggested that nutrition interventions may be helpful in combating the opioid crisis (156, 198, 221).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [156] Peles, 2016, Risk factors for weight gain during methadone maintenance treatment, Subst Abus source

      Not checked in the free run.

    • cites [198] Wiss, 2018, Rapid assessment of nutrition services in Los Angeles substance use disorder treatment centers, J Commun Health source

      Not checked in the free run.

    • cites [221] Nabipour, 2014, Burden and nutritional deficiencies in opiate addiction- systematic review article, Iran J Public Health

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    The reductionistic approach to generating high quality evidence contributes to the absence of evidence for more complex approaches, such as those discussed herein.

    “Meanwhile, the reductionistic approach to generating high quality evidence contributes to the absence of evidence for more complex approaches, such as those discussed herein.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    It has been argued that the microbiome is the link between person, public, and planetary health.

    “It has been argued that the microbiome is the link between person, public, and planetary health (184) and therefore we must consider environmental, psychosocial, and personal/nutritional factors implicated in gut dysbiosis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [184] Prescott, 2018, Dysbiotic drift and biopsychosocial medicine: how the microbiome links personal, public and planetary health, BioPsychoSoc Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    This concept has been described as a "biological embedding" of the environment and of one's lived experiences.

    “This concept has been described as a “biological embedding” of the environment and of one's lived experiences (214, 215).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [214] Lei, 2018, Biological embedding of neighborhood disadvantage and collective efficacy: influences on chronic illness via accelerated cardiometabolic age, Dev Psychopathol. source

      Not checked in the free run.

    • cites [215] Glass, 2006, Behavioral science at the crossroads in public health: extending horizons, envisioning the future, Soc Sci Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Skills for distress tolerance and managing negative affect appear to be critical for maintaining sobriety.

    “Skills for distress tolerance and managing negative affect appear to be critical for maintaining sobriety.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    In the case of OUD, social advantage may protect one from stress, or facilitate an individual receiving better treatment.

    “In the case of OUD, social advantage may protect one from stress, or facilitate an individual receiving better treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The LCP considers multiple pathways contributing to disease, at the biological level but also emphasizing how social ties influence health behavior and how these accumulate throughout the life course.

    “The LCP considers multiple pathways contributing to disease, at the biological level (genetic/epigenetic) but also emphasizing how social ties influence health behavior and how these accumulate throughout the life course (217).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [217] Umberson, 2010, Social relationships and health behavior across life course, Annu Rev Sociol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Taken together, the potential for use of nutrition as part of a BPS framework for OUD treatment appears underutilized and poorly documented.

    “Taken together, the potential for use of nutrition as part of a BPS framework for OUD treatment appears underutilized and poorly documented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Premisecitation

    With such strong evidence of overlapping pathways between drugs of abuse and food, it is surprising that food has not been investigated as a long-term modulator of reward pathways in humans.

    “With such strong evidence of overlapping pathways between drugs of abuse and food (220), it is surprising that food has not been investigated as a long-term modulator of reward pathways in humans.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [220] Gordon, 2018, What is the evidence for “food addiction?” A systematic review, Nutrients source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    LCP considers not only how disadvantage impacts health outcomes, but how cumulative advantage can play a role.

    “Meanwhile, LCP consider not only how disadvantage impacts health outcomes, but how cumulative advantage can play a role (218).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [218] Willson, 2007, Cumulative advantage processes as mechanisms of inequality in life course health, Am J Sociol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    While genetics cannot be changed, epigenetics and the microbiome are both potential intervention targets by way of nutrition, albeit much slower than medication, and therefore difficult to measure.

    “While genetics cannot be changed, epigenetics and the microbiome are both potential intervention targets by way of nutrition, albeit much slower than medication, and therefore difficult to measure (behavioral outcomes vs. biomarkers).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Epigenetic modifications acquired in one generation can be inherited by the next generation and can involve behavioral or social transmission, including the transmission of trauma.

    “Furthermore, epigenetic modifications acquired in one generation can be inherited by the next generation and can involve behavioral or social transmission (107), including the transmission of trauma (216).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [107] Vassoler, 2014, Mechanisms of transgenerational inheritance of addictive-like behaviors, Neuroscience. source

      Not checked in the free run.

    • cites [216] Lehrner, 2018, Trauma across generations and paths to adaptation and resilience, Psychol Trauma source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Life Course Perspective is not new to public health.

    “The Life Course Perspective (LCP) is not new to public health (213).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [213] Lu, 2003, Racial and ethnic disparities in birth outcomes: a life-course perspective, Matern Child Health J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    One major shortcoming is that MAT does not address individuals' underlying psychological and emotional issues that contribute to addiction susceptibility.

