As Hurricane Florence barreled toward the southeastern United States in September, North Carolina officials and relief organizations banded together to preemptively help a group of people often overlooked during natural disasters: opioid addicts.
While efforts to supply medication weren’t entirely flawless, experts say North Carolina’s response is an early model for other states. As both nationwide addiction rates rise and storms become increasingly severe and destructive, this is undoubtedly a crisis first responders will have to manage again.
“I don’t think we’ve had a storm, or haven’t in a long time, of this magnitude that caused us to have to make such extreme decisions and staff involvement to make this work so that everybody would remain safe,” Kenny House, vice president of clinical services at patient treatment provider Coastal Horizons Center in Wilmington, North Carolina, told ThinkProgress.
ThinkProgress spoke to individuals from aid organizations and the state health department who worked on relief efforts during Florence. Everyone said they felt that, overall, North Carolina’s efforts to assist residents with opioid addictions were successful, and that the state’s proactive approach paid dividends. This includes easing access to medication ahead of the storm to keeping clinics up and running as much as possible during and after Florence hit.
“We all kind of pitched together to make [it] work, including our state authority,” House said.
In North Carolina, a growing number of people are addicted to opioids. Between 2016 and 2017, drug overdoses in the state increased by 22 percent, according to estimates by the U.S. Centers for Disease Control and Prevention. During this time, some 2,515 people are thought to have died as a result — the second-highest rate in the country.
It’s not just North Carolina: across the U.S., opioid addiction and overdoses are on the rise. And natural disasters, like hurricanes, are an unhelpful stressor.
After Superstorm Sandy in New York, one study of people who injected drugs found the storm had a measurable impact: 60 percent of those interviewed experienced withdrawal after the storm, while 70 percent said they couldn’t get sufficient doses of their medication one week after the storm. And following Hurricanes Matthew and Irma, shelters in Florida reported drug overdoses as a new challenge to tackle.
While it may be difficult to draw a direct correlation between a storm and an individual’s death due to overdose, experts agree storms are disruptive. Beyond that initial connection, it’s clear more research is needed; the Superstorm Sandy study, for instance, didn’t compare its data to pre-hurricane figures. It did, however, show that severe storms make it far more difficult for residents to access regular medical treatment.
Not being able to access treatment as one does regularly can risk triggering withdrawal symptoms during a disaster. Disruptions and withdrawal symptoms can then lead to some people seeking out riskier options, such as sharing needles or using other drugs. All of this exacerbates the risk of overdose in an indirect way.
“We have seen this issue over and over again in many disasters,” Mary Casey-Lockyer, senior associate for disaster health services at the American Red Cross, told ThinkProgress.
“For a lot of people, [treatment is] considered a basic essential because it’s what allows them to function on a day-to-day basis in a way that works,” House said.
“Oftentimes, people don’t realize that for our people, medication sometimes takes priority over food,” he continued. “Because, they know that if they don’t get their medication, something very, very bad can happen. So, these people are more tolerant of sleeping in the woods than they are of going to sleep without their medicine.”
Medication to treat opioid addiction — methadone and buprenorphine in particular — is tightly regulated in North Carolina, but there are 70 opioid treatment centers that provide daily services to 20,000 patients across the state. Georgia has a similar number, while other states have far fewer. Tennessee, for instance, has only 13.
Before Florence made landfall, residents had to make sure they had sufficient medication to last through the initial days of the storm; if not, they could risk withdrawal or relapse. Due to the strict regulations, it’s often difficult to get more than the typical daily dosage. To help with this, North Carolina’s opioid treatment authority, with federal guidance, relaxed the rules to allow for between four and six days’ worth of take-home medication for those living in areas at highest risk from the hurricane. These extra dosages helped many people weather the storm until the rain stopped.
The state “strongly encouraged treatment programs to grant these exceptions for take-home doses of medication to the degree the medical director deemed necessary and appropriate,” a spokesperson for the North Carolina Department of Health and Human Services (DHHS) told ThinkProgress via email. Individuals could also receive their medication from other licensed opioid centers if theirs was closed, or if they had to evacuate to a different city.
And for North Carolina, making all of these exceptions was a big step. “I think it is fairly new,” House said, “in the sense that I think the state’s intervention was more proactive than it had been in the past.”
House said that the state’s opioid treatment authority “was extremely proactive with us… to make sure that nobody got hung up on red tape in the process of giving people what they need. The emphasis was on taking care of the patient and safety. And I think that kind of carried through.”
For shelters, meanwhile, having safety supplies on hand, like clean needles and doses of naloxone, is also important to prevent overdoses and the spread of injection-related disease. Health department officials worked with the Red Cross to distribute naloxone kits and train staff in shelters and equipped the state’s public health nurses with kits.
Prior to Florence, the Red Cross adopted a new policy to have naloxone on hand during disasters in shelters with over 80 people. During the storm, it had some 980 doses of the common naloxone brand Narcan available in its shelters across North and South Carolina to be administered by volunteers if needed. It also helped coordinate access to clinics or mobile deliveries from the clinics to the shelters.
For those not in shelters, however, access to some treatment centers was restricted during the storm. One program was under mandatory evacuation and had to close for five days, others had minor storm damage, several operated without power, and some had employees who were affected by the storm. In Wilmington, among the worst hit cities, a local treatment program “had trouble with receiving necessary supplies,” the DHHS spokesperson said.
In response, centers shifted their hours and many waived their guest dosing fees to serve displaced people. “Two programs waived all fees for displaced individuals, and many served displaced patients regardless of their ability to pay,” according to DHHS.
Margaret Bordeaux, an outreach and volunteer coordinator with the North Carolina Harm Reduction Coalition, echoed the feeling that centers were prepared. For the most part, things went smoothly — particularly for the Coastal Horizons treatment center in Wilmington. Others experienced a few “hiccups,” she said in an email to ThinkProgress.
Bordeaux said most of the challenges she heard about included some providers or pharmacies not having enough supplies in stock or clients who were unable to get their prescriptions filled due to closures. Some shipping trucks also had difficulties reaching certain areas due to flooding. Wilmington, for instance, became an island for days until the water receded.
Despite all the preparations, though, experts caution that many residents who needed help might not have been reached. For those already in treatment who needed extra assistance during the storm, they could access it, but, “obviously for people who needed to be in treatment I’m sure it was a whole different story,” said House.
Once the storm passed and people started to return home, the challenges didn’t end for North Carolina residents. Many people continued to struggle to access opioid addition treatment.
As DHHS told ThinkProgress, “In the most impacted areas of the state, people have reported not being able to access treatment due to flooding in their homes and road closings, and some have reported difficulty attending treatment due to modified hours that conflicted with their work requirements.”
People struggling to find work after the storm may also not be able to afford their medication — a particular challenge for people earning hourly wages. According to a jobs report released in September 2017, businesses across the Southeast lost 33,000 jobs that month, largely due to Hurricanes Harvey and Irma. Some 1.5 million people were unable to work as a result of the storms, according to the government — the highest number in 20 years.
“Sometimes… clinics might be open but the clients may not be working and so they don’t have the co-pays,” Casey-Lockyer said, adding that the Red Cross sometimes helps cover these costs.
Several weeks removed from Florence, North Carolina is still reeling from the impacts of one of the country’s wettest storms on record. But as storms become more intense with climate change — moving slower and dumping ever more water over cities — and the opioid crisis continues to worsen, North Carolina showed that advance planning, as Casey-Lockyer said, “is necessary to address the critical health needs of individuals affected by disaster.”
House agreed. “We learned that preparation and not underestimating the effort that goes into preparation, is really essential,” he said.