Journal of Urban Health

, Volume 91, Issue 2, pp 366–375 | Cite as

Psychiatric Comorbidity, Red Flag Behaviors, and Associated Outcomes among Office-Based Buprenorphine Patients Following Hurricane Sandy

  • Arthur R. Williams
  • Babak Tofighi
  • John Rotrosen
  • Joshua D. Lee
  • Ellie Grossman
Article

Abstract

In October 2012, Bellevue Hospital Center (Bellevue) in New York City was temporarily closed as a result of Hurricane Sandy, the largest hurricane in US history. Bellevue’s primary care office-based buprenorphine program was temporarily closed and later relocated to an affiliate public hospital. Previous research indicates that the relationships between disaster exposure, substance use patterns, psychiatric symptoms, and mental health services utilization is complex, with often conflicting findings regarding post-event outcomes (on the individual and community level) and antecedent risk factors. In general, increased use of tobacco, alcohol, and illicit drugs is associated with both greater disaster exposure and the development or exacerbation of other psychiatric symptoms and need for treatment. To date, there is limited published information regarding post-disaster outcomes among patients enrolled in office-based buprenorphine treatment, as the treatment modality has only been relatively approved recently. Patients enrolled in the buprenorphine program at the time of the storm were surveyed for self-reported buprenorphine adherence and illicit substance and alcohol use, as well as disaster-related personal consequences and psychiatric sequelae post-storm. Baseline demographic characteristics and insurance status were available from the medical record. Analysis was descriptive (counts and proportions) and qualitative, coding open-ended responses for emergent themes. There were 132 patients enrolled in the program at the time of the storm; of those, 91 were contacted and 89 completed the survey. Almost half of respondents reported disruption of their buprenorphine supply. Unexpectedly, patients with psychiatric comorbidity were no more likely to report increased use/relapse as a result. Rather, major risk factors associated with increased use or relapse post-storm were: (1) shorter length of time in treatment, (2) exposure to storm losses such as buprenorphine supply disruption, (3) a pre-storm history of red flag behaviors (in particular, repeat opioid-positive urines), and (4) new-onset post-storm psychiatric symptoms. Our findings highlight the relative resilience of buprenorphine as an office-based treatment modality for patients encountering a disaster with associated unanticipated service disruption. In responding to future disasters, triaging patient contact and priority based on a history of red-flag behaviors, rather than a history of psychiatric comorbidity, will likely optimize resource allocation, especially among recently enrolled patients. Additionally, patients endorsing new-onset psychiatric manifestations following disasters may be an especially high-risk group for poor outcomes, warranting further study.

Keywords

Buprenorphine Opioid dependence Psychiatric comorbidity Risk factors Disasters Substance use disorders Cross-sectional studies 

