Importance: Evidence regarding the organization of civilian health care systems in active war zones is limited, yet critical for maintaining services for vulnerable populations. Objective: To describe the operational challenges and adaptive strategies implemented by an opioid agonist therapy (OAT) clinic to ensure continuity of care for patients maintained on methadone and buprenorphine during a period of prolonged armed conflict. Design: A descriptive case study of clinical, logistical, and regulatory adaptations following the escalation of conflict in Israel beginning 7 October 2023, through the 12-day Israel-Iran war in June 2025. Setting: A hospital-based ambulatory methadone maintenance treatment (MMT) clinic in the Tel Aviv region. Participants: A vulnerable population of patients with opioid use disorder (OUD) receiving daily or supervised OAT. Exposure(s): National emergency conditions, including mass evacuations, fluctuating missile threats from multiple fronts (Gaza, Lebanon, Yemen), and direct regional strikes in 2024 and 2025. Main Outcome(s) and Measure(s): The primary focus was maintaining treatment continuity through rapid protocol modifications and expanded take-home dose (THD) regulations. Results: The conflict necessitated immediate departures from standard clinical protocols. Key adaptations included the rapid expansion of THD eligibility to mitigate the risks associated with travel to the clinic during active shelling and the reallocation of resources. Regulatory frameworks were iteratively revised as the security situation evolved, shifting from daily supervised dosing to flexible, safety-oriented dispensing models. Conclusions and Relevance: Findings suggest that during national emergencies, decentralizing OAT through expanded THD regulations is essential to prevent treatment interruption and relapse. These adaptive strategies offer a framework for health policy in other conflict-affected regions to protect high-risk populations.
Schreiber et al. (Tue,) studied this question.