Facing the Wrath of Hurricanes

As of this writing, Hurricane Irma is about to invade Florida. It is reported to be a Category 5 storm. Many people are evacuating, while others cannot leave their homes and must prepare to shelter in place. The region will inevitably experience catastrophic effects, and this is on the heels of the devastating Hurricane Harvey that struck Texas.

If  Hurricane Katrina of twelve years ago is any indication, here’s what we can expect. Along with the immediate toll on human life and property (more than 1,800 deaths and $100 billion of damage), Hurricane Katrina left thousands of people isolated for weeks, unable to obtain access to life-sustaining essentials. Three million people were left without power. Many residents of Louisiana and Mississippi were forced from their homes, and their belongings were destroyed. The media provided extensive coverage of those things. What the media didn’t report, however, was how many people in pain were not able to get access to their medications, and the life-threatening situations this created.

Greater Threat to Those With Chronic Illnesses

Even when we plan for disasters, as Floridians have for Hurricane Irma, there’s often little that can be done to protect personal belongings. That’s difficult for everyone. But the largest threat is to those with chronic illnesses, particularly people whose diseases require regulated medications that are, by law, dispensed only in 3- and 7-day intervals.

During Hurricane Katrina, one of my colleagues in Mississippi told me that hundreds of patients in the area with intrathecal delivery systems used to delivery pain medications to the spinal canal were not able to be seen. Unfortunately, many of the pumps ran dry during, and after, the hurricane because the patients could not reach their doctors, or the doctors could not obtain the medications from the compounding pharmacy. The result was a tremendous increase in pain, and many patients were forced into severe opioid withdrawal.

Pain patients weren’t the only ones who suffered. Intraabdominal pumps delivering insulin also ran dry. Thousands of patients experienced insulin withdrawal or diabetic coma. Many people with complex medical problems, including cancer, could not receive their life-sustaining therapies. Some people died.

Why Limits on Medications Endanger Patients

Another friend and colleague of mine had to leave a West coast meeting early this week to be home in Miami Beach just ahead of Hurricane Irma’s arrival, because he has patients who need their medication next week. Because of rigid regulations, there is no flexibility for doctors to allow patients to have an extra few weeks, or a month, of medications. Patients are required to be seen by their providers. That means patients and their doctors are trapped in a city because these patients can’t live without their medications. Being forced to stay where they are instead of evacuating creates unnecessarily life-threatening circumstances for everyone involved.

Victims of the approaching hurricanes may be left without a home. If that weren’t bad enough, they also may be unable to see a healthcare provider or pharmacy to obtain their controlled substance medications for days, weeks, or even months. Three-, seven-, and thirty-day supplies will run out, and there will be no way to relieve the agony that people in chronic pain will experience. While it is rare for people to die from opioid withdrawal, it is a miserable experience, and no one should have to go through it.

The recent 3- to 7-day limits on medications are based on the concept that everything will always go smoothly.

However, things rarely go the way you hope they will. Cars break down. Children have emergencies. Family members who typically go to pharmacies get injured. Doctors get sick. Appointments get canceled. Paychecks don’t arrive on time. Weather makes travel impossible. Houses burn down, are flooded, or are destroyed by earthquakes. Hurricanes march in and destroy everything in its path.

Planning for the Unexpected

If people in pain had more flexibility in the amount of medication they could receive, then they could handle the situation when accidents, setbacks, or natural disasters, such as hurricanes, occur. That’s why the one-size-fits-all model of limiting prescriptions is potentially harmful.

Hurricane Harvey was predicted to hit Texas for days before it struck, and forecasters expected it would be severe. An article in The Atlantic says that Hurricane Harvey is ”just the kind of weird weather that scientists expect to see more of as the planet warms.” Worsening storms because of climate change is something we now must expect.

We know that hurricanes and other disasters will hit. We understand that evacuations will be ordered, and sometimes, “shelter in place” mandates will be given. Sometimes, travel will be impossible. And, during those times, people will run out of the medication they need.

When disasters like Harvey and Irma hit, it amplifies the weaknesses in our system. Strict limits on medications have become a huge problem. We can only hope that people who rely on medication to survive, and who are in the paths of Hurricane Harvey, Hurricane Irma, and other hurricanes, will be able to receive timely, effective treatment.

We can’t prevent hurricanes, but we can ask our policymakers to ensure that the most vulnerable among us are prepared for them. The earth’s climate may be worsening, but our approach to preparing ourselves for catastrophic storms is entirely in our control.

Photo by Milada Vigerova on Unsplash