Table 5 System & Service Accountability for Responsive OUD Care during Disaster-Driven Disruptions

Disasters focus attention on single risks & generalized solutions

Prepare cross-systems protocols & coordinate to anticipate how disruptions affect populations rendered at risk.

Mitigate multiple sources of risk by attending to patients’ as whole persons & diverse populations in widely varying social contexts.

Engage in theoretically and historically-informed planning to anticipate risk & project implementation to mitigate future risks.

Avoid using emergency departments as universal safety nets during disasters.

Anticipate, track, and address risks from emergent disasters as they interact with risks from associated social and health systems disruptions (e.g., impacts of pandemic as well as of distancing measures).

Orient health system data analytics to generate & circulate knowledge on multiple sources of risk and population groups.

Lack of information transparency in decision-making perpetuates stigma & produces policy inattentive to social determinants

Address social determinants of population health inequities (including racism) by tailoring public health guidelines for socially vulnerable groups (e.g., feasible, accessible, effective measures).

Prevent misinformation and reduce stigma by grounding policy and service decisions in evidence around what drives increased risk from disasters (e.g., that disruption in financial situations of people in poverty increases negative outcomes)

Enhance supports linking social & medical systems for vulnerable populations during disasters to prevent predictable intensification of adversities & treat addictions services equitably with other chronic/pre-existing diseases services that received additional tools and guidelines.

Harm reduction & contextually-tailored care

Ensure safer supply of opioids and supplies to help PWOUD through an emergency, while helping them to access other components of care.

The system accommodates more change than individual patients are expected to accommodate.

The burden of trying to determine what constitutes high quality care or appropriate attention to patient needs is not put on individual, unsupported, providers or care settings acting in isolation, and is instead achieved through a collaborative public health system.

Empower systems & service providers; shift burden to the system to minimize strain on patients.

Support providers with informed order sets, care pathways, lists of resources, and links to social service and community partners to enable them to provide high quality and contextually-tailored care.