Written by Rachel Kachur
At first glance, food insecurity and unintentional overdose may appear to be two separate public health issues. In reality, they are closely connected. Food insecurity is increasingly recognized as a social determinant of health that contributes to overdose risk across a range of populations, including people with substance use disorders, older adults, individuals living with chronic pain, and those prescribed opioids or other medications. Professionals in the field and communities at large need to begin to understand and address the relationship between food insecurity and overdose risk. Hunger is often a driver for substance mis-use or consuming additional medications. Recognizing this connection reminds us that preventing overdose requires more than addressing medications or substance use alone; it also means addressing food insecurity—the lack of consistent access to enough nutritious food—creates significant physical and emotional stress.
Research consistently demonstrates that food insecurity is associated with a greater likelihood of chronic pain, prescription opioid use, and higher-risk opioid use behaviors, including daily opioid use, taking more medication than prescribed, and using opioids not prescribed by a physician (Men et al., 2021). Additionally, studies have found that food insecurity and opioid-related mortality are closely intertwined at the population level, with communities experiencing higher rates of opioid overdose deaths also experiencing greater levels of food insecurity (Heflin & Sun, 2022).. Food insecurity can worsen physical and emotional health, making it more difficult for individuals to safely manage medications, recover from illness, or access consistent healthcare and supportive services. Individuals struggling to meet their basic needs are more likely to experience anxiety, depression, and other mental health concerns that can affect their overall well-being and likelihood of overdose. For older adults and individuals living with chronic pain, inadequate nutrition can worsen existing medical conditions, reduce physical resilience, and complicate the safe use of prescribed medications. Across all of these populations, food insecurity contributes to circumstances that increase vulnerability to an unintentional overdose.
Food insecurity can increase the risk of an unintentional overdose by affecting how the body processes medications. Poor nutrition may alter medication absorption and metabolism, increasing the likelihood of adverse drug reactions, while the effects of chronic undernutrition can reduce the body’s ability to tolerate medications safely (Men et al., 2021). Food insecurity is also associated with a higher prevalence of chronic pain, more severe pain, and greater use of prescription opioids (Men et al., 2021). In addition, inconsistent access to food can make it difficult to follow medication instructions, particularly for medications that should be taken with meals, increasing the risk of medication errors, adverse drug events, and accidental overdose. Together, these findings demonstrate that food insecurity is an important, yet often overlooked, contributor to overdose risk and should be addressed as part of comprehensive overdose prevention efforts.
Food insecurity also creates barriers to prevention, treatment, and recovery. When someone is worried about where their next meal is coming from, attending healthcare appointments, accessing behavioral health services, or focusing on recovery becomes much more challenging.
By recognizing the relationship between food insecurity and overdose risk, healthcare providers, community organizations, and public health professionals can develop more comprehensive prevention strategies that support healthier, safer, and more resilient communities.
References
Dahlhamer, J. M., Lucas, J. W., Zelaya, C. E., Nahin, R. L., Mackey, S., DeBar, L., Kerns, R. D., Von Korff, M., Porter, L., & Helmick, C. G. (2021). Prescription opioid use among adults with chronic pain: United States, 2019. National Health Statistics Reports, 162, 1–13.
Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830–1839. https://doi.org/10.1377/hlthaff.2015.0645
Heflin, C., & Sun, X. (2022). Food insecurity and the opioid crisis. The ANNALS of the American Academy of Political and Social Science, 703(1), 262–284. https://doi.org/10.1177/00027162221149287
Men, F., Fischer, B., Urquia, M. L., & Tarasuk, V. (2021). Food insecurity, chronic pain, and use of prescription opioids. SSM – Population Health, 14, 100768. https://doi.org/10.1016/j.ssmph.2021.100768
Rachel Kachur is a graduate student pursuing her Master of Social Work (MSW) at Tulane University. She earned her Bachelor of Arts in Political Science from Syracuse University and has experience working with nonprofit organizations and in legal immigration services. Rachel is currently completing her field placement with Zero Overdose.
