The Systems That Were Keeping People Alive

The night Hurricane Helene hit western North Carolina, September 27, 2024, Devon ran from one side of his house to the other, listening to trees snap in the dark. His wife and their four-year-old daughter hid in a closet. The wind took twenty pines off the steep hill in Asheville where they lived. Five of them took the porch and a corner of the house.

Devon survived the storm. What he has been losing since then is harder to see, and no form exists to measure it.

Before Helene, his days had a structure that kept him alive in a way the house also kept him alive. Suboxone, taken daily, eased his cravings for opioids. Twelve-step meetings gave him a room full of people who understood. Individual therapy gave him a place to say the things he couldn't say anywhere else. He and his wife had welcomed their daughter in 2020. Recovery and marriage were sometimes bumpy, he told Blue Ridge Public Radio, but he felt he was building something lasting.

The storm left his sobriety intact. It took apart the scaffolding holding it up, piece by piece.

His 12-step group moved online for a couple of weeks. When in-person meetings resumed, Devon couldn't make them. He was repairing his house. He stopped going to therapy. He avoided hobbies that triggered the urge to drink, which meant he stopped doing things he loved. By the summer of 2025, he and his wife had divorced. Between the marriage and the storm, he'd lost about $100,000. "I was suicidal," he said.

He did not relapse. He wants that on the record. The distance between where he was and where he'd been measures something that no damage assessment captures. No FEMA form asks about the meeting you stopped attending. No disaster declaration accounts for the therapist you couldn't reach because you were pulling drywall out of your living room.

Devon's experience is one thread in a pattern that BPR reporter Katie Myers documented across western North Carolina this spring, in a series co-published with Grist and The Assembly. Recovery from substance use disorder depends on stability. The same meeting at the same time in the same room with the same people. A network where someone notices when a chair is empty. Helene shattered that stability across a region where it was already stretched thin.

North Carolina had been celebrating progress. Between April 2024 and April 2025, the state saw a 35 percent decline in overdose fatalities, one of the largest drops in the country. Harm reduction workers in the mountains knew what the statewide numbers couldn't show. Hill Brown, working in western NC, warned that once the disrupted drug supply came back online and people who'd lost housing were coping with compounding stress, "there is going to be an uptick in overdoses, because we just don't know what the supply is going to look like." County-level data for the post-Helene period has not been finalized. The statewide trend and the ground-level reality may be telling very different stories.

In the days and weeks after the storm: roads washed out, cell service gone, pharmacies closed, clinics dark. For people on methadone, which must be dispensed daily at federally controlled treatment centers, the closures were immediate and total. For people on buprenorphine, regulations around controlled substances meant that even pharmacies still standing couldn't always verify insurance or process prescriptions without internet. Blake Fagan, clinical director of substance use disorder initiatives at the Mountain Area Health Education Center, reported that the system delayed medications numerous times after Helene, with no exceptions allowed. Regulations designed to prevent diversion of controlled substances became, in a disaster, barriers to survival.

Cordelia Stearns, chief medical officer at High Country Community Health in Watauga County, said the first calls to her clinics were for buprenorphine. "The things that my patients did to be able to access their bupe," she told BPR, "it was astonishing."

One of her patients had been living in a shed after Helene. He accidentally burned it down trying to stay warm through the winter. He walked hours to reach the clinic and keep up with his treatment. "He did actually make these heroic efforts to stay in care," Stearns said. Despite that, he was incarcerated multiple times for nonviolent drug offenses. As of this spring, he's out of touch again. Stearns assumes he's probably in jail. "It's always a little nerve-racking when you can't reach people," she said, choking up.

Nobody counts that chain. Displacement leads to missed appointments. Missed appointments become violations. Violations become incarceration. For people whose recovery depends on continuity of care, a disaster can turn a missed dose into a criminal record.

At FIRST at Blue Ridge, a halfway house in Black Mountain, about 30 residents left to deal with Helene's aftermath. Some lost the homes they'd planned to return to. Others, there as a condition of probation, had to navigate spotty cell service to get court permission to check on their families. A few walked off, hoping to hike home. Most came back. Drug tests administered on return showed several had relapsed.

When the formal systems broke, the informal ones held longer. Tyler Yates, North Carolina's state opioid coordinator, watched treatment centers become depots for first aid supplies, clean water, and gasoline, filling survival needs alongside their clinical mission. Harm reduction workers in Marshall shared their own medication supplies when pharmacies couldn't fill prescriptions, knowing that pooling controlled substances broke the law but that the alternative was worse. John and Cinnamon Kennedy, musicians who had spent years distributing naloxone through Buncombe County's nightclubs and music halls after John lost his brother and several friends to overdoses, leaned on their network to keep supplies moving.

Sinn, a staff member at the Steady Collective with a history of substance use, put it simply:

In the months after Helene, that feeling was the thing most likely to kill someone.

The historical parallels offer no comfort. After Superstorm Sandy, an estimated 70 percent of New Yorkers relying on recovery medications couldn't get enough of them; after Hurricane Maria in Puerto Rico, overdose reports climbed for two years. The pattern is documented, and the response architecture still hasn't caught up. A multi-university NIH-funded study led by Virginia Tech researcher Julie Gohlke is now tracking the long-term health consequences of Helene's inland impacts on Appalachian communities. The research will take years. The people it's studying are living on a different clock.

This past Memorial Day weekend, communities across western North Carolina gathered at cookouts and cemeteries, doing the ordinary things that hold a place together. For people in recovery, a holiday weekend is its own kind of test. The routines that anchor you through a Tuesday don't always hold on a long weekend when everyone else is drinking. Before Helene, the meeting was there. The sponsor picked up. The room was open.

Devon did not relapse. He held on through the divorce, through the financial loss, through the suicidal ideation, through the months of rebuilding a house while the structure holding him together came apart. He is still in Asheville. Whether the scaffolding he lost has been rebuilt, or whether he is simply standing without it, is the kind of question that eighteen months after a hurricane still has no answer.

The roads are mostly repaired. The buildings are being rebuilt. The rhythm of staying alive, the Tuesday meeting, the pharmacy run, the chair someone notices is empty, is still fractured across these mountains. Nobody is counting what that costs, because no instrument exists to count it.