    “One major shortcoming is that it does not address individuals' underlying psychological and emotional issues that contribute to addiction susceptibility.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Methadone maintenance patients have received nutritional counseling aimed at reducing diet-related morbidity but a lack of measurable changes (e.g., weight) reduce the scientific salience.

    “Methadone maintenance patients have received nutritional counseling aimed at reducing diet-related morbidity but a lack of measurable changes (e.g., weight) reduce the scientific salience (204).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [204] Sason, 2018, Knowledge about nutrition, eating habits and weight reduction intervention among methadone maintenance treatment patients, J Subst Abuse Treat source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Therefore, nutrition research has been constrained to reductionistic approaches, such as looking at single nutrients or single outcome measures such as changes in weight.

    “Therefore, nutrition research has been constrained to reductionistic approaches, such as looking at single nutrients or single outcome measures such as changes in weight.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Nutrition does not easily lend itself to randomized controlled trials given the amount of time needed for measurable outcomes, and the presence of confounders introduced during this period.
65 of 65

  • The paper relies on this without support.

    Over-prescription of opioid medications in the past two decades is a primary upstream driver of the opioid crisis.

    “It has become increasingly clear that over-prescription of these medications in the past two decades is a primary upstream driver of the crisis.”

  • The paper relies on this without support.

    Consumption of substances activates mesolimbic reward pathways.

    “Consumption of substances activate mesolimbic reward pathways (path H).”

  • The authors state this as an assumption.

    Nutrition interventions may improve the body's resilience in response to stress and negative affect throughout the recovery process.

    “At a minimum, nutrition interventions may improve the body's resilience in response to stress and negative affect throughout the recovery process, but this is unproven.”

  • The authors state this as an assumption.

    Eating behaviors in recovery from opioid use disorder may impact reward pathways and be mediated by epigenetic and microbial mechanisms.

    “Given the overlap between nutritional programming and altered incentive motivation via the mesolimbic dopaminergic system (123), it is being hypothesized that eating behaviors in recovery from OUD may impact reward pathways and be mediated by epigenetic and microbial mechanisms.”

  • The paper relies on this without support.

    There is a paucity of high-quality evidence regarding the role of nutrition in OUD recovery.

    “There is a paucity of high-quality evidence regarding the role of nutrition in OUD recovery.”

  • The paper relies on this without support.

    Nutrition does not easily lend itself to randomized controlled trials given the amount of time needed for measurable outcomes, and the presence of confounders introduced during this period.

    “Nutrition does not easily lend itself to randomized controlled trials given the amount of time needed for measurable outcomes, and the presence of confounders introduced during this period.”

  • The paper relies on this without support.

    Less is known about how eating behaviors during the early months/years of recovery impacts reward processing.

    “Less is known about how eating behaviors during the early months/years of recovery impacts reward processing.”

  • The paper relies on this without support.

    A study evaluating the impact of nutrition on the reward-related neurochemistry of OUD patients has not been done.

    “A study evaluating the impact of nutrition on the reward-related neurochemistry of OUD patients has not been done.”

  • The paper relies on this without support.

    To date, a study on the use of nutrition therapy to reduce inflammation in OUD subjects has not been conducted.

    “To date, a study on the use of nutrition therapy to reduce inflammation in OUD subjects has not been conducted.”

  • The paper relies on this without support.

    Given how challenging it is to conduct nutrition interventions in SUD detox settings, it is not surprising there is a lack of evidence.

    “Given how challenging it is to conduct nutrition interventions in SUD detox settings, it is not surprising there is a lack of evidence.”

  • The paper relies on this without support.

    Clinicians have been relying on case reports rather than published standards.

    “Clinicians have been relying on case reports rather than published standards.”

  • The paper relies on this without support.

    Constipation typically persists as long as opiates are being administered.

    “Constipation typically persists as long as opiates are being administered, and emerging microbiome data presents compelling new questions related to the origins and consequences of pathophysiological motility.”

  • The paper relies on this without support.

    It is not yet clear whether the microbiome can contribute to craving in OUD, or to what extent opioid-induced dysbiosis impacts mental status in humans.

    “It is not yet clear whether the microbiome can contribute to craving in OUD, or to what extent opioid-induced dysbiosis impacts mental status in humans.”

  • The paper relies on this without support.

    Efforts to address the opioid epidemic are being led by pharmaceutical companies promoting new medications (MAT) as the solution.

    “Efforts to address the opioid epidemic are being led by pharmaceutical companies promoting new medications (MAT) as the solution.”

  • The paper relies on this without support.

    Individuals with a history of PTSD, complex trauma, stress, or ACEs can experience physiological as well as emotional changes that increase the likelihood of opioid addiction.

