A public health emergency was declared for the opioid crisis in 2017 and remains in place. Between 2017-2024, there were 164 billion dollar disasters. People who use drugs (PWUDs) are highly susceptible to disasters; however adaptive capacity of opioid treatment programs (OTP) is not well understood. Identifying and addressing gaps to increase resilience and reduce morbidity and mortality among PWUDs is critical.

A semi-structured interview guide with 8 questions was developed to assess how disasters impact service provision and other aspects of OTPs. OTP leaders, government officials, community health navigators, and advocates received an email invitation to complete an interview via Zoom. Transcripts were independently hand coded to inductively identify themes.

Eleven interviews were completed. Four themes were identified including client challenges securing housing and reliable transportation, disaster-related communication barriers, stigma around help seeking, and issues related to policies and practices such as regulations and insurance coverage that are inflexible during a disaster.

Disruptions to OTPs during disasters require preparedness planning adaptations like more flexible guest dosing. The ongoing public health emergency of the opioid epidemic and the increasing frequency and severity of climate and weather emergencies requires adaptations to a highly regulated system to address vulnerabilities.