The role of remote care for continuing opioid use disorder treatment during natural disasters

INTRODUCTION: In April 2024, two severe flooding events in southwestern Pennsylvania caused regional disruptions. How smaller-scale, rapidly unfolding disasters affect opioid use disorder (OUD) treatment and recovery services remains underexamined in disaster and public health research. This study explores how these localized floods influenced OUD service provision. METHODS: We conducted 18 semi-structured interviews with treatment program directors, clinicians, counselors, and emergency service providers in Allegheny and Washington counties. Interviews focused on general operational challenges, disruptions in patients' OUD treatment, and adaptations made to the provision of OUD services during and after the flooding events. RESULTS: Participants described the April floods as disruptive but not catastrophic, noting that the impacts on service provision were substantially mitigated by telehealth infrastructure that had been established during the COVID-19 pandemic. Virtual service delivery was critical in sustaining continuity of care when transportation systems and in-person appointments were interrupted. Telehealth, however, was uneven in its effectiveness: it supported stable patients, caregivers, and those with transportation barriers, while presenting challenges for individuals in early recovery, those lacking private or safe home environments, and those with limited digital literacy. Across interviews, providers emphasized flexibility and patient-centered care as essential to adapting service delivery during the floods. CONCLUSIONS: Findings demonstrate that smaller, fast-onset disasters warrant greater attention in disaster preparedness planning for behavioral health systems. Strengthening telehealth access and embedding flexibility into OUD treatment models may enhance resilience for both patients and providers as climate change increases the frequency of localized hazard events.