Consider Sam, a 45-year-old man with opioid use disorder (OUD) who has just started treatment with methadone when severe flooding forced him to evacuate his Midwestern home. The road to his opioid treatment program (OTP) was impassable. The shelter he reached had no certainty of bed availability, no cellular service to help him locate another OTP, and no provision of medical care for his OUD. Within days, Sam faced a choice: withdrawal or return to an unregulated, volatile, and deadly drug supply.

Sam is fictional, but his situation is not. Climate-related events (CREs)—floods, hurricanes, wildfires, and extreme heat—are becoming more frequent and severe, constituting an emerging crisis as of yet largely unaddressed in the field of addiction medicine.

The Toll

CREs disrupt access to prevention, treatment, and harm reduction services;¹ destabilize drug markets;² and raise the risk of overdose, withdrawal, and toxic exposure.³ Extreme periods of cold are associated with increased opioid overdose mortality;⁴ heat waves compound the risks of stimulant use and unsheltered homelessness.⁵ Flooding and other hazards damage critical infrastructure facilitating access to care and basic needs resources. People with substance use disorders (SUD) are often already at greater socioeconomic vulnerability, making the loss of housing, transportation, and other essentials that follow a disaster especially destabilizing.

The scale of the climate crisis is not in question. The National Oceanic and Atmospheric Administration identified 27 separate billion-dollar disasters in the US in 2024 alone, totaling an estimated $182.7 billion in damages.⁶ Meanwhile, the overdose crisis persists: the CDC’s most recent provisional data estimate more than 65,000 overdose deaths in the 12 months ending May 2026.⁷ These two crises are converging on the same patients, in the same communities, at the same time, yet research, evaluation, and practice innovation at their intersection remain limited.⁸ When CREs strike, systems of care serving people who use alcohol and other drugs (PWUD) are critically challenged and, more often than not, wholly unprepared.

Why This Belongs on Addiction Medicine’s Agenda

We may often consider the work of disaster preparedness to be someone else’s job, like emergency management, public health, FEMA, etc, but when an OTP, pharmacy, or clinic providing life-saving treatment becomes inoperable, the consequences land squarely in our field. Continuity of medications for opioid use disorder, alcohol use disorder, and other substances; access to harm reduction programs and safer-use supplies; and the basic ability to locate and support patients during a CRE affect the entire continuum of care and resulting outcomes. Clinicians and researchers in addiction medicine have an opportunity to develop innovative solutions and interventions to anticipate, mitigate, and be prepared for CREs.

A Path Forward

The Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA), a nonprofit whose mission is to improve health and well-being through interdisciplinary leadership in substance use education, research, clinical care, and policy, recently published a policy statement on CREs and substance use, laying out a framework for preparedness and offering a call-to-action to the addiction medicine community. It calls for three coordinated efforts: (1) advancing research that centers people with lived experience of CREs and SUD; (2) ensuring continuity of treatment and harm reduction services during and after disasters, including support for legislation like the Addressing Addiction After Disasters Act, which would make SUD services eligible for FEMA emergency funding;⁹ and (3) building multidisciplinary education and preparedness training for providers, shelters, pharmacies, and harm reduction organizations alike.

As global climate change approaches a tipping point, and associated CREs intensify, it is urgent that we begin the work of developing and implementing preparedness planning in our field; no first step is too small. Addiction medicine treatment programs can begin by assessing whether patients have enough of their medications and supplies to weather a CRE, contingency plans for receiving treatment elsewhere, alternate points of contact, and other vital necessities. Programs can build resource- and data-sharing relationships with neighboring providers and OTPs before an emergency occurs. Researchers can characterize impacts of CREs on PWUD and those with SUD and investigate effective interventions. Professional societies can push for policy that treats SUD care as essential infrastructure, not an afterthought.