When a Natural Disaster Strikes: How to Get Pain Medication

Power outages. Downed trees. Evacuations. The devastating consequences of a natural disaster such as the recent hurricanes (Irma, Harvey, Maria) affect everyone, but the situation can be especially grim for individuals who regularly take prescription pain medications. If patients are unable to get their medications, the consequences can be serious.

How to Get Presciption Medication in a Natural DisasterIf you take prescription medication, getting your medicine filled during a natural disaster can be challenging. Taking preventative measures now can help you be prepared. Harshal Kirane, MD, director of addiction services at Staten Island University Hospital in Staten Island, New York, recalls working at Bellevue Hospital in Manhattan during Superstorm Sandy in 2012. The hospital had to be evacuated, he recalls, and a number of outpatient services were affected.

“We had many folks on maintenance regimens with controlled substances,” Dr. Kirane recalls. “We needed to make arrangements for these patients so that they could be ‘guest dosed’ at other clinics. One of the fundamental dilemmas with medicines that are controlled substances is the need to respect the treatment needs and autonomy of patients while also setting limits so that these patients aren’t vulnerable to relapse or misuse of medications.”

Robert Duarte, MD, director of the Pain Center at the Neuroscience Institute at Northwell Health in Great Neck, New York, and president of the New York State Pain Society, faced a similar challenge during Sandy. It was difficult to make sure that patients taking opiates for pain, whether chronic back pain, cancer pain, or post-surgical pain, got their medications. In some instances, they could get to a hospital. And, Dr. Duarte says, hospital pharmacies may be able to provide a limited emergency supply with a prescription to patients.

These days, there is a heightened awareness of the impact of natural disasters on patients who regularly take prescription painkillers, and a spotlight on how health care providers and patients can be prepared when disaster strikes, Dr. Kirane says.

To help ensure that patients on prescription pain medications make it through a hurricane or other natural disaster with minimal disruption, experts say it’s important to be prepared.

For Providers

Plan ahead. This is obviously not always possible in events such as an earthquake or tsunami. But there is generally some lead time before a hurricane hits, Dr. Kirane says. “Patients and providers should make some general preparations in advance,” he advises. “If there are barriers to the access of the medication, providers may be able to coordinate services in the extended network and throughout the community.”

This could involve reaching out to area hospitals or clinics for guest dosing. “In many communities, access to health care is so limited that there could be a 50-mile commute to another facility,” Dr. Kirane says. “But a hospital may be able to create special services or find a temporary out-patient clinic that could provide medications.” If there is an unavoidable interruption of services, patients may be given their medications a few days in advance, Dr. Kirane says.

Farrukh Shamsi, director of the Texas Clinic, a methadone clinic in Houston, which was hit by Hurricane Harvey in September, said that having a disaster plan in place before the storm struck paid off. Following their plan, in which they cooperated with clinics around the state, the Texas Clinic stayed open throughout the storm and “guest dosed” patients from other clinics, some of whom waded through five miles of floodwater to get their dose, Mr. Shamsi says. “We had tried to contact everyone in our clinic before the storm hit, but we weren’t able to reach every person,” he recalls. “We stayed open throughout the storm. But if a clinic has to close, there has to be a plan in place for how the affected people will get their medication. That’s the way it is supposed to work, and it did work during Harvey.”

The cooperation among methadone clinics benefitted Texas Clinic patients who had decided to evacuate to Dallas or to Austin. The staff at the Texas Clinic was able to call ahead and set up a medication dispensing schedule with clinics in the other cities so that the evacuated patients could be dosed there.

For Patients

Talk to your doctor now. If you live in a region that is prone to natural disasters be sure to have a conversation with your health care provider well in advance about steps you can take in an emergency. “Be transparent about it,” says Bradley F. Sorte, vice president of Florida Operations and executive director of Caron Renaissance and Caron Ocean Drive, a not-for-profit addiction treatment and behavioral healthcare center in South Florida, which endured a hurricane this fall. “Don’t wait until the disaster is about to happen. Especially given the controlled nature of some of these drugs, you can’t just show up at a new clinic when your medical records may be inaccessible.”

Make a list in advance. Assemble all your providers’ names and contact information and keep this with you, Dr. Kirane advises. “This can save a lot of time and prevent medication mistakes,” he says. “Also, it is important for a patient to have documentation from their clinic confirming their dose. If the person suddenly finds herself in a convention center and there is no record of what their dosage is, having documentation eliminates this problem.”

It’s a good idea to make such a list even before a natural disaster strikes, Dr. Kirane adds, because there can be resistance on the part of the provider to give opioids to a patient without appropriate context and documentation.

Put together an emergency kit. Well in advance, assemble a kit of essentials. This might contain batteries, chargers for medical devices, any extra medications they may have available, and a brace for chronic pain, if you use one, recommends Dr. Kirane.

Do a post-disaster medication safety evaluation. Any drugs that have been exposed to flooding or unsafe municipal water could be contaminated and should be discarded, according to the Food and Drug Administration. For more information about proper disposal, consult with your pharmacist or visit the U.S. Department of Justice, Drug Enforcement Administration (DEA) website. The DEA sponsors drug take back days a few times a year (typically in October and April).

Consider alternatives.  Just before a hurricane strikes is not the right time to start tinkering with your dose or a medication change, but once things are back to normal, discuss with your health care provider the possibility of tapering your opioid medications to a lower dose or asking about non-opioid medication alternatives. “When a hurricane strikes, you are less vulnerable if you don’t require opioids,” Dr. Kirane says. “It’s likely that tapering will work better for those who take the medication for pain than for addiction.”

Many patients require the opiates to manage chronic conditions, Dr. Duarte says. However, he explains, there are other options, including anti-inflammatories and other non-opiate treatments that are used to control pain.

Other Helpful Resources

  • RxOpen.org can help you locate open pharmacies during disasters. The American Red Cross has used the service to connect people in shelters to pharmacies and infusion centers.
  • A charity known as Direct Relief provides free prescription drugs and medical supplies to vulnerable people during emergencies.
  •  Medicare.gov recommends locating the nearest network pharmacy by contacting your plan if you’re covered by a Medicare prescription drug plan. They should also be able to put you in touch with an out-of-network pharmacy if necessary. If you end up paying full price for medication, you may be able to file for a refund. Call 1-800-Medicare for your plan’s phone number.

 

 

Updated on: 11/07/17
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