Theresa is a Scientia PhD candidate at the Centre for Social Research in Health, UNSW Sydney. Her current research focuses on experiences of stigma in drug treatment and health settings. She has a history of working directly with populations experiencing structural disadvantage, and lives in Lismore (Bundjalung country).

Introduction and Aims: In February 2022, northern New South Wales was inundated by record-breaking levels of flood water. Eight pharmacies dispensing opioid agonist treatment were completely washed out and many others experienced damage. Consumers faced property destruction, homelessness and community despair, and many missed doses in the days that followed. This study interviewed pharmacists and consumers to gain an understanding of what happened and how to better prepare for service continuation following a natural disaster.

Design and Methods: I conducted semi-structured interviews with eleven pharmacists and thirteen consumers, and used interpretative phenomenological analysis to describe embodied narratives and learnings.

Key Findings: The extent and damage of the disaster was unexpected, and treatment continuation was not an immediate priority for many directly affected. Most pharmacy-based consumers close to Lismore made their way to the still operating hospital clinic to access treatment. Poor communication, long waits, and withdrawal symptoms compounded consumer distress, exacerbated by the volume of consumers in need, a lack of records authorising dispensation, and supply scarcity limiting some to daily dosing. Inundated pharmacies recommenced services within a few days to months; a few were flooded a second time. Power outages, damaged roads and geographical displacement hampered access. Some pharmacists went to extraordinary lengths to maintain services. These included operating without power, sleeping onsite, using boats and helicopters to restock, continuing service from entrances of destroyed shops, as well as communicating with each other, the public clinic and State Emergency Services to safeguard ongoing service coverage.

Discussion and Conclusions: Consumers appreciated the actions of service providers in maintaining or recommencing opioid agonist treatment services, but coordination was difficult and did not sufficiently address consumer circumstances and need. Electronic records, prioritising communication and emergency supplies for pharmacies, and better coordination with emergency services may mitigate service disruptions in future crisis events.