COVID-19 Pandemic Affected Opioid Disorder Prescription Rates

Janet Currie, PhD (Princeton University)

While the COVID-19 pandemic affected traditional medical care, a new study suggests that patients receiving treatment of opioid use disorder (OUD) had continued access to medications throughout.

However, the rates of new patients receiving treatment for OUD decreased significantly through the beginning of the pandemic. 

Investigators, led by Janet M. Currie, PhD, of the Center for Health and Wellbeing at Princeton University, evaluated how the prescription of medications for OUD changed for new and current patients during COVID-19. 

The 2 medications generally prescribed included opioid analgesics for pain management and buprenorphine for OUD. Investigators found a decrease in opioid analgesic prescriptions and an increase in buprenorphine prescriptions for OUD before the COVID-19 pandemic.

The team hypothesized that patients experiencing reductions in medication supply may lead to nonprescription opioid abuse, and a decreased likelihood of prescriptions given to opioid-naïve patients.

The Study

The cross-section study compared the evolution rates of opioid-use prescription from January 2018 to September 2020 to projected rates of prescriptions for 2020. Prescription data was assessed from the IQVIA LRx database from the United States. 

The data included 2 billion prescriptions, with 90% of prescriptions filled at retail pharmacies, 70% in mail-order medications, and 70% of medications used in long-term care. 

Patients without an opioid analgesic prescription in the past 365 days of study were considered opioid-naïve by the investigators. Similarly, patients who had not filled a prescription for buprenorphine in 365 days were considered new patients.

Investigators used 4 weekly measures of opioid analgesic prescriptions, including total number of prescriptions filled, total milligrams of morphine equivalents (MMEs), mean MMEs per prescription, and mean number of dispensed units per prescription.

They utilized 3 weekly measures of buprenorphine for OUD, including total number of prescriptions, total number of units prescribed, and mean number of dispensed units per prescription. 

Investigators projected values in 2 periods of COVID-19, with the initial period being the declaration of a national emergency from March 18 to May 19, 2020, and the second period from May 20 to September 1, 2020. 

The Results

The team’s exact numbers included 452,691,261 opioid analgesic prescriptions and 90,420,353 buprenorphine prescriptions, with a 56% female patient rate and mean age of 49 years old.

From March to May, there were 1877 million units of MME opioid analgesics prescribed weekly, versus the 1843 million that were projected.

Opioid-naïve patients received 370,051 prescriptions, versus the 564,929 projected. 

Existing OUD patients for buprenorphine experienced similar numbers to those projected by investigators. Despite initial decreases in prescriptions, each prescription was for a larger quantity, causing little change in MME supply rates. 

New patients of buprenorphine experienced 9865 prescriptions versus the 12,008 projected, or 18% lower than the expected levels.

From May to September, the prescription of opioids returned to 100%, with levels reaching 90% of projected numbers for new patients by August. 

Existing patients did not experience a disruption in their supply during the COVID-19 pandemic, but opioid-naïve patients were less likely to be prescribed. 

“On the other hand, estimates imply that 1.75 million fewer opioid-naive patients received opioid prescriptions in the weeks from March 18 to May 19, 2020,” investigators wrote. “Given the decreasing trends in opioid prescribing before the pandemic, some of these patients may never receive opioids, thereby reducing future use.”

The data showed the largest change in prescribing occurred in new patients who may have been prescribed buprenorphine for OUD, with rates that remained decreased through August 2020. 

However, an estimated 36,954 patients did not seek out treatment due to the complications of the pandemic, which investigators say may have been associated with the increase in overdose deaths during COVID-19. 

“These results suggest that the pandemic reversed some of the improvement in access to buprenorphine for OUD that occurred during the past decade,” investigators concluded. “Improving and maintaining access to treatment should be a priority.”

The study, “Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic,” was published online in JAMA Network Open.