References

  1. 1.
    Deaths associated with Hurricane Sandy—October–November 2012. MMWR Morbidity and mortality weekly report 2013, 62(20): 393–397.Google Scholar
  2. 2.
    Blake ES KT, Berg RJ, Cangialosi JP, Beven JL: Tropical cyclone report Hurricane Sandy. In. Edited by Center NH; 2013.Google Scholar
  3. 3.
    Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary care. J Gen Intern Med. 2009; 24(2): 226–32.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Lee JD, Grossman E, Truncali A, Rotrosen J, Rosenblum A, Magura S, et al. Buprenorphine-naloxone maintenance following release from jail. Subst Abus. 2012; 33(1): 40–7.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Tofighi B, Grossman E, Williams AR, Biary R, Rotrosen J, Lee JD. Outcomes among buprenorphine-naloxone primary patients after Hurricane Sandy. Addiction Science & Clinical Practice. 2014; 9(3). doi:10.1186/1940-0640-9-3.
  6. 6.
    Vlahov D, Galea S, Ahern J, Resnick H, Kilpatrick D. Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after September 11, 2001. Am J Public Health. 2004; 94(2): 253–4.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Vetter S, Rossegger A, Rossler W, Bisson JI, Endrass J. Exposure to the tsunami disaster, PTSD symptoms and increased substance use—an Internet based survey of male and female residents of Switzerland. BMC Public Health. 2008; 8: 92.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kishore V, Theall KP, Robinson W, Pichon J, Scribner R, Roberson E, et al. Resource loss, coping, alcohol use, and posttraumatic stress symptoms among survivors of Hurricane Katrina: a cross-sectional study. Am J Disaster Med. 2008; 3(6): 345–57.PubMedGoogle Scholar
  9. 9.
    Shimizu S, Aso K, Noda T, Ryukei S, Kochi Y, Yamamoto N. Natural disasters and alcohol consumption in a cultural context: the Great Hanshin Earthquake in Japan. Addiction. 2000; 95(4): 529–36.PubMedCrossRefGoogle Scholar
  10. 10.
    Cepeda A, Valdez A, Kaplan C, Hill LE. Patterns of substance use among hurricane Katrina evacuees in Houston, Texas. Disasters. 2010; 34(2): 426–46.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Wang PS, Gruber MJ, Powers RE, et al. Mental health service use among hurricane Katrina survivors in the eight months after the disaster. Psychiatr Serv. 2007; 58: 1403–11.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Rodriguez JJ, Kohn R. Use of mental health services among disaster survivors. Curr Opin Psychiatr. 2008; 21: 3270–378.CrossRefGoogle Scholar
  13. 13.
    Ferrando L, Galea S, Sainz Corton E, Mingote C, Garcia Camba E, Fernandez Liria A, et al. Long-term psychopathology changes among the injured and members of the community after a massive terrorist attack. Eur Psychiatr. 2011; 26: 513–7.CrossRefGoogle Scholar
  14. 14.
    Rhodes J, Chan C, Paxson C, Rouse CE, Waters M, Fussell E. The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans. Am J Orthopsychiatry. 2010; 80(2): 237–47.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Ford JD, Adams ML, Dailey WF. Factors associated with receiving help and risk factors for disaster-related distress among Connecticut adults 5–15 months after the September 11th terrorist incidents. Soc Psychiatry Psychiatr Epidemiol. 2006; 41: 261–70.PubMedCrossRefGoogle Scholar
  16. 16.
    Boscarino JA, Galea S, Adams RE, et al. Mental health services and psychiatric medication use following the terrorist attacks in New York City. Psychiatr Serv. 2004; 55: 274–83.PubMedCrossRefGoogle Scholar
  17. 17.
    Zywiak WH, Stout RL, Trefry WB, LaGrutta JE, Lawson CC, Khan N, et al. Alcohol relapses associated with September 11, 2001: a case report. Subst Abus. 2003; 24(2): 123–8.PubMedGoogle Scholar
  18. 18.
    Frank B, Dewart T, Schmeidler J, Demirjian A. The impact of 9/11 on New York City’s substance abuse treatment programs: a study of program administrators. J Addict Dis. 2006; 25(1): 5–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Stovell K (ed). Hurricane Sandy and daily doses of methadone: challenges for N.Y. and N.J. Alcoholism & drug abuse weekly 2012, 24(43):1–2.Google Scholar
  20. 20.
    Movaghar AR, Goodarzi RR, Izadian E, Mohammadi MR, Hosseini M, Vazirian M. The impact of Bam earthquake on substance users in the first 2 weeks: a rapid assessment. J Urban Health. 2005; 82(3): 370–7.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Gabriel R, Ferrando L, Sainz Corton E, Mingote C, Garcia-Camba E, Fernandez Liria A, et al. Psychpathological consequences after a terrorist attack: an epidemiological study among victims, the general population, and police officers. Eur Psychiatr. 2007; 22: 339–46.CrossRefGoogle Scholar
  22. 22.
    Gerra G, Borella F, Zaimovic A, Moi G, Bussandri M, Bubici C, et al. Buprenorphine versus methadone for opioid dependence: predictor variables for treatment outcome. Drug Alcohol Depend. 2004; 75: 37–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Gerra G, Leonardi C, D’Amore A, Strepparola G, Fagetti R, Assi C, et al. Buprenorphine treatment outcome in dually diagnosed heroin dependent patients: a retrospective study. Prog Neuro-Psychopharmacol Biol Psychiatry. 2006; 30: 265–72.CrossRefGoogle Scholar
  24. 24.
    Ngo HTT, Tait RJ, Hulse GK. Hospital psychiatric comorbidity and its role in heroin dependence treatment outcomes using naltrexone implant or methadone maintenance. J Psychopharmacol. 2011; 25: 774–82.PubMedCrossRefGoogle Scholar
  25. 25.
    McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, et al. The fifth edition of the addiction severity index. J Subst Abus Treat. 1992; 9(3): 199–213.CrossRefGoogle Scholar
  26. 26.
    Vlahov D, Galea S, Ahern J, Resnick H, Boscarino JA, Gold J, et al. Consumption of cigarettes, alcohol, and marijuana among New York City residents six months after the September 11 terrorist attacks. Am J Drug Alcohol Abuse. 2004; 30(2): 385–407.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2014

Authors and Affiliations

  • Arthur R. Williams
    • 1
  • Babak Tofighi
    • 1
  • John Rotrosen
    • 1
  • Joshua D. Lee
    • 1
  • Ellie Grossman
    • 1
  1. 1.New York UniversityNew York CityUSA

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