To smoothie or not to smoothie? A mixed-method approach of nutrition pilot intervention among individuals in opioid agonist treatment.

Background: Patients with substance dependence typically have unhealthy diets and low degree of nutritional awareness. They frequently face nutritional deficiencies in both micro- and macronutrients, which can have a significant impact on their overall health. Incorporating more fruits and vegetables into their diet has been associated with reduction in diseases such as cardiovascular diseases and certain cancers. This mixed-method study aims to gain insight into participants' experience and feasibility of a pilot intervention of receiving 250 ml/day of fruit smoothies for a six-week period.

Methods: Individuals undergoing opioid agonist treatment in Bergen and Stavanger, Norway, were recruited for this multi-center pilot study. This study had a pre- and post-intervention design where an explanatory sequential design was employed, integrating qualitative methods to delve into patients' experiences and perspectives. In addition, psychological distress (Hopkins Symptom Checklist (SCL-10), fatigue (three-item Fatigue Severity Scale (FSS-3)), and nutrition status (folic acid) were measured.

Results: Twenty-four individuals with a mean age of 47 years (standard deviation: 8.6) participated. They expressed feeling more energetic and being more active, and some reported eating more meals than before and adding new food items to their diet. Oral health was a barrier to eating more vegetables and fruits while smoothies, on the other hand, were easy to consume even with poor dental status. There were no clear indications of changes in psychological distress (pre-test: 2.09 vs. post-test: 2.08) or fatigue (post-test: 4.19 vs. post-test: 4.43). Folic acid levels increased from 15.3 nmol/L at baseline to 17.0 nmol/L after the intervention.

Conclusion: Receiving fruit smoothies seems to have several benefits for patients undergoing opioid agonist treatment, including helping them reflect on their health and diet and expressing more awareness about nutrition. Providing smoothies alongside patients' opioid agonist treatment was seen as feasible and can be a door opener for clinicians to discuss nutritional issues in this population. To evaluate the effectiveness, a sufficiently powered randomized controlled trial is needed.