Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022

Abstract

ImportanceThe COVID-19 pandemic reportedly increased behavioral health needs and impacted treatment access.ObjectiveTo assess changes in incident prescriptions dispensed for medications commonly used to treat depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and opioid use disorder (OUD), before and during the COVID-19 pandemic.Design, Setting, and ParticipantsThis was a cross-sectional study using comprehensive, population-level, nationally projected data from IQVIA National Prescription Audit on incident prescriptions (prescriptions dispensed to patients with no prior dispensing from the same drug class in the previous 12 months) dispensed for antidepressants, benzodiazepines, Schedule II (C-II) stimulants, nonstimulant medications for ADHD, and buprenorphine-containing medication for OUD (MOUD), from US outpatient pharmacies. Data were analyzed from April 2018 to March 2022.ExposureIncident prescriptions by drug class (by prescriber specialty, patient age, and sex) and drug.Main Outcomes and MeasuresInterrupted time-series analysis to compare changes in trends in the monthly incident prescriptions dispensed by drug class and percentage changes in aggregate incident prescriptions dispensed between April 2018 and March 2022.ResultsIncident prescriptions dispensed for the 5 drug classes changed from 51 500 321 before the COVID-19 pandemic to 54 000 169 during the pandemic. The largest unadjusted percentage increase in incident prescriptions by prescriber specialty was among nurse practitioners across all drug classes ranging from 7% (from 1 811 376 to 1 944 852; benzodiazepines) to 78% (from 157 578 to 280 925; buprenorphine MOUD), whereas for patient age and sex, the largest increases were within C-II stimulants and nonstimulant ADHD drugs among patients aged 20 to 39 years (30% [from 1 887 017 to 2 455 706] and 81% [from 255 053 to 461 017], respectively) and female patients (25% [from 2 352 095 to 2 942 604] and 59% [from 395 678 to 630 678], respectively). Trends for C-II stimulants and nonstimulant ADHD drugs (slope change: 4007 prescriptions per month; 95% CI, 1592-6422 and 1120 prescriptions per month; 95% CI, 706-1533, respectively) significantly changed during the pandemic, exceeding prepandemic trends after an initial drop at the onset of the pandemic (level changes: −50 044 prescriptions; 95% CI, −80 202 to −19 886 and −12 876 prescriptions; 95% CI, −17 756 to −7996, respectively). Although buprenorphine MOUD dropped significantly (level change: −2915 prescriptions; 95% CI, −5513 to −318), trends did not significantly change for buprenorphine MOUD, antidepressants, or benzodiazepines.Conclusions and RelevanceIncident use of many behavioral health medications remained relatively stable during the COVID-19 pandemic in the US, whereas ADHD medications, notably C-II stimulants, sharply increased. Additional research is needed to differentiate increases due to unmet need vs overprescribing, highlighting the need for further ADHD guideline development to define treatment appropriateness.

Investigating self-reported compensation strategies for attention-deficit/hyperactivity disorder on Reddit: An analysis of user content from 2012-2023 with a focus on trends during COVID-19 (Preprint)

“…Conversely, the Psychopharmacological category (including stimulant medication) had proportional rises in the early intervals of the COVID-19 pandemic (from 14.38% of posts and comments about compensation strategies on r/ADHD in 2019 to 20.73% in 2020) and an overall upsurge in content from 2020-2022. Given the disruptions to care services caused by COVID-19, these temporal trends could instead imply a reliance on ADHD medication as a more accessible form of symptom management, which is consistent with evidence showing stimulant prescription growth throughout COVID-19 [49]. Additionally, COVID-19 saw burgeoning general consumption rates for psychotropic substances (e.g., alcohol [50]).…”

Characterising incident opioid use among incident users of prescription sedative hypnotics: A national cohort study

“…The incident prescription was defined as a prescription with no previous transaction within the same drug class within a year (365 days). 38 The index date was defined as the day an individual received their first sedative prescription. Individuals who received sedatives or an opioid in the 365 days preceding the index date were excluded from this cohort.…”

The impact of the COVID-19 pandemic on Antidepressant Prescribing with a focus on people with learning disability and autism: An interrupted time-series analysis in England using OpenSAFELY-TPP

“…In Israel Frangou et al found COVID-19 was associated with an increase in antidepressant prescription fills [30] . Using data from the IQVIA National Prescription Audit in the US, Chai et al found no significant change in trend for new antidepressant prescriptions through March 2022 [35] . Wolfschlang et al found no observed change in psychotropic or antidepressant medications in one Swedish region [36] .…”