Hurricanes, and other natural disasters, present an added safety concern for former drug users or addicts in the midst of treatment.

If unable to receive proper care, patients of rehab facilities may relapse in order to ease withdrawal symptoms.

Additionally, they may contract other diseases through the use of shared, unclean needles.

As Hurricane Florence descends on North Carolina, the government has a plan to help those who are receiving treatment.



Hurricanes bring about a number of dangers for people in its path, and Hurricane Florence is no exception. The now-Category 1 storm has been making its way toward the Carolina's all week, forcing the governments to issue mandatory evacuation notices. Although forcing people out of state keeps many residents safe, it puts those in the middle of addiction recovery in danger.

"Addicts require qualified care to manage their addictions into a state of remission," Brook McKenzie, director of clinical outreach at New Method Wellness, told INSIDER. "If that care becomes inconsistent, or falls into a state of neglect, the results can be devastating, leading directly to relapse."

And in North Carolina, where deaths by drug overdose increased by 22% between 2016 and 2017, according to the U.S. Centers for Disease Control and Prevention, consistency of care is especially crucial.

In crisis situations, recovering addicts may lose their daily routines and face additional stress, which are both associated with relapse

"Routine and structure are important parts of building a sober life, especially in early sobriety," Katie Serra, a registered psychiatric nurse at McLean Hospital, told INSIDER. "Most sober houses or halfway houses require residents to have daytime structure, whether that be a day treatment program or a job."

In North Carolina, drug overdose increased by 22 percent between 2016 and 2017 AP

This routine keeps their minds — and in some cases, bodies — too occupied to think about or even crave drugs. But, as Serra noted, "natural disasters obviously interrupt this structure, leaving users vulnerable to relapse and overdose."

It also leaves them worried about where to go and how to stay safe. Such stress can trigger relapse by activating the kappa opioid receptors in the region of the brain where, "neural activities leading to a stress-induced drug relapse take place," as HuffPost reports.

Patients can also suffer intense withdrawal symptoms, forcing them to turn to drugs to relieve the pain

Recovering from addiction is as much a physical task as it is a mental one.

"The addict may require medical detox, the process of ridding the body of harmful toxins related to alcohol and drug abuse," McKenzie said.

During this detox, a patient will likely suffer from withdrawal. Though the symptoms will vary depending on the type and length of addiction, the American Addiction Centers notes that people in withdrawal will likely experience flu-like symptoms, restlessness, tremors, depression, and anxiety.

"All of these are hard to deal with on an ordinary day, but factor in a lack of water, electricity, socialization, and support system, and that makes it all the worse," Bernadette Calicchio, who oversees HIV/HCV testing and linkage to care at the North Carolina Harm Reduction Coalition (NCHRC), told INSIDER.

Fortunately, there are medications, such as methadone, buprenorphine, and naltrexone, that can blocks opiate receptors and relieve withdrawal symptoms. Unfortunately, you have to receive regulated daily doses for this to be effective — a problem when you are being forced to evacuate. When this happens, patients will turn to their drug of choice to relieve the symptoms.

Such was the case during Hurricane Katrina in 2005.

A 2011 paper found that low-income users experienced panic and showed signs of withdrawal during Hurricane Katrina due to difficulties maintaining their habits and treatments. In order to cope, some turned to drugs being offered in the Superdome.

Local residents wait with their belongings for the New Orleans Superdome to open as an emergency shelter ahead of Hurricane Katrina Chris Graythen/Getty

"At one point they just started givin' it away, you know, because it was nothin' they could do with it," Fatigue, a crack and marijuana user told the authors of the paper. "It was just a whole bunch of people in one big place tryin' to survive."

New York users faced a similar situation when Hurricane Sandy struck in 2012, according to a 2015 report. Roughly half of the 300 people interviewed were participating in a drug-related-maintenance therapy at the time of the storm. Of those people, about 46% were unable to obtain sufficient take-home doses of their medications and, as a result, had to use "informal sources" to avoid withdrawal.

Additionally, the authors noted that 27% of users interviewed said they shared drug injection or preparation equipment with strangers. The practice of sharing needles, of any kind, increases a person's risk of contracting HIV or other diseases.

To combat relapse and HIV contraction during Hurricane Florence, patients are being given take-home medications and have access to mobile services

"As part of our routine disaster preparedness work, we've been working with federal and other state partners to make sure we're implementing the best practices," Kody Kinsley, a deputy secretary for North Carolina's Department of Health and Human Services, told INSIDER via email.

As part of this practice, Kinsley said the state is, "allowing patients to receive medication at another licensed opioid treatment program if their facility closes or if they have to evacuate to another city."

Additionly, as Calicchio told INSIDER, NCHRC stayed operating, "until the weather declined in an effort to deliver clean supplies (naloxone, syringes, cotton, metal cookers, tourniquets, and sterile water packs)."

"We made every effort to over-supply everyone we saw to make sure they’d have more than enough rather than not enough."

The center also passed out large quantities of Naloxone, a medication designed to reverse an opioid overdose. Serra added that the clinics also provide shelters with the medication and supplies.

Kinsley also announced via Twitter that "opioid treatment programs have been advised to provide patients with four to six days of take-home medication to treat opioid-use disorders during the storm."

However, "there is always a risk when take-home dosing is involved," Calicchio said. To combat the risk, most medically assisted treatment clinics require patients to complete at least two months of an intensive outpatient program before being allowed take-home doses.

"A lot of patients are aware that if they over-medicate, they will deplete their resource and ultimately end up in a state of withdrawal," she said.

There are also outlets for mental and emotional support

Serra encouraged those in recovery to use all available resources when stripped of their treatment program.

For those with access to a phone, she recommended the Disaster Distress hotline (1-800-985-5990), which provides counseling to people experiencing "emotional distress related to natural or human-caused disasters."

Similarly, Narcotic Anonymous and SMART Recovery provide online meetings and support groups for those struggling.

Visit INSIDER's homepage for more.