Disaster Resilience and Opioid Treatment Access: Investigating Hurricane Impacts on Rural MOUD Systems

About This Grant

ABSTRACT The ongoing opioid crisis in the United States, with over 80,000 overdose deaths in 2023, disproportionately affects rural communities where access to medications for opioid use disorder (MOUD) remains limited. Natural disasters, such as hurricanes, further disrupt healthcare infrastructure, treatment continuity, and medication supply chains—exacerbating barriers to care in these underserved regions. Yet, little is known about how such disasters impact MOUD systems, especially in rural areas. This 12-month R36 study will investigate how hurricanes affect MOUD access through two complementary aims. First, a triple-difference analysis will quantify changes in buprenorphine and methadone distribution to pharmacies and treatment centers across rural and urban counties using ARCOS (Automation of Reports and Consolidated Orders System) data—a national DEA-managed database that tracks controlled substance shipments at the transaction level. Second, in-depth interviews with MOUD providers in Western North Carolina, a rural region severely affected by Hurricane Helene, will explore how providers adapted to treatment disruptions. Guided by the Healthcare Resilience Model, this multi-methods approach will assess system absorptive, adaptive, and transformative capacities in disaster contexts. Findings will provide actionable insights to strengthen rural health system resilience, inform disaster preparedness policy, and improve continuity of MOUD care during future emergencies—supporting NIDA’s priority to overcome barriers to addiction treatment.