Johnny Durst headed into the streets of Houston equipped with toothpaste, toothbrushes, soap and water on the evening of August 30th, just days after Hurricane Harvey had ravaged the city. He went straight for the parking lot of the Fiesta Mart south of downtown, just to to north of the Highway 59 bridge where a large number of homeless folks, many of them active drug users, rode out the storm in tents. Durst, an outreach worker with the Montrose Counseling Center, had other important supplies to give out to people who needed them – bleach kits for IV drug users to sterilize their syringes. Clean water, intended for drinking purposes, also becomes an important item for people who need to prepare their injection equipment.
In his syrupy Texas drawl, Durst explains over the phone that people told him they "did what they had to do to get what they needed." That meant that, while other people may have been seeking out small amounts of food or water during breaks in the storm, these people were out looking for drug dealers when the rain let up, hoping to score enough to hold them over until the next lull. For people who are physically dependent on a substance, their need to avoid withdrawal symptoms could trump their ability to tend to other crises happening around them.
It's not just people whose addiction has led them to homelessness who prioritize drugs during storm prep. Posts on the subreddit r/opiates show people trying to figure out how to stock up on drugs before Harvey hit Texas, or wondering whether dealers will serve them during a hurricane. One commenter wrote: "Before a storm everyone was buying out all the water and bread and I was buying all the dope to last through the floods." Another poster said he was planning for two to three days of "a ghost town," while commenters offer suggestions like trying to get ahold of Suboxone, an opiate blocker that can be used to stave off withdrawal symptoms.
"If a person in active addiction is seeking a drug of use, they usually know where they can go to get something," says Matt Feehery, CEO of Memorial Hermann Prevention and Recovery Center (PaRC), an alcohol and drug treatment center in Houston. "If there is a disruption to that, where the people they usually see or access drugs from leave or are displaced, they will be left trying to find someone who has it and can provide that." On another post in r/opiates, a commenter wrote: "[Hurricane] Matthew fucked our shit up. The entire town was in ruins, yet the day after, there I was driving through down trees, debris, live power lines, no traffic lights, cops everywhere, but I still got my shit."
A 2011 study following Hurricane Katrina found that many active drug users chose not to evacuate before the storm. As Eliza Player, who was addicted to heroin in New Orleans when Hurricane Katrina hit in 2005, wrote in an essay for The Fix, "I stayed behind because I didn't have enough heroin to last more than a day. I never even thought about leaving my beloved home city. Why would I venture to some unknown place where I had no idea where to score?" Not only that, but many navigated the flooded, debris-strewn streets, choosing to expose themselves to danger in order to try to get what they needed, much like the people who stayed under the Highway 59 bridge in Houston instead of seeking shelter.
Research looking at IV drug users who experienced Hurricane Sandy in New York found similar results. They often had to make risky decisions regarding their use, like sharing injection or preparation equipment with people they normally would not have. The study also showed that 60 percent experienced withdrawal and 70 percent on medication assisted treatment could not obtain sufficient doses of their maintenance medications. Researchers concluded that "though relatively brief, a hurricane can be viewed as a Big Event that can alter drug environments and behaviors, and may have lasting impact."
This impact, which is often traumatic for those who experience devastation, loss, or displacement as a result of these storms, can lead people to self-medicate with substances. "I numbed the flashing images from those days of Katrina with alcohol and pills, trying to drown out the anxiety and depression just like the floodwater drowned New Orleans," wrote Player. The Centers For Disease Control found that rates of hospitalizations for substance use disorders increased in the aftermath of Hurricane Katrina, more so in the areas that experienced the most flooding. Even among people who had evacuated to Texas, they saw a spike in treatment numbers. Similar results were found after Sandy, too.
Feehery says that makes sense, and that research shows a direct link between people who suffer traumatic loss and reach for substances as a way of coping. "When people go through a lot of stress, anxiety, depression and loss, there's a grieving process that goes with it, an emotional response," he says. "Many people may turn to self-medication to manage those feelings of grief or loss."
Jemma Dinsmoor, 34, says that the fallout from the severe storms she experienced as a child in North Central Florida led to the beginning of her substance use problems. She says her family was poor and isolated and lived in a small trailer outside the town of Citra, where they stayed during hurricanes, tropical storms and thunderstorms that ravaged their home. "We would wait out storms with no supplies, no way to evacuate," she says. "Our pets would be gone or worse in their pens outside. You never knew what you would wake up to." In fifth grade, Dinsmoor began drinking when her parents would go outside to clean up the wreckage of the storms. "I couldn't deal with the anxiety and sadness of what came when they came back inside."
Dinsmoor says that the experience has caused her immense anxiety, even today. She has struggled with addiction to alcohol and drugs for most of her life, though she is currently sober. "Even tropical storms make me panic now," she says. "I over-prepare to the point of breaking the bank… I make sure my animals are over tagged with identification, I make sure we have an exit plan, I make sure that we have batteries and lamps and technology so that we know exactly where everyone is and where to go and we have evacuation routes and we have plans if there's flooding and we have a high place to go."
The Right Step, a drug and alcohol treatment program with multiple locations throughout the Houston area, said they evacuated the patients in their residential treatment program last week, prior to Harvey making landfall. Because they have many locations, they had the ability to move patients with relative ease, says Chris Karkenny, the chief executive officer of Elements Behavioral Health, The Right Step's parent company. Karkenny says that many of their outpatient locations have been closed at some point over the past week, but that they're in the process of opening them all back up again, and as far as he knows, no one has called seeking a detox bed specifically because of displacement or withdrawal as a result of Harvey.
According to Feehery, PaRC never stopped admitting patients and they currently have open detox beds available. He also says it's too early to tell whether Harvey will result in a spike of people seeking treatment. "If you're in the middle of a different kind of crisis, people know how to self-medicate and manage through it. It's part of a survival technique and, being someone with addiction, you know how to manage and maintain and hold it together until you can't anymore," he says.
PaRC has deployed social workers and mental health professionals to serve at evacuation shelters to help identify people struggling with mental health and substance use issues. Mental health professionals at the shelters should also be able to provide drugs like buprenorphine and naloxone, opiate blockers that can prevent withdrawal symptoms in someone with a physical dependence, or be prescribed as medication assisted treatment for people with opiate addictions.
As the clouds clear and the sun shines over the city of Houston, many people are stepping out into the light to survey the damage. Durst says that activity near the Fiesta Mart is picking up, too. "There were so many people out [on Wednesday] and it was like everyone was trying to catch up, making [drug] deals and trying to get money," he says.
But for Plaza, Katrina was the catalyst that spurred her to eventually get sober, though it wouldn't happen for several more years. "Although I'd escaped New Orleans, I hadn't escaped the confusion, fear and regret in my head," she wrote. "For years to come, I would struggle with the bloated images that rolled like a movie reel through my thoughts." But drug users in Houston are still too close to the storm, still in the thick of the trauma, to know how this event will shape their lives and their addiction.