By Elizabeth Brico
Original Source: vox.com
“It’s awful. I haven’t dosed in 5 days.”
The message popped up on my Facebook feed on August 29, a day after Hurricane Harvey first hit Texas. A woman named Clair, a methadone patient who lives near Houston, could not make it through the flood waters to get the dose she needed. She was going through withdrawal.
This was just one of several such stories populating my newsfeed. I’m a recovering heroin addict and former methadone patient who lives in Seattle, far from the paths of Hurricane Harvey or Hurricane Irma. But through a private Facebook group for methadone patients and allies, I’ve witnessed a crisis develop: the inability of people in addiction recovery to access methadone due to the storm.“It happened so fast and took a turn for the worst so fast we didn’t have time to prepare,” Clair wrote. “Keep us in your prayers.” A day later: “Today is day 6. I’m very sick.” She stopped responding to replies after that.The desperation of Clair’s comment reminded me of my own experience trying to obtain methadone doses in the middle of a natural disaster. It was the Fall of 2013 when Boulder was hit with record floods that destroyed 1,500 homes and took the lives of eight people. On the day of the flood, I was stranded at home with no way to access a methadone clinic. I was five months pregnant. Missing my dose wasn’t just about being in pain — it was about my unborn baby, who might not have survived the physical toll of withdrawal.
Not having access to methadone was my worst fear. It’s a fear that consumed both body and mind, fueled by memories of nights without heroin, and rumors shared in the clinic waiting rooms that methadone withdrawals are even worse.
Methadone is a long-acting prescription opioid primarily used as a replacement therapy for opioid addiction. Patients are prescribed controlled doses of the drug to help them recover from heroin or painkiller addiction. There are an estimated 360,000 methadone patients in the United States and approximately 1.4 million worldwide, according to the addictive diseases laboratory at Rockefeller University.
I enrolled in a methadone program in 2013, when I became pregnant while battling heroin addiction. Methadone was a safe way for me to ensure I wouldn’t go into withdrawal, which might have ended my pregnancy.
Methadone regulations in the United States are extremely strict. New patients must take their daily dose at a dedicated clinic, racking up single “take-home” doses over months and years of satisfactory urinalysis results that signify they aren’t taking other drugs. Even though methadone does not have euphoric effects, it is more regulated than other prescription drugs like oxycodone.
When a natural disaster hits, these strict standards often become impossible to maintain amid the chaos. With so many people in acute danger, methadone quickly becomes deprioritized. Though state authorities sometimes allow for shelters and hospitals to dispense doses, or for clinics to allow patients to take the drug home, protocols vary from location to location. The stigma that drives the strict regulations still exists during a disaster.
And methadone is just one drug. Countless other pharmaceuticals are necessary for people to stay healthy during natural disasters. Storms, floods, and wildfires create unforeseen complications that can prevent people from accessing needed medication. These stories are too often overlooked.
As natural disasters continue to batter our nation, stories like Clair’s will become even more common.
The flood that almost made me miss my dose
When the creek water surged from its banks and spilled onto the streets of Boulder, Colorado, I was five months pregnant, and taking 40 mgs daily of methadone. By Friday, September 13, 2013, Gov. John Hickenlooper had already declared Boulder County under a state of emergency. My university was closed. Shops were dark and empty. All of my schoolmates were inside keeping dry, but I couldn’t miss my dose. So I trudged through town while the rain quickened.
What people never mention about floods is the silence. We’re used to imagining floods as noisy events, the way we see on television, where every shriek and surge is amplified. But what I remember as I walked to the clinic was the total quiet.
The clinic was just a few blocks from my bus stop. “Hey, are you going to be open tomorrow?” I asked the receptionist.
“We’ve never closed for rain,” she answered.
I wasn’t convinced. What would I do if she was wrong? Methadone can take up to two days to leave your system, but once the withdrawals begin, they are extremely harsh. People commonly describe opiate withdrawal as feeling like an intense flu that you know you can instantly cure with a dose. That’s technically accurate, but it fails to capture the full scope of the experience. Withdrawal feels like being deprived of something you need in order to survive. I asked the receptionist to see my case manager, who could potentially authorize “take-home” doses to last the weekend. He was willing to see me, but did not authorize the take-homes, certain the clinic would not close.
That evening, the phrase “100-year flood” made its first appearance on my Facebook feed. The next morning, I was greeted by a text alert from my clinic’s emergency communication service. As I suspected, it was closed. I was told to go instead to a clinic in Denver, which would be open till 3 pm.
I swore and shook my husband awake. We checked the bus routes and learned they weren’t running. I spent hours that day back and forth on the phone with my counselor, and the State Methadone Authority. I was near tears, begging them to find a way for me to dose as rain pounded on our windows. After hours with no results, my husband began scrolling through his phone, trying to locate contact information for a heroin dealer who might be able to serve me. We’d been sober for four months, but the prospect of losing our baby if I went into withdrawal was unbearable.
My counselor called back. “I got through to FEMA,” she said, “they’re going to helicopter you to the Denver clinic. I’ll call you back soon with the details.”
I stared out our small basement window, shocked. How was a FEMA helicopter easier to obtain than a methadone dose? And while this was the solution to our biggest problem, it was one that came with other issues. Our landlord, who lived in the main portion of the house, had made it clear to me that she held little sympathy for addicts. She didn’t know about my prescription, and it was going to be really hard to explain the helicopter in her front yard.
