title: Psychiatric Comorbidity and Substance Use Outcomes in an Office-Based Buprenorphine Program Six Months Following Hurricane Sandy.
abstract: BACKGROUND
  On October 2012, Hurricane Sandy struck New York City, resulting in unprecedented damages, including the temporary closure of Bellevue Hospital Center and its primary care office-based buprenorphine program.
  
  
  OBJECTIVE
  At 6 months, we assessed factors associated with higher rates of substance use in buprenorphine program participants that completed a baseline survey one month post-Sandy (i.e. shorter length of time in treatment, exposure to storm losses, a pre-storm history of positive opiate urine drug screens, and post-disaster psychiatric symptoms).
  
  
  METHODS
  Risk factors of interest extracted from the electronic medical records included pre-disaster diagnosis of Axis I and/or II disorders and length of treatment up to the disaster. Factors collected from the baseline survey conducted approximately one month post-Sandy included self-reported buprenorphine supply disruption, health insurance status, disaster exposure, and post-Sandy screenings for PTSD and depression. Outcome variables reviewed 6 months post-Sandy included missed appointments, urine drug results for opioids, cocaine, and benzodiazepines.
  
  
  RESULTS
  129 (98%) patients remained in treatment at 6 months, and had no sustained increases in opioid-, cocaine-, and benzodiazepine-positive urine drug tests in any sub-groups with elevated substance use in the baseline survey. Contrary to our initial hypothesis, diagnosis of Axis I and/or II disorders pre-Sandy were associated with significantly less opioid-positive urine drug findings in the 6 months following Sandy compared to the rest of the clinic population.
  
  
  CONCLUSIONS
  These findings demonstrate the adaptability of a safety net buprenorphine program to ensure positive treatment outcomes despite disaster-related factors.
authors.affiliation: a Department of Population Health , New York University School of Medicine , New York , New York , USA.
authors.forename: Babak
authors.initials: B
authors.lastname: Tofighi
authors.affiliation: b Division of General Internal Medicine , New York University School of Medicine , New York , New York , USA.
authors.forename: Ellie
authors.initials: E
authors.lastname: Grossman
authors.affiliation: a Department of Population Health , New York University School of Medicine , New York , New York , USA.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Goldfeld
authors.affiliation: a Department of Population Health , New York University School of Medicine , New York , New York , USA.|c Department of Psychiatry , New York University School of Medicine , New York , New York , USA.
authors.forename: Arthur Robinson
authors.initials: AR
authors.lastname: Williams
authors.affiliation: c Department of Psychiatry , New York University School of Medicine , New York , New York , USA.
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.affiliation: a Department of Population Health , New York University School of Medicine , New York , New York , USA.|b Division of General Internal Medicine , New York University School of Medicine , New York , New York , USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Lee
mesh_terms: D000701:Analgesics, Opioid / Q000652:urine; D001071:Appointments and Schedules; D001569:Benzodiazepines / Q000652:urine; D001714:Bipolar Disorder / Q000453:epidemiology*; D002047:Buprenorphine / Q000627:therapeutic use*; D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D055867:Cyclonic Storms; D003866:Depressive Disorder / Q000453:epidemiology*; D004189:Disaster Planning; D004190:Disasters; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009519:New York City; D016017:Odds Ratio; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000453:epidemiology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D001569:Benzodiazepines; D002047:Buprenorphine; D003042:Cocaine
keywords: buprenorphine; cyclonic storm; disaster planning; disasters; hurricane; opioid replacement therapy