When Hurricanes Strike, Recovery Medications Become a Lifeline at Risk

When Hurricane Helene tore through western North Carolina in September 2024, Toni Brewer did what thousands of others did—she packed her car and evacuated. But as she opened the center console hours later, she discovered a crisis within the crisis: just three days of Suboxone remained.

For someone 18 months into recovery from opioid addiction, running out of buprenorphine isn't merely inconvenient. It represents the threshold of withdrawal, craving, and potential relapse. "It's terrifying just to have that feeling again of, 'I need this, and I'll do whatever it takes to get this,'" Brewer recalled.

Her story, detailed in a new NPR report, illustrates a growing concern among addiction medicine specialists: as climate change intensifies natural disasters, patients in medication-assisted treatment face disproportionate risks. Four physicians have now published an editorial in the American Journal of Public Health urging federal lawmakers to reform emergency protocols for substance use medications.

The Data Behind the Danger

Research consistently shows that disasters disrupt addiction treatment access with deadly consequences. After Superstorm Sandy struck New York in 2012, an estimated 70% of patients on recovery medications couldn't obtain sufficient supplies. Following Hurricane Maria's devastation of Puerto Rico in 2017, overdose reports increased over the subsequent two years. California's Tubbs and Camp fires caused substantial disruptions in medication access for patients across Northern California.

The pattern isn't coincidental. Natural disasters compound existing vulnerabilities—destroying clinics, closing pharmacies, severing transportation routes, and overwhelming emergency services. For patients on tightly regulated medications like methadone and buprenorphine, these disruptions can prove catastrophic.

"We make it so challenging for them to access treatment medications in the first place," said Dr. Elizabeth Cerceo, climate health director at Rowan University's Cooper Medical School and co-author of the AJPH editorial. "When people are displaced or unable to get to their usual clinics or pharmacies, those challenges just become insurmountable."

Regulatory Barriers in Crisis

The obstacles facing patients during emergencies aren't merely logistical—they're embedded in federal policy. Methadone for opioid use disorder can only be dispensed through federally regulated opioid treatment programs requiring in-person visits. When Hurricane Helene forced these clinics to close for days or weeks, patients had no legal alternative for obtaining their medication.

Buprenorphine, while more accessible under the MAT Act of 2022, faces its own barriers. The Drug Enforcement Administration's suspicious orders reporting system restricts pharmacy supply when orders exceed specified thresholds. In western North Carolina, this system delayed medications repeatedly after Helene—without exceptions for disaster circumstances.

Dr. Blake Fagan, clinical director of substance use disorder initiatives at the Mountain Area Health Education Center, documented cases where pharmacies refused to fill prescriptions for evacuees. "They didn't want to fill a month's worth," Fagan reported. "And in our mind, we're sitting in the disaster, and we're like, 'They're not coming back in a month.'"

What Patients Endure

Dr. Cordelia Stearns, chief medical officer at High Country Community Health in North Carolina's Blue Ridge Mountains, said her clinics' first calls after Helene were for buprenorphine. Patients traveled over mountains and crossed rivers to reach medication.

"The things that my patients did to be able to access their bupe," Stearns said, "it was astonishing."

Toni Brewer's experience exemplifies this determination. After discovering her depleted supply, she logged into her patient portal—uncertain whether any physician would respond given the communications breakdown. Two doctors did respond, and one filled her prescription. But when she reached the local Walgreens, they were out of stock. She drove to Clayton, Georgia, where she finally obtained a month's supply—paying $130 out-of-pocket because North Carolina Medicaid wouldn't cover out-of-state purchases.

The cost represented a significant burden for someone who had temporarily lost employment when her workplace, a sober living facility, closed due to storm damage. But Brewer paid it. The alternative—relapsing into active addiction—was unthinkable.

Proposed Solutions

The AJPH editorial outlines several policy reforms that could protect patients during future disasters. The authors recommend allowing patients to take home larger medication supplies when emergencies are forecast, creating interstate registries of patients on recovery medications who need treatment access when evacuating, and incorporating substance use medication needs into formal disaster response planning.

Specific proposals include stocking emergency vehicles with buprenorphine, installing backup generators at opioid treatment clinics, and training volunteer responders in medication access protocols. The authors also urge states to adopt emergency measures like those North Carolina implemented after Helene—temporarily relaxing restrictions to ensure continuity of care.

The Substance Abuse and Mental Health Services Administration coordinates with states to prevent medication disruptions, and spokesperson Emily Hilliard noted that states can approve emergency flexibility measures. But the process varies by jurisdiction, and not all states have established protocols.

An Emerging Climate Threat

As climate change increases the frequency and intensity of natural disasters, the intersection of environmental and public health policy grows more urgent. The same storms, fires, and floods that displace communities also disrupt the delicate infrastructure supporting addiction recovery.

For the more than 800,000 Americans who have died of overdose since 1999, and for the millions more in various stages of recovery, these disruptions aren't abstract policy questions. They're immediate survival concerns.

Toni Brewer eventually made it home to Asheville. Her panic subsided once her prescription was secured. "Now I can worry about everything else," she remembered thinking. But the experience revealed how quickly disaster can threaten the stability that recovery requires—and how much work remains to build resilient systems for the patients who depend on them.