When my counselor called back, the phone lines were beginning to fail. She told me the Lafayette hospital had agreed to dose me and give me take-homes for the rest of the weekend. She helped me arrange a cab ride, paid for by emergency funds, and I was able to dose at the hospital. My nightmare was over for the time being.
When I stepped back into the clinic on Monday, open again as promised, the lobby was abuzz with stories from listless, sweat-slicked patients who were waiting to dose for the first time in days. My pregnancy had led the hospital to agree to dose me, but many other people were left stranded. Not everyone was as lucky as me.
Methadone patients in Harvey
Colorado’s “100-year flood,” now known as the Front Range flood, lasted eight days. The single Boulder County methadone clinic was closed for two. Compared to the devastation caused by Hurricane Harvey in the state of Texas, or the havoc that Irma will almost certainly unleash on Florida, it was a minor event.
As the weather settles over Houston, the storm’s toll is still being assessed. At least 17 people are dead, and more than 30,000 in the Houston area have been evacuated from their homes. For those enrolled in methadone maintenance treatment, evacuation also means leaving their home clinics, sometimes without any doses.
I reached out to several people from my methadone patient Facebook group who got hit by Harvey to get a sense for how they are coping. Clair, the methadone patient who went a week without dosing, told me on Facebook messenger that her Houston clinic remained open during most of the hurricane and its aftermath. Still, flooding prevented her from reaching it. She was only able to dose when a friend gave her a take-home. She says the withdrawals were like nothing she ever imagined.
“Don’t get me wrong,” she explained, “I’ve detoxed many, many times before. But this time was different. My family, my town, my state was going through a disaster like we’ve never seen before. And knowing an ambulance couldn’t get to me because water was up to our red lights was the most bone crunching sense of panic I’ve ever felt.”“If I could have made it into Houston, I would have relapsed in a heartbeat,” she added.
Tyler, a methadone patient in Corpus Christi, told me on Facebook messenger that his clinic provided him with just three take-home doses, enough to get him through the weekend. When Monday came around, roadway flooding prevented him from accessing his clinic. He tried calling his program to get help, but the lines were down. He describes those two days without medicine as hell.
“I woke up next to my 2-year-old daughter and immediately had to go to the bathroom,” he reports, “I was in there for about 45 minutes. I came out and was sweating … I could barely move.” “
He tried his best to help with their 2-week-old son, but the jitters, lethargy, and gastrointestinal problems that mark opiate withdrawals prevented him from holding the baby longer than five minutes. By Wednesday, the roads were clear enough that he could get to the clinic. There he learned it had been open but without power since Monday. No more take-homes were being dispensed. What about other patients in the areas that are still affected by flooding?
Substance abuse services need to prioritize methadone patients during natural disasters
When I think about my own experience in the Boulder floods, I remember clinic workers who just weren’t prepared to care for patients during a natural disaster. I began to wonder how national organizations dedicated to treating substance abuse think about this issue.
Nicole Smith, who oversees certifications and wavers to dispense methadone at the national Substance Abuse and Mental Health Services Administration, or SAMHSA, told me over the phone that all methadone programs are required to have emergency contact services in place to reach patients, like the text message I received during the Colorado flood. If they had been successful in locating Clair, Smith said, she may have been able to have a dose delivered to her by boat, or to dose daily at a local shelter.
Still, Smith admits that while all Texas and Louisiana hospitals are authorized to dose verified methadone patients during Harvey, it is ultimately up to the hospital’s discretion. When asked to provide statistics about how many patients received methadone in hospitals during the disaster, neither Smith nor the two other SAMHSA colleagues on the phone could do so.
Joycelyn Woods, the executive director for the National Alliance for Medication Assisted Recovery, a methadone advocacy group, offers a different opinion.
“When you go to a regular doctor of medicine, they don’t view [addiction]as a medical issue,” she tells me over the phone from New York.
It is historically common for methadone clinics to be ill-prepared to dose patients during disasters. During Hurricane Katrina, shelters were not authorized to dispense methadone, so displaced patients going through withdrawal found themselves quarantined by inexperienced care workers. New York City was unprepared for the longevity of Hurricane Sandy’s aftermath, and many patients suffered unpredicted clinic closures and other dosing disruptions. Besides the discomfort of withdrawal, these types of inadequacies during traumatic disasters leave patients vulnerable to relapse. Tyler, for example, admits that the only reason he didn’t get high was because he couldn’t reach a dealer.
Numerous studies confirm that opiate addiction is a physical disorder that results from a combination of environmental and genetic factors, not the outcome of moral weakness. The deprioritization of methadone patients during crisis situations is a result of long-standing stigma. Now that Tyler has been able to dose, he is heading out to a neighboring town that is still flooded to help with relief work. But he could never have done that while he was in withdrawal. Denying these patients their medication needlessly disables a population that could otherwise contribute to the relief efforts.
It will likely be months before we know how well the teamwork between SAMHSA and the Texas and Louisiana State Opioid Treatment Authorities worked during Hurricane Harvey. Now, as Hurricane Irma heads toward Florida, we can only hope that area patients are able to get their doses.
For now, many of them remaining waiting, posting Facebook messages to see if anyone can help.
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