In the whirr of preparations for Hurricane Irma, a needle exchange program in Miami's Overtown neighborhood handed out extra syringes to heroin users. Others trying to break from the drug's grasp picked up advance medication from methadone clinics.
Disasters cause stress, and stress can cause relapse for people struggling with addiction, whether their problem is alcohol, tobacco, pills or heroin. Authorities planning for the devastating effects of hurricanes now factor in the heightened danger of relapse and overdose.
The problems of alcoholism and addiction become more public in a storm, said researcher Andrew Golub of the National Development and Research Institutes in New York, who studied illicit drug users in New Orleans after Hurricane Katrina.
"During a storm, it becomes harder to hide and cope with one's addiction in private," Golub said.
Scientists learned from Hurricane Katrina and Superstorm Sandy. Drug users took chances during storms, researchers found, avoiding evacuation to stay near their dealers or sharing needles with strangers putting themselves in danger of HIV and hepatitis. Those in treatment missed doses of medications and went back to street drugs to avoid withdrawal sickness. During Sandy, clinics that lost power measured methadone by candlelight.
"Disasters like this interrupt treatment," said Enrique Pouget, whose team interviewed 300 injection drug users in New York after the 2012 storm.
Methadone programs, highly regulated by the government, are required to have disaster emergency plans. The state of Florida, in cooperation with federal authorities, granted methadone clinics discretion to provide up to five days of medication ahead of Hurricane Irma.
In Texas and Louisiana, some patients took home advance doses of methadone. Others received it in shelters or from alternative facilities.
Florida's first needle exchange program -- aimed at preventing overdoses and blood-borne infections -- faces its biggest challenge yet with Irma. This past week, Dr. Hansel Tookes and his team gave away a week's supply of clean needles and overdose reversal kits, or Narcan.
"We want to make sure all of our people have Narcan so they can save lives and be first responders in the storm," Tookes said of the 400 drug users who rely on his program . Drug users equipped with Narcan can save others who overdose.
Mark Kinzly, co-founder of the Texas Overdose Naloxone Initiative, said his group distributed around 500 kits to clinics along the Texas coast in the midst of Harvey cleanup. Storms can be disastrous for people with addictions because they interrupt routines and schedules, he said.
"There's people that are going to be without jobs and without homes because of this hurricane," Kinzly said. "They're going to be less stable in their overall lives to begin with. That can be dangerous."
In the aftermath of flooded Houston, Julie Boon oversaw repairs at a sober-living home while giving advice to residents based on her own 30 years of sobriety.
"Have faith in the foundation you've built," said Boon of Eudaimonia Recovery Homes. "If you get into fear, reach out and speak to somebody."
People in long-term recovery have the ability to cope with disasters, said Julia Negron of Venice, Florida, a former injection drug user and organizer of the Suncoast Harm Reduction Project, a grassroots group working to prevent overdoses.
"You deal with life as it comes. So here you go: Here's a test," she said.