Partnerships, tools, and tabletop exercise tackle preparedness, continuity of opioid treatment programs during a disaster

In Brief

Patients who cannot access their designated opioid treatment center during a disaster could begin experiencing withdrawal symptoms, or worse, could relapse. With support from the King County Healthcare Coalition, stakeholders in King County, Washington, formed partnerships, created tools, and challenged the region's capacity to ensure continuity of care for such patients. The effort involved 14 months of quarterly stakeholder workgroup meetings, a multisector tabletop exercise, clarified roles, and formalized agreement on how to dispense medication during disasters.


Every day in the United States, more than 1 million patients, on average, receive drug abuse treatment at some 13,500 outpatient, medication-assisted, and/or residential/inpatient treatment facilities. About 24% of all substance abuse patients participate in methadone maintenance treatment programs (MMTPs), which provide a daily dose of methadone to individuals addicted to heroin or other opiates. Of some 1,200 licensed MMTPs in the US, most are located in New York, California, Texas, and Illinois. In contrast, North Dakota, South Dakota, and Wyoming have none.

Managing an emergency event at a MMTP facility requires communication with patients about alternate dispensing locations and collaboration with partners to manage displaced patients. Considering a patient’s need for regular, if not daily access, to a MMTP, facility managers need to be prepared to serve patients during a variety of emergency situations.

Specific issues

MMTPs and their patients are particularly vulnerable to disasters. The issues include:

  • Communication and capacity. Facilities can face power outages, communication disruptions, an influx of displaced patients, and difficulties verifying records of displaced patients.
  • Limited prescriptions from designated facilities. Usually, patients can only get their medication in limited take-home quantities at MMTP facilities, but not at local pharmacies. Any disaster that prevents patients from accessing their designated facility on a regular basis—such as a snow storm, flood, or earthquake—heightens the risk of withdrawal symptoms onset and potential relapse. 
  • Emergency shelter policies. Emergency shelter policies regarding drug abuse treatment patients vary widely, and finding a shelter that allows patients to keep their take-home methadone medication can be challenging.
The practice

The collective efforts of stakeholders from multiple sectors in King County, Washington, over a 14-month period produced role clarity and a plan for streamlined emergency communication.

Central activities included:

  • The King County Healthcare Coalition convened a summit in November 2007 for key stakeholders involved in methadone treatment for opioid dependence in King County. The goal was to clarify roles and identify ways to collaborate and ensure continuity of care during a community-wide emergency or disaster for patients in opioid treatment programs (OTPs), which include methadone-dependent patients and individuals not enrolled in an OTP but experiencing withdrawal symptoms.
  • Participants developed a phone tree and agreed to use Washington System for Tracking Resources, Alerting, and Communications (WATrac) to increase communication and coordination among providers. WATrac is the web-based application serving the Washington State healthcare system to support healthcare information sharing and resource coordination.
  • Opioid treatment programs (OTPs) wrote and signed a Memorandum of Agreement (MOA) to establish a mechanism whereby a receiving provider, during an emergency, can dispense methadone (or other prescribed opiate substitution medication) to a patient on behalf of the primary provider. While the MOA is not legally binding, the document clarifies the roles and expectations of partners during an emergency.
  • The King County Healthcare Coalition facilitated a tabletop exercise in January 2009 The focus of the tabletop exercise was OTP preparedness and response activities during a large-scale earthquake in the Puget Sound region. The four exercise objectives were to:
    • Determine ability to support timely decisions regarding operations of the treatment programs in an emergency
    • Demonstrate ability to coordinate communication and resources among key stakeholders
    • Evaluate the process for activating and implementing mutual aid between OTP providers
    • Discuss protocols and rules of regulatory agencies

Participants were presented with a 6.8 magnitude earthquake and four situation updates detailing event developments over a 2-day period. Each situation update was accompanied with an additional message about the specific situation at various OTPs. The tabletop exercise lasted 1.5 hours and involved 10 partners including treatment facilities; city, county, and state offices; the Veterans Administration; and the Drug Enforcement Administration.

The tabletop exercise demonstrated the importance of the partnerships and tools that were developed prior to the exercise, while outlining gaps and next steps to increase preparedness among OTPs during a disaster or emergency.

What made this practice possible?
  • Regular meetings. Stakeholders met on a quarterly basis as the King County Methadone Preparedness Workgroup to address pressing issues and develop several tools (eg, phone tree).
  • Open communication. Stakeholders were able to clarify roles among partners and review treatment regulations, including how regulations change during a disaster.
  • Supportive planning structure. The King County Healthcare Coalition is a network of healthcare organizations and providers working together to strengthen emergency preparedness and response.  The Coalition facilitates collaborative planning, training and exercises, and coordination of resources and information to help organizations and providers prepare for an emergency. This structure ensures that responders are supported during an emergency and patients get the care they need.
  • Increased access to medication. The formalized MOU enables patients to access prescriptions at alternate facilities during an emergency, decreasing the risk of withdrawal symptoms onset and potential relapse among patients.
  • Central communication system. Using WATrac as a central communication tool, providers will be better equipped to handle displaced patients, verify records, track pharmaceuticals, and provide updates on facility status to other providers.


 Note: As of January 1, 2014, the King County Healthcare Coalition has nonprofit status and has changed its name to the Northwest Healthcare Response Network.

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