Research Communications in
Substances of Abuse
Nutritional Status and Immune Function
in Cocaine and Heroin Abusers and
in Methadone Treated Subjects
N.D. Huggins (1), M.A. Khaled (1,2) P.E. Cornwell (2), and J.O. Alvarez (2,3)
Departments of Psychiarty and Behavioral Neurobiology,
(2) Nutrition Sciences, and (3) Public Health Sciences,
University of Alabama at Birmingham, University Station,
Birmingham, Al 35294, U.S.A.
Abstract
The plasma levels of some essential nutrients and the lymphocyte CD 4 to CD8 ratio were measured in four groups of
individuals that included: (a) cocaine and (b) heroin abusers, (c) methadone treated and (d) healthy subjects. Folate and
B-carotene levels were lower in the three drug groups while vitamin C was lower in the methadone and heroin subjects.
Vitamin E levels were boderline low in the methadone and cocaine groups. The methadone group also showed a
significantly higher level of lipid peroxidation which correlated well with the low values observed for the antioxidant nutrients.
Interestingly, the methadone group was the only one with a significantly reduced lymphocyte CD4/CD2 ratio.
Introduction
Drug users, particularly intravenous drug abusers, are at signigicant risk of contracting HIV, hepatitis B and other infections.
Chandra, 1983 and numerous other authors have shown that malnutrition and infection are mutually aggravating through
their common association with immunity. Also, malnutrition has been linked to the reduction of lymphocyte T-helper ( CD4 )
to T-suppressor ( CD8 ) ratio ( Casey et al., 1983 ). On the other hand, addictive drugs of abuse have been shown not only to
produce significant nutritional aberrations ( Mohs, Watson and Leonard Green, 1990), but can also modulate
immunocompetence ( Donahoe and Falek, 1988).
Almost 25 years ago, methadone maintenance programs were started to prevent drug abusers from taking hard-core
narcotic drugs. Methadone, however, is a psychoactive drug, which ranks 17th on the Drug Abuse Warning Network, albeit
far below heroin. Immunological abormalities have been reported to occur frequently in heroin addicts and in methadone treated
subjects ( Kreek, 1990 ) although Novic et al., 1989 have reported that subjects on methadone programs for more than 11
years have normal immune functions in terms of CD4/CD8 T-cell ratio. Recently, however, Herbert et al., 1990 reported
nutritional abnormalities in terms of body mass index (BMI), hematocrit and hemoglobin concentration in patients on
a methadone maintenance program.
Nutritional status in general and specific nutrient imbalances in particular have been shown to affect the immune response. It is
plausible that nutritional deficits, common in drug abusers, may mediate or contribute to the deterioration of the immune
function in these individuals. Since there is a lack of information in the literature, a preliminary study was designed in order to
gain some insight into this problem.
Methods
Twenty-four human subjects participated in this study to compare four groups of six subjects: group 1, healthy subjects as
control; group 2, methadone treated for more than six months and less than five years; group 3, heroin addicts prior to entering
into the methadone maintenance program; and group 4, cocaine abusers. Noneof the subjects were HIV positive and the
human use protocol was approved by the Institutional Review Board of the University of Alabama at Birmingham (UAB).
Blood samples were withdrawn from each subject for the analysis of some essential micronutrients and to estimate their immune
status in terms of CD4/CD8 including lipid peroxidation ( as MDA ) and glutathione ( GSH ) levels.
Vitamin levels were determined using standard laboratory procedures in UAB's Nutrition Diagnostic Laboratory while the
measurements of CD4 and CD8 cells were made by the fluorescence tecnique ( Fahey, et al., 1984 ) using FITC conjugated
OKT4 and OKT8, respectively. The GSH level was measured spectophotometically, ( Beutler et al., 1963 ) and the lipid
peroxidation level in terms of malondialdehyde ( MDA ) production was estimated by HPLC ( Satoh, 1978 ). Statistical
calculations were performed by using ANOVA analysis and the significant differences are reported in the table.
Results and Discussion
The values in the Table show that the drug abusers in general have considerably lower folate and carotene levels. The vitamin C
status in both methadone and opiate groups were significantly lower than the control while the cocaine group showed a value
that falls in the lower side of the normal range. Although the vitamin E status was not statistically different, the values in the
methadone and cocaine groups were borderline normal.
In summary, the methadone group has more nutrient shortages than either the heroin or cocaine abusers, showing low values for
folate, and the antioxidant nutrients B-Carotine, vitamin C and vitamin E. Interestingly, the methadone group is the only one
that showed significantly elevated levels of MDA indicating an abnormally high level of lipid peroxidation. This supports the
notion that methadone treatment may be associated with an increased utilization of the body's antioxidant systems.
The finding that only the methadone-treated subjects have a lower lymphocyte CD4/CD8 ratio ( see table ) may suggest a
relationship, direct or indirect, between thir level of free radical production ( i.e., as evidenced by a high lipid perioxidation and
low levels of antioxidant nutrients ) and their immune function. It is not clear whether the methadone treatment is the cause of the
depletion of the antioxidant nutrients and immunodepression or whether the latter may result from the life-style and poor died of
these subjects.
Although the sample size in this preliminary study is small, the results presented here provide some significant information on the
nutritional status of drug abusers. Since intravenous drug abusers have a higher risk for contracting HIV infection and since
free radicals may be involve in the pathogenisis of viral infections, particularly AIDS ( Papadopulous-Eleopulos, 1988 ), the
potential interaction between nutritional status and immunodepression in these subject becomes even more important.
Cellular oxidative injury, mesured as an increased production of malondialdehyde ( Sonnerborg, et al., 1988 ) may play a role
in the progression of HIV infection. A double-blind, placebo-controlled study with sodium diethyldithiocarbonate, a potent
antioxidant, in patients with AIDS or AIDS-related complex have shown significant reduction in primary opportunistic
infections ( Lang, et al., 1988). Based on this information, a pertinent question may be asked: Will the nutritional and
immunological status of HIV-infected drug abusers who enter into methadone maintenance programs deteriorate fater, thus
leading to an earlier onset of full-blown AIDS disease? A larger, more thorough investigation of this relationship
is, therefore, warranted.
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