    “Individuals with a history of PTSD, complex trauma, stress, or ACEs can experience physiological as well as emotional changes that increase the likelihood of opioid addiction.”

  • The paper relies on this without support.

    The current paradigm for OUD treatment is typically centered on psychotherapy in individual and group settings, in addition to psychiatry.

    “The current paradigm for OUD treatment is typically centered on psychotherapy in individual and group settings, in addition to psychiatry.”

  • The paper relies on this without support.

    “Holistic” approaches including nutrition is not widely accepted but have been growing in popularity in the private sector.

    ““Holistic” approaches including nutrition is not widely accepted but have been growing in popularity in the private sector.”

  • The paper relies on this without support.

    It remains unknown how these supplements interact with MAT.

    “It remains unknown how these supplements interact with MAT, and the reader is deferred to a more comprehensive review (200).”

  • The paper relies on this without support.

    While no one single policy intervention on opioid addiction has proven to be highly effective, several promising proposals have been made.

    “While no one single policy intervention on opioid addiction has proven to be highly effective, several promising proposals have been made.”

  • The paper relies on this without support.

    What happens in early life has profound consequences in adulthood, and what happens in one generation may hold significance for future generations.

    “What happens in early life has profound consequences in adulthood, and what happens in one generation may hold significance for future generations.”

  • The paper relies on this without support.

    It has been emphasized that the potential for nutrition to be utilized as one facet of a BPS approach may improve recovery outcomes.

    “It has been emphasized that the potential for nutrition to be utilized as one facet of a BPS approach may improve recovery outcomes.”

  • The paper relies on this without support.

    To date, gut-based nutrition interventions for OUD have not been investigated in humans but do appear to be timely.

    “To date, gut-based nutrition interventions for OUD have not been investigated in humans but do appear to be timely.”

  • The paper relies on this without support.

    The psychosocial theory of addiction vulnerability is focused on the individual but is highly dependent upon social and environmental factors.

    “The psychosocial theory of addiction vulnerability is focused on the individual but is highly dependent upon social and environmental factors (path B).”
23 of 23

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Biopsychosocial approaches that consider the cumulative interplay between social and biological factors are helpful when conceptualizing multiple systems driving substance-related disorders, whether it be alcohol, drugs, nicotine, or food.

    “Biopsychosocial approaches that consider the cumulative interplay between social and biological factors are helpful when conceptualizing multiple systems driving substance-related disorders, whether it be alcohol, drugs, nicotine, or food [243].”

    From Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications (2020) · cites this paper as [243]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Prescription-guideline result cites a mental-illness article

    Minor

    The reported nearly 40% reduction in discharge prescriptions is attributed to reference 185. The reference list identifies 185 as an article estimating the global burden of mental illness, not a study of emergency-room prescription guidelines.

  • Emergency-department prescribing claim cites an unrelated reference

    Minor

    The text cites reference 39 for data on socioeconomic status and opioid prescribing in emergency departments. Reference 39 is listed as an article on biological correlates of complex posttraumatic stress disorder.

  • Vitamin-deficiency claim cites a study of morphine-induced sepsis

    Minor

    The cited range 160-165 is presented as support for well-described vitamin and mineral deficiencies in opioid addiction. Reference 160, at the start of that range, is listed as a study of morphine-induced bacterial virulence and sepsis in mice.

  • Southern California mortality study is cited as a stress article

    Minor

    The text attributes an ecological study of opioid-related deaths in Southern California to reference 42, but reference 42 is listed as an article about addiction and stress.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Sandwell, 2009, Healthy eating advice as part of drug treatment in prisons, Prison Service J, 15

Cited by

Sorted by citations

Related

Authors
Wiss, D. A.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Wiss, David A.
ORCID
Wiss, David A.
Venue
Frontiers in Public Health
Publisher
Frontiers Media SA
Published
2019-07-09
Volume
7
Pages
193-193
ISSN
2296-2565 (ISSN-L)
DOI
10.3389/fpubh.2019.00193
PMC
PMC6629782
OpenAlex
W2959143638
Semantic Scholar
4dfb2186a2ab2fcbfbb9d3a99b43d7434863c17e
Cited by
41
References
233
Citations by year
2026: 4 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 7 · 2021: 6 · 2020: 3 · 2018: 2
FWCI
3.68
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
University of California, Los Angeles
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
opioid epidemic, opioid use disorder, biopsychosocial model, addiction vulnerability, nutritional therapy, gut health, self-medication, stress and trauma, adverse childhood experiences, epigenetics, brain reward system, impulsivity, opioid overdose, addiction prevention, risk and protective factors, substance use disorder recovery

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

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