Challenges to Opioid Treatment Programs After Hurricane Sandy: Patient and Provider Perspectives on Preparation, Impact, and Recovery

ABSTRACT

Over 300,000 patients with an opioid use disorder (OUD) receive methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in New York and New Jersey, areas (largely but not exclusively coastal) impacted by Hurricane Sandy (Sandy) on October 29th, 2012. Disruption of methadone dispensing and other services can have severe consequences to patients (and treatment seekers) such as relapse, dropping out of treatment and resumption or increase in HIV/HCV injection risk behaviors. To facilitate OTP preparedness and response, we developed recommendations for OTPs for future emergencies. Using both qualitative and quantitative measures, we obtained data from OTP directors, staff, patients and out-of-treatment persons to learn how OTPs prepared for the impending hurricane, whether recovery efforts were successful, and what impact the hurricane has had. We observed a wide range of preparation and recovery efforts among participating programs. Director, staff, and patient perspectives on programs' responses and storm impact often differed. Triangulated data suggest that program responses were adequate for a majority of patients. For a sizeable minority of patients, program responses were very successful; for at least 20% of the clinics, program planning and responses were inadequate to meet the needs of patients. Among the recommendations made for sustaining continuity of care in future emergencies are: a focus on improving communication, procuring transportation, guest dosing, and take home provisions.

KEYWORDS:

• Disaster preparedness
• opioid treatment
• Hurricane Sandy
• methadone
• buprenorphine
• treatment access
• OTPs

Acknowledgment

The authors would like to thank the state authorities, OTP directors, staff and patients, and harm reduction clients who participated in our study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

The study was funded by grant # HITEP140014 from the Health and Human Services Office of the Assistant Secretary for Preparedness and Response.