For those in recovery from a substance use disorder, a disaster can be particularly challenging. Many rely on medication to prevent a relapse, but during an emergency, these medications can be difficult to access. Knowing this, Helena Likaj sprung into action when Hurricane Ida hit New Orleans last month.
“We didn’t want any [patients] to have to go through medication withdrawal,” she said.
Likaj is the Clinic Practice Manager at Odyssey House – the largest substance use treatment facility in New Orleans. The facility consists of two primary care health centers and several recovery homes. Many patients at Odyssey House are receiving medication assisted treatment (MAT) for an opioid use disorder. The treatment involves taking regulated opioids to wean patients off more dangerous ones, such as heroin. But because these medications prevent cravings and withdrawal, missing a dose can have dangerous side effects, relapse being one of them. “It’s a lot of pressure,” said Likaj.
After Ida, Likaj and her staff immediately started calling patients to ensure they had their prescriptions. “We worked as much as we could to…do telehealth appointments with them,” she said. Without power, mobile phones were the only way to reach people.
While people are often instructed to stock up on their medications before a disaster, that isn’t possible for those receiving medication assisted treatment. Opioid treatment medications, such as Suboxone, are controlled substances and ordering early refills is not allowed. That means patients must obtain a new prescription every time their medication runs out, even during a disaster.
Since Ida, Likaj and her staff have been coordinating with displaced patients to fill prescriptions at pharmacies close to where they’re sheltering. But for patients who went out of state, getting them their medication has been more complicated. Regulations around filling out-of-state prescriptions vary by state. Even during an emergency, it can be hard to transfer a prescription for a controlled substance. Unlike chronic disease medications, prescriptions for controlled substances can’t be phoned in by a prescriber. They must be sent through an electronic medical system, which may not be up and running after a disaster.
To help patients navigate this regulatory landscape and get their medications on time, Likaj has been making a lot of calls. “We’ve just been working with the clients, like, ‘Where are you? What’s the nearest pharmacy next to you? Let’s call them and see if they can fill your script of Suboxone. Or, if not, let’s find somewhere else that we can fill your script in.’”
The work has been all consuming. Staff members have been working up to 14 hours a day while dealing with their own personal upheavals, according to Likaj. Most were without power in the days following Ida, some sleeping in sweltering conditions while under water boil notices. Others lost their homes or incurred serious property damage.
Still, staff have been onsite throughout the disaster. During the worst of the storm, Likaj described providers “mopping [water] out as it came in” as it threatened to flood one of the health centers. Recovery home providers have worked night shifts and made long treks to pick up food for residents while deliveries were halted. Others have found ways to get to work, even while evacuated.
The work is beyond the scope of a typical provider, but Likaj says it’s critical: “We recognize that during a disaster our services are needed much more.”
“Our doors need to stay open,” she said.
In response to Hurricane Ida, Direct Relief has shipped Odyssey House several doses of the overdose-reversal drug, Naloxone. In addition, Direct Relief is preparing a shipment of two solar-powered batteries to ensure Odyssey House has backup power in the case of another disaster-related outage. These batteries can be used to power medical equipment, maintain temperature-sensitive medications and vaccines, and keep electronic medical systems online.