The purpose of this project is to examine emergency responses to disruptions in the delivery of methadone maintenance treatment in the aftermath natural disasters. The focus will be on disaster preparedness and response with respect to treatment disruptions in five Gulf Coast states during the 2005 and 2006 hurricane seasons. We focus on methadone treatment because federal and state governmental regulations impose strict conditions on the delivery of methadone, and because any disruption in the provision of methadone treatment to clients produces an onset of withdrawal symptoms that may lead to relapse and high-risk injection practices that contribute to the spread of HIV/AIDS. The vulnerability of the methadone treatment system to natural disasters and other emergencies is not a well-established area of research. This pilot study is intended to collect systematic empirical data on this topic that can be applied to improve contingency planning and mitigation strategies for future disasters and to test tentative hypotheses about emergency management effectiveness derived from applying concepts from the disaster literature. Hurricane response by the methadone treatment system will thus serve as the lens to develop findings and recommendations that may be relevant to other types of natural and man-made disasters and to disaster preparedness in other treatment modalities, such as residential, outpatient, and hospital-based. In addition, the application and testing of these recommendations will provide a platform for further research. The project will employ four research methods-archival research, survey research, qualitative key informant interviews and focus groups, and secondary data analysis-to examine the impacts of the hurricanes on actors at multiple levels of the methadone treatment system: federal regulatory officials, state regulatory officials, treatment providers, treatment clients, and stakeholder organizations. This project will answer the following research questions, which also act as Specific Aims: (a) What types of disaster-related treatment disruptions do methadone treatment programs experience, and how effectively have different levels of the treatment system responded to these disruptions? (b) What are the long-term consequences of a natural disaster on drug use, mental health and treatment utilization among methadone patients who are disaster-related evacuees? (c) What is the status of disaster preparedness, response, and mitigation efforts at the level of the individual states? (d) Based on study findings, what recommendations can be made to the substance abuse treatment field to improve emergency preparedness and response by the methadone treatment system (and other treatment modalities) in the event of future disasters? This proposal involves research on emergency management of disruptions in access to methadone medication-assisted treatment as a result of natural and man-made disasters. The problem of lack of access to medication following a natural disaster is an important public health problem that is relevant to multiple medical settings. In addition, in the case of methadone treatment, lack of access to methadone can lead patients to experience aversive withdrawal symptoms, to search for illicit alternatives, and to engage in high-risk behaviors, such as injection drug use, which may contribute to the possible spread of HIV/AIDS and Hepatitis C, both significant public health problems. ? ? ?
