Disaster planning should account for the emergency that’s already here — the opioid epidemic| Opinion
As North Carolina enters the second year of recovery from the devastation caused by Hurricane Helene, it’s worth turning our attention to the impacts this disaster has had on a historic crisis already plaguing Appalachia: opioid use.
As a community health center physician in Boone, I saw firsthand how patients in recovery for opioid use disorder (OUD) are left out of disaster planning. The consequences have been dire.
One patient, “Alex”, had been stable on a medication called buprenorphine for six months and was rebuilding his life after a long incarceration. When Helene hit, he was rescued from his flooded trailer by a boat. After a stay in an emergency shelter, he wound up in a hotel room with four adult family members, two children, and five pets for months. Alex was cut off from public transit — he couldn’t reach his clinic, pharmacy or job. As a result, he missed appointments and treatments. Eventually, he fell back into fentanyl and methamphetamine use, and is now back in prison. After Helene, Alex faced insurmountable barriers to what should have been simple: refilling his medication. We can do better.
Like hypertension or diabetes, recovery from OUD depends on steady, consistent treatment. But patients face a unique challenge: recovery medications are among the most heavily regulated. Federal and state rules require frequent in-person clinic visits, electronic prescription tracking, stocked pharmacies, and reliable communication systems. After Helene, many of those essentials – including phone service, power, passable roads, and dependable supply chains — were gone. Regulations meant to protect patients in “sunny weather” became barriers to treatment as essential structures collapsed.
Meanwhile, access to street opioids, including fentanyl, remains widespread in rural Appalachia, where opioid-related overdose deaths were 64% higher than the national average in 2022. Natural disasters can further increase substance use, both among people who have a history of substance use and those who do not. For example, a study comparing injectable drug use habits in Puerto Rico before and after Hurricane Maria found that monthly injectable drug use rose from 3% before the hurricane to 22.7% after the hurricane, and study participants were twice as likely to have experienced a drug overdose following the storm.
For those in treatment when a disaster strikes, continuity of care can become impossible. When Hurricane Sandy hit New York City in 2012, one study found that 70% of those on opioid maintenance therapy were not able to obtain their full prescription doses. For people facing withdrawal — without their prescribed buprenorphine and potentially in emergency shelters or homes without running water or electricity, while also coping with trauma — fentanyl may seem like the only option. In these settings, risks of overdose, relapse, incarceration, and family disruption intensify, compounding the devastation of the disaster itself.
After an extreme weather event, time and resources are spread thin. Some might argue that we ought to prioritize the health needs of infants, elders, and others with visible vulnerabilities in our communities. That’s true, and we must prepare to support everyone at risk. Making sure that people can stay on their recovery medications not only supports our state health department’s goal of expanding access to evidence-based care, it is also a meaningful strategy to care for many others at risk. When people in recovery stay on stable treatment, they are better able to care for their families, maintain employment, and support others in their community.
Minimizing harms from severe weather requires coordination among government and community organizations. We already plan for groups at higher risk including infants, elders, those with unstable housing, food insecurity, disabilities and chronic illness. Yet, no comprehensive plan exists to support the unique medical needs of people in treatment for opioid use disorder after a disaster. As we continue to hone our responses and prepare for the next weather emergency, Governor Stein and North Carolina’s emergency response community must ensure that these patients are not left behind.
Strategies to consider include:
• Allowing phone visits when in-person or video visits aren’t possible.
• Giving alternate providers or pharmacists temporary access to treatment plans to ensure continuity of care.
• Including buprenorphine and similar medications in emergency stockpiles, with appropriate security measures. • Pre-identifying helicopter or drone landing sites for medication delivery.
• Equipping outreach teams and first responders to provide short-term refills while connecting patients to functioning longer term services.
• Incorporating these scenarios into emergency response drills. Since Helene, our western North Carolina communities have become more aware of the need to prepare for the next severe weather event. That awareness will continue to spread as weather emergencies become more frequent. By planning for everyone at risk, including those with a history of opioid use disorder, we can give people like Alex the best chance to care for themselves, their children, and their communities.
Dr. Stearns lives and works in western North Carolina and is the chief medical officer for High Country Community Health.