Outcomes among buprenorphine-naloxone primary care patients after Hurricane Sandy

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.

Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand

“…This was seen as important for the health and wellbeing of clients, developing suitable emergency plans, and in considering issues around stock, dose verification, and scripting in a disaster context. These findings are consistent with previous research highlighting issues that have occurred following disasters in the USA [2,16,17,19,20], particularly around getting access to medication, verifying correct dosages, and obtaining scripts.…”

“…Although buprenorphine treatment had less regulatory barriers, there was no supporting coverage due to the limited number of providers. Tofighi et al [19] investigated the effects of relocating a hospital centre that provided buprenorphine treatment after Hurricane Sandy. Over half of the 91 people they surveyed had treatment disruptions and coped by lowering doses themselves to make the medication last longer.…”

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

“…Prior clinic data suggest a 13 % baseline rate of inaccurate opioid use self-report compared with urine toxicologies (i.e., 13 % of visits involve divergent self-report and urine toxicology results). 5 Many interviews were conducted by staff known to patients as part of our practice, potentially leading some respondents to under-report substance misuse or other aberrant behavior despite being guaranteed confidentiality. Nonetheless, most respondents were quite forthcoming in describing many types of coping strategies, illicit and licit.…”

“…The disaster led to the suspension of clinic services caring for all 132 active patients, along with a variety of citywide hospital, outpatient clinic, pharmacy, and transit closures. 5 On the second day after the Hurricane (Wednesday, 31st October), while the inpatient units of the hospital were being evacuated, Bellevue ambulatory care staff downloaded patient schedule information for targeted groups of "high-risk" patients, including those on chronic opioid maintenance (e.g., the buprenorphine clinic), to triage patient outreach. Using this list of patient phone numbers, the buprenorphine program director attempted to make contact with patients in order of appointments scheduled starting with those who had already had appointments canceled that week.…”

“…Patients with visit intervals of 4 weeks or less were highly likely to have faced difficulties maintaining their supply of buprenorphine peri-or post-event as they would have had the least medication on hand when the storm hit and no refills available. 5 Bellevue's outpatient facilities, including primary care buprenorphine services, were reopened 3 weeks after the hurricane on 19 November 2012.…”