Experiences Accessing Health and Social Services during and after Natural Disasters among People Who Use Drugs in Houston, Texas.

People who use drugs (PWUD) disproportionately experience health-related and social vulnerabilities, which may affect service needs and access during and after natural disasters. We conducted qualitative interviews with = 18 PWUD recruited via a syringe services program in Houston, Texas. We assessed their health and social service needs, as well as related service access experiences, during and after natural disasters using a combined inductive-deductive approach. Participants described a range of service-related needs related to illicit drug use, poverty, neighborhood disadvantage, acute and chronic health problems, and housing insecurity. They endorsed decreased access to medical and substance-related services and difficulty accessing disaster relief aid. Interviews highlighted the importance of mutual aid for sharing harm reduction supplies and meeting practical needs. Results suggest that some PWUD experience disproportionate vulnerability after natural disasters related to multiple marginalized identities that intersect with illicit drug use.