Severe flooding raises deadly overdose risk in rural Appalachia, study finds, and the harm lasts for years

In July 2022, McKayla awoke to a raging storm outside her trailer in southeastern Kentucky, a place she’d already grown accustomed to frequent summer storms. While the creek near her home would often rise, it had never come close enough to be a concern. However, at 6:30 a.m. the next morning, McKayla’s child came into her room in panic after witnessing neighbors’ belongings floating by.

In a matter of hours, the water had begun flooding her home, eventually forcing McKayla and her children to seek refuge on the kitchen counter. With the assistance of her oldest son, McKayla and her children escaped to the roof, where they remained until a National Guard boat rescued them. The destruction was immense; McKayla lost her entire home and its contents.

Having been in recovery from a substance use disorder when the flood struck, the trauma and instability of her situation led her back to drug use.

Ge, Lei, and the author’s study found that severe floods in rural Appalachian areas, such as the one that destroyed McKayla’s home, can weaken support systems that have taken years to build and increase substance use-related harms. In the decade following the flood, the annual opioid overdose death rate in affected counties was 26% higher than in unaffected counties, resulting in 1,368 additional overdose deaths over a decade.

These effects were not evenly distributed; they impacted individuals with less education and those living in economically distressed rural areas.

The researchers spoke with professionals in substance use treatment and harm reduction, who shared how the flood disrupted access to treatment, recovery, and harm reduction services. Patients were unable to travel to facilities due to flooded roads, and facilities themselves were rendered unusable. Additionally, the loss of jobs and homes, coupled with the trauma of widespread devastation, led some individuals in recovery to relapse and caused drug use among those who had never used before.

The lack of access to tools such as naloxone and fentanyl test strips also heightened overdose risks. These factors combined to create an environment where overdose deaths could spike both immediately after a flood and persist for years afterward. The study emphasizes the long-term mental health and drug use implications of natural disasters and suggests potential solutions, such as mobile methadone providers and enhanced harm reduction strategies, to maintain substance use treatment and recovery services in the face of such challenges.