When a disaster strikes public health and medical responders need to be ready to treat recreational users of opioids who are suffering from withdrawal, opioid patients who are in recovery, and patients who rely on opioids for pain management. Public health and health care professionals need to include the management of issues related to opioid use and addiction as part of their overall disaster preparedness, response and recovery plans.

Amid this year’s historic hurricane season, for example, some of the health care facilities, including opioid treatment centers, in the impacted areas struggled to reestablish services. Some area residents who relied on opioids for pain management or were being treated for opioid addiction had to manage the stress of the storm and the symptoms of opioid withdrawal at the same time.

Many of those patents also relied on emergency shelters in the wake of the storm. HHS medical responders who provided support to emergency shelters saw a number of patients who did not have their medications with them or ways to get replacements. In addition, some people in the shelter were non-medical opioid users who were unexpectedly cut off from their regular supplies and were suffering from withdrawal.

The opioid epidemic is a problem that has spread to communities throughout the country. According to the Substance Abuse and Mental Health Services Administration, in 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use was prescription pain reliever misuse rather than heroin use; there were 11.5 million pain reliever misusers and 948,000 heroin users.

Planning for Disruptions in Treatment and Potential Increases in Illicit Drug Use

Disruptions in service are a reality in many major disasters. The disruption of steady-state systems needed for medical care, such as pharmacies, medical facilities, and treatment centers, could result in an increase in people seeking alternatives to prescribed opioids, such as illicit drugs like heroin and illegally made fentanyl,that may be more readily available. It could also lead to people suddenly having to manage the symptoms of withdrawal when other support systems may be weakened or non-existent.

Public health, healthcare and emergency management planners and responders need to consider they can minimize the adverse effects of addition withdrawal on the community, residents in emergency shelters, and protect responders. Before a disaster affects your community, plan to address the needs of people who are addicted to opioids, recovering from opioid addiction, or require opioids for pain management.

HHS agencies are available to assist states and localities in contingency planning for disasters that disrupt systems, including having important supplies such as naloxone available at shelters, having shelter staff trained to respond to addiction withdrawal or overdoses, and engaging local and regional partners to share information about the availability of medical infrastructure. To get assistance with planning, contact the HHS Substance Abuse and Mental Health Services Administration or the HHS Office of the Assistant Secretary for Preparedness and Response.

In addition, state and local health agencies and health care providers can collaborate with law enforcement agencies to monitor and deter the use of illegal substances in communities that have suffered an emergency event. Such partnerships can help protect communities that may be vulnerable after disasters.

Protecting Responders from Accidental Exposure

According to the Drug Enforcement Administration, law enforcement officers, K9 units, emergency medical service personnel, and fire rescue professionals are also being adversely affected by accidental opioid overdose and particularly by the shift in the use of prescription opioids to the more potent illicit fentanyl into many communities.

Illicit fentanyl, although similar to prescription opioids and heroin, is 50 to 100 times more potent. Exposure to even a small amount can be fatal. First responders need resources and guidance to reduce and prevent occupational exposure to this dangerous substance in the field.

The first defense to treat an opioid overdose, whether intentional, accidental or occupational, is naloxone. Naloxone can reverse opioid-related overdoses and is administered by intranasal spray, intramuscular, subcutaneous, or intravenous route. Because fentanyl is extremely potent, multiple doses of naloxone may be needed to overcome the overdose. There are other precautionary steps that can be taken to reduce exposure to fentanyl, such as personal protective equipment.

Next Steps: Planning and Response

Federal agencies created the following resources to help local and state responders and planners:

• ASPR TRACIE’s Opioids: Frequently Asked Questions provides answers to some of the most frequently asked questions that affect their audience (e.g., regional ASPR staff; healthcare coalitions, entities, and providers; emergency managers, and public health practitioners).
• Centers for Disease Control and Prevention, Protecting Workers at Risk: Guidance on occupational safety and health preventing fentanyl exposure to emergency responders.
• Drug Enforcement Administration, A Brief Guide for First Responders: Educational awareness on practices for those that could encounter synthetic opioids.
• Substance Abuse and Mental Health Services Administration, Opioid Overdose Prevention Toolkit: Offers strategies to health care providers, communities, and local government for developing practices and policies to help prevent opioid-related overdoses and deaths.
• CDC Health Advisory: Influx of Fentanyl-laced Counterfeit Pills and Toxic Fentanyl-related Compounds Further Increases Risk of Fentanyl-related Overdose and Fatalities: This August 2016 Health Advisory Network publication offers advice and resources for responders.
• Fentanyl handling guidance for first responders, released by federal and external partners in 2017.
• U.S. Food and Drug Administration, Disposal of Unused Medicines: Instructions to dispose of medicines following treatment to properly reduce accidental exposure or intentional misuse.
• U.S. Department of Health and Human Services, Toolkit for Faith and Community Leaders: Targeted at practical solutions to increase awareness and get ahead of crisis by building community capacity to respond.
• HHS Health Research Services Administration also has a health center finder.

As efforts to address this epidemic unfold, federal, state, local, and community organizations will need to work together in planning for and responding to crises. Saving lives amid our nation’s opioid crisis requires a multidisciplinary approach.

Let’s get the conversation going among public health, behavioral health, law enforcement, and emergency management professionals to develop best practices in assessing risks and in planning to protect the health and safety of responders and the people they serve. Doing so can protect health and save lives not just during disasters but every day.