Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

Abstract

IMPORTANCEThe COVID-19 pandemic disrupted medical care, impacting prescribing of opioid analgesics and buprenorphine for opioid use disorder. Understanding these patterns can help address barriers to care. OBJECTIVE To evaluate how prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic among both new and existing patients. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, use of opioid analgesics and buprenorphine for opioid use disorder from March 18 to September 1, 2020, was projected using a national database of retail prescriptions from January 1, 2018, to March 3, 2020. Actual prescribing was compared with projected levels for all, existing, and new patients. EXPOSURESThe data include prescriptions to patients independent of insurance status or type and cover 90% of retail prescriptions, 70% of mail-order prescriptions, and 70% of nursing home prescriptions. MAIN OUTCOMES AND MEASURESPrescriptions for opioid analgesics and buprenorphine for opioid use disorder. Outcomes included total number of prescriptions, total morphine milligram equivalents, mean morphine milligram equivalents per prescription, mean dispensed units per prescription, and number of patients filling prescriptions. RESULTSA total of 452 691 261 prescriptions for opioid analgesics and buprenorphine for opioid use disorder were analyzed for 90 420 353 patients (50 921 535 female patients [56%]; mean [SD] age, 49 [20] years). From March 18 to May 19, 2020, 1877 million total morphine milligram equivalents of opioid analgesics were prescribed weekly vs 1843 million projected, a ratio of 102% (95% prediction interval [PI], 94%-111%; P = .71). The weekly number of opioid-naive patients receiving opioids was 370 051 vs 564 929 projected, or 66% of projected (95% PI, 63%-68%; P < .001). Prescribing of buprenorphine was as projected for existing patients, while the number of new patients receiving buprenorphine weekly was 9865 vs 12 008 projected, or 82% (95% PI, 76%-88%; P < .001). From May 20 to September 1, 2020, opioid prescribing for new patients returned to 100% of projected (95% PI, 96%-104%; P = .95), while the number of new patients receiving buprenorphine weekly was 10 436 vs 11 613 projected, or 90% (95% PI, 83%-97%; P = .009). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, existing patients receiving opioid analgesics and buprenorphine for opioid use disorder generally maintained access to these medications during the COVID-19 pandemic. Opioid prescriptions for opioid-naive patients decreased briefly and then rebounded, while initiation of buprenorphine remained at a low rate (continued) Key Points Question How has prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic? Findings This cross-sectional study analyzed prescriptions from 90 420 353 patients and found that from March 18 to May 19, 2020, total morphine milligram equivalents of opioid analgesics prescribed to existing patients followed ...

Prescription fill patterns for benzodiazepine and opioid drugs during the COVID-19 pandemic in the United States

“…The decrease may be explained by disruptions to outpatient and hospital clinical services and elective surgeries mandated during the early phase of the pandemic. Our results are consistent with a report indicating that existing patients maintained access to opioid medications, but the weekly number of opioid-naïve patients receiving opioid prescriptions decreased over March 18-May 19, 2020 ( Currie et al, 2021 ). A similar study reported plateauing of buprenorphine prescriptions ( Nguyen et al, 2021 ).…”

“…The observed increase in benzodiazepine prescriptions in our study may be partly explained by the pivot toward telemedicine, which has been shown to be related to less attrition and improved depression symptoms in patients receiving teletherapy ( Mohr et al, 2008 ). Given the low rate of buprenorphine initiation during the pandemic ( Currie et al, 2021 ) and the prevalence of chronic pain in US adults (20.4% as of 2016, Dahlhamer et al, 2018 ), our finding of decreased opioid prescriptions following the emergency declaration suggests the need for further structural support in increasing telemedicine access among patients needing opioid prescriptions. Research on increasing and maintaining access to telemedicine across all patient needs including antidepressants, analgesics, and substance use disorder treatment remains crucial ( Di Carlo et al, 2021 ).…”

Characterizations of Opioid Prescribing in Community Health Centers in 2018

“…CHCs experienced enormous financial losses as a result of the pandemic, 26 some closing completely, creating uncertainty for patients receiving prescriptions and especially those at risk for opioid use disorders. 27 Our results can inform CHCs in their decision-making with regard to prioritizing patient outreach (eg, reaching out to their more medically complex patients) and providing access during this and future pandemics to mitigate high-risk opioid use.…”

The NCSBN 2022 Environmental Scan: Resiliency, Achievement, and Public Protection

“…The data revealed that while existing patients maintained access to buprenorphine treatment during the early months of the pandemic, the number of new patients receiving buprenorphine for opioid use disorder during the early months of the pandemic decreased by almost 25% and remained depressed through August 2020, even then only reaching 90% of projected levels. The study results imply that 36,954 fewer patients entered opioid use disorder treatment, which may have been associated with increases in overdose deaths ( Currie et al, 2021 ).…”

“…Most medication-assisted treatment (suboxone or methadone), support groups, and 12-step programs require in-person visits. Disruption to access for the usual in-person treatments may be associated with increase overdose deaths ( Currie et al, 2021 ).…”