Abstract
BackgroundThe extent of damage in New York City following Hurricane Sandy in October 2012 was unprecedented. Bellevue Hospital Center (BHC), a tertiary public hospital, was evacuated and temporarily closed as a result of hurricane-related damages. BHC’s large primary care office-based buprenorphine clinic was relocated to an affiliate public hospital for three weeks. The extent of environmental damage and ensuing service disruption effects on rates of illicit drug, tobacco, and alcohol misuse, buprenorphine medication supply disruptions, or direct resource losses among office-based buprenorphine patients is to date unknown.MethodsA quantitative and qualitative semi-structured survey was administered to patients in BHC’s primary care buprenorphine program starting one month after the hurricane. Survey domains included: housing and employment disruptions; social and economic support; treatment outcomes (buprenorphine adherence and ability to get care), and tobacco, alcohol, and drug use. Open-ended questions probed general patient experiences related to the storm, coping strategies, and associated disruptions.ResultsThere were 132 patients enrolled in the clinic at the time of the storm; of those, 91 patients were recruited to the survey, and 89 completed (98% of those invited). Illicit opioid misuse was rare, with 7 respondents reporting increased heroin or illicit prescription opioid use following Sandy. Roughly half of respondents reported disruption of their buprenorphine-naloxone medication supply post-event, and self-lowering of daily doses to prolong supply was common. Additional buprenorphine was obtained through unscheduled telephone or written refills from relocated Bellevue providers, informally from friends and family, and, more rarely, from drug dealers.ConclusionsThe findings highlight the relative adaptability of public sector office-based buprenorphine treatment during and after a significant natural disaster. Only minimal increases in self-reported substance use were reported despite many disruptions to regular buprenorphine supplies and previous daily doses. Informal supplies of substitute buprenorphine from family and friends was common. Remote telephone refill support and a temporary back-up location that provided written prescription refills and medication dispensing for uninsured patients enabled some patients to maintain an adequate medication supply. Such adaptive strategies to ensure medication maintenance continuity pre/post natural disasters likely minimize poor treatment outcomes.
Highlights
The extent of damage in New York City following Hurricane Sandy in October 2012 was unprecedented
Population and recruitment The population of interest consisted of opioid-dependent patients enrolled in the Bellevue Hospital Center (BHC) primary care office-based buprenorphine program at the time of the event (N = 132)
While post-traumatic stress disorder and resource loss have been associated with increased substance misuse post-disaster, cultural and social factors were suggested as Survey instrument and analysis A 52-item administered survey instrument was developed and refined by the research team following a review of the disaster, addiction, and post-traumatic stress literature
Summary
The extent of damage in New York City following Hurricane Sandy in October 2012 was unprecedented. BHC’s large primary care office-based buprenorphine clinic was relocated to an affiliate public hospital for three weeks. Hurricane Sandy struck the Northeastern United States on Monday, October 29, 2012. It was the largest and second costliest hurricane in United States’ history that resulted in 117 deaths and approximately $50 to 65 billion in damages [1,2]. The disaster led to the suspension of office-based operations of BHC’s primary care buprenorphine practice, along with a variety of citywide hospital, outpatient clinic, and pharmacy closures. Since 2006, BHC has operated a large primary care office-based buprenorphine practice serving predominantly Medicaid and uninsured patients [3,4]. At the time of Hurricane Sandy, 132 adults were actively in the clinic
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