Climate change and the opioid epidemic in combination may pose significant challenges for individuals with opioid use disorder due to potential disruptions in access to essential addiction treatment services caused by extreme weather events. Despite concerns over the escalating health impacts of climate change, limited research has documented and explored the vulnerability of patients enrolled in opioid treatment programs to disruptions caused by climate change and particularly extreme cold events. In this commentary, we describe the impact of a catastrophic flooding event during record-setting cold temperatures at an opioid treatment program in Seattle, WA. By examining this event, we highlight the potential vulnerabilities the methadone treatment infrastructure faces regarding climate change and future extreme weather events. In doing so, we hope to draw attention to a critical need for research that describes, plans for, and addresses disruptions to opioid use disorder treatment resulting from climate change–related weather events.