Effects of Regulation on Methadone and Buprenorphine Provision in the Wake of Hurricane Sandy

Abstract

Hurricane Sandy led to the closing of many major New York City public hospitals including their substance abuse clinics and methadone programs, and the displacement or relocation of thousands of opioid-dependent patients from treatment. The disaster provided a natural experiment that revealed the relative strengths and weaknesses of methadone treatment in comparison to physician office-based buprenorphine treatment for opioid dependence, two modalities of opioid maintenance with markedly different regulatory requirements and institutional procedures. To assess these two modalities of treatment under emergency conditions, semi-structured interviews about barriers to and facilitators of continuity of care for methadone and buprenorphine patients were conducted with 50 providers of opioid maintenance treatment. Major findings included that methadone programs presented more regulatory barriers for providers, difficulty with dose verification due to impaired communication, and an over reliance on emergency room dosing leading to unsafe or suboptimal dosing. Buprenorphine treatment presented fewer regulatory barriers, but buprenorphine providers had little to no cross-coverage options compared to methadone providers, who could refer to alternate methadone programs. The findings point to the need for well-defined emergency procedures with flexibility around regulations, the need for a central registry with patient dose information, as well as stronger professional networks and cross-coverage procedures. These interventions would improve day-to-day services for opioid-maintained patients as well as services under emergency conditions.

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.…”

“…Following Hurricane Sandy in New York in 2012, McClure and colleagues [17] found that clinics were unable to operate and were relocated. There were problems with communication with regulatory agencies as well as verification of dosages and client status.…”

Opioid Use Disorder and the COVID 19 Pandemic: A Call to Sustain Regulatory Easements and Further Expand Access to Treatment

“…7 Post Hurricane Sandy interviews were conducted with providers and administrators that offer pharmacological treatment for opioid use disorder using methadone and/or buprenorphine in public clinics and in community practices accepting Medicaid. 8 Methadone providers reported more barriers to continuity of care (i.e. poor communication with regulatory agencies, clinic relocation problems, lack of emergency preparedness strategies, and dosage and patient status verification difficulties) than buprenorphine providers (i.e.…”

Geographic Distribution of Disaster-Specific Emergency Department Use After Hurricane Sandy in New York City

“…Drug dependence encounters also increased, which may be related to known loss of methadone treatment centers. 29 In addition, administrative encounters were also frequent, which we found almost universally to be visits for prescription refills, evidence of disruption of access to primary care. In each of these cases, the resulting effect was an increase in ED use, which reflects the need to anticipate and prepare for these disruptions.…”