When Natural Disasters Strike, Another Crisis Hits Those Recovering From Opioid Addiction
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A day after Hurricane Helene hit western North Carolina in late September 2024, Toni Brewer had no power or water. The storm had scattered fallen trees across most roads, destroyed phone and Internet communications and submerged some neighborhoods near his Asheville home.
Brewer emptied the food in her refrigerator, grabbed some clothes and drove more than an hour southwest with her partner to Franklin, to stay with relatives.
When she arrived, she opened the center console of her car, where she kept her medication, and discovered another seizure. She was just three days into Suboxone, a brand of buprenorphine, a prescription medication that relieves opioid cravings. Without it, she risked falling back into a life she described as miserable.
She remembered what it felt like to have these urges and panicked.
“It’s terrifying to feel that feeling again of ‘I need this and I’ll do whatever it takes to get it,'” said Brewer, who was then in recovery from 18 months of opioid addiction. She needed a new prescription, but knew the communication lines at her doctor’s office were down.
Now, a group of doctors is using the example of Hurricane Helen to urge federal lawmakers to help improve access to addiction medications during a climate emergency. Four doctors working in the addiction field published an editorial in the American Journal of Public Health that outlines strategies for providing medication to people recovering from natural disasters.
As climate change threatens to bring an increasing number of disasters to the United States, the doctors’ group urged state and federal governments to act quickly or risk allowing more disasters to worsen overdoses, relapses and deaths caused by opioid use disorder, an ongoing epidemic that has killed more than 800,000 people in the United States since 1999.
One study estimated that after Superstorm Sandy in 2012, 70 percent of New Yorkers who relied on recovery medications didn’t have enough. In the two years following the devastation caused by Hurricane Maria in Puerto Rico in 2017, overdose reports increased, another study found. The Tubbs and Camp fires in Northern California caused substantial disruptions in patients’ access to opioid addiction medications, according to a study published in 2022.
A combination of factors is worsening the opioid crisis in the United States, AJPH editorials noted. Mental health stressors, treatment interruptions, drug market volatility, and economic decline all create conditions where climate-related disasters increase the risk of overdose deaths.
“We’re making it very difficult for them to access treatment drugs in the first place,” said Elizabeth Cerceo, director of climate health at Rowan University’s Cooper Medical School and co-author of the editorial. “When people are displaced or unable to get to their usual clinics or pharmacies, these challenges become simply insurmountable. »
The move comes as President Donald Trump has had a markedly different approach to substance use policy over the past year compared to his first term. In 2017, Trump declared the nation’s opioid crisis a national public health emergency and signed legislation, known as the SUPPORT Act, to expand access to treatment.
But his administration has also cut federal resources for mental health and substance abuse services, last year cutting staff at the Substance Abuse and Mental Health Services Administration and ending many grants intended to advance research on prevention efforts.
Disasters threaten treatment
SAMHSA is working with states to ensure access to opioid use disorder medications is not disrupted, Health and Human Services spokeswoman Emily Hilliard said. States can approve emergency measures to give people more flexibility in getting their treatments, she added, which North Carolina has done.
Cordelia Stearns, another co-author of the editorial, saw these access issues manifest in the wake of Hurricane Helene.
Stearns, chief medical officer at High Country Community Health in North Carolina’s Blue Ridge Mountains, said the first calls to his clinics were for buprenorphine. She said people who needed medicine crossed mountains and rivers to get to her clinics.
“The things my patients did to be able to access their bupe,” Stearns said, “it was amazing.”
The editorial’s authors recommend that the federal government work with pharmacies to allow patients to take more medications home in case of an emergency. They suggest keeping a record of patients who have prescriptions for recovery medications and who can receive treatment as they evacuate across state lines.
And they propose factoring the need for such drugs into disaster response plans, whether stocking emergency vehicles with buprenorphine, adding backup generators to opioid treatment clinics, or training volunteer responders.
People with substance use disorders already often have to comply with strict and complex regulations to obtain medications. For example, methadone can only be obtained through an in-person visit to federally supervised opioid treatment centers, many of which closed for days or weeks after Hurricane Helene.
Buprenorphine is monitored by the Drug Enforcement Administration’s Suspicious Order Reporting System, which restricts supply when pharmacies order more than allowed under specified thresholds. The system is intended to detect potential overuse of recovery medications in a region.
Blake Fagan, clinical director of substance use disorder initiatives at Mountain Area Health Education Center in western North Carolina, said the system delayed medication several times in the wake of Helene. No exceptions were allowed, Fagan and colleagues reported.
The agency did not respond to questions about the system.
Individual pharmacies also control who receives medications and who does not. When people try to obtain opioid medication away from home, it can raise alarms.
“We realized there were some pharmacies that would just say, ‘I don’t know this person. I’ll only give you three days, and I’m sure they’ll be back in Asheville soon,'” Fagan said. “They didn’t want to fill a month. And in our minds, we’re sitting in disaster and we’re saying, ‘They’re not going to come back in a month.’
Risk of relapse
When Brewer traveled to Franklin, she immediately logged into the Mountain Area Health Education Center’s patient portal, doubting whether she would be able to get her three-month Suboxone prescription refilled.
Little did she know that her doctors had also left the area to get a stable internet connection. They were trying to call and email patients to fill their prescriptions.
Trying to be thorough, Brewer messaged several doctors. Two responded and one filled her prescription.
But when she went to a local Walgreens, they were out of Suboxone. So Brewer made another trip, this time to Clayton, Georgia, where she was finally able to recover a month’s worth.
The medications that would have largely been covered by North Carolina Medicaid had she remained in the state cost about $130, a steep price for Brewer, who temporarily lost her job when her workplace, a sober living facility, lost power and closed because of the storm.
Despite the little income she had at the time, Brewer said, she paid for her prescription. The idea of slipping back into her previous life while her addiction went untreated scared her, she said.
“I woke up every day and the only thing on my mind was finding my next dose so I could get on with my day, or even just taking care of things like feeding myself or bathing myself and showing up for my daughter,” she said.
Brewer remembers feeling relief after refilling his prescription. His panic vanished.
“Now I can worry about everything else,” she remembers thinking as she drove home to Asheville.
