Opioid Use Disorder Treatment Adherence Stable During COVID-19 Pandemic

Haiden A. Huskamp, PhD

While there has been a big push for at least the last decade in decreasing the prevalence of opioid use disorder (OUD), the coronavirus disease 2019 (COVID-19) may have complicated that initiative.

A team, led by Haiden A. Huskamp, PhD, Department of Health Care Policy, Harvard Medical School, examined how OUD treatment during the early months of the pandemic compared to 2019 in a number of ways, including medication fills, outpatient visits, and urine tests, among patients with private insurance.

With stress levels expected to be high because of several factors, including social isolation and unemployment, there may be an increase in opioid use and overdoses.

Factoring into these problems also include a decline in out-patient visits and concerns patients who were treated for OUD prior to the pandemic not adhering to the same level of services with fewer patients beginning treatment.

Another factor has been a rapid increase in telemedicine, facilitated by expanded reimbursement and regulatory waivers, including the requirement for an in-person visit with a clinician that can prescribe certain OUD medications. However, it is not entirely known to what extent the use of telemedicine has changed access to OUD care.

The researchers analyzed data for patients between 18-64 years old on claims for commercial and Medicare Advantage enrollees, who are overrepresented in the south and Midwest. The patients included in the analysis were continuously enrolled with medical, behavioral health, and pharmacy benefits from January through May in 2019 and 2020.

The researchers divided the patients into different cohorts, including patients already receiving OUD medication and patients not already receiving OUD medication.

The team sought outcomes of weekly and cumulative percentages with at least 1 OUD medication prescription or facility/clinician administration, at least 1 OUD visit, and at least 1 urine OUD toxicology test from March through May.

They defined significance as a confidence interval excluding 0 and examined the prop-portion of weekly OUD visits delivered through telemedicine among patients with at least 1 visit.

Overall, enrollee demographics were similar between the 2 years, with a mean age of 42.

Among those continuously enrolled in January and February 2020, 92.78% remained enrolled through May, similar to 93.44% in 2019.

There were 16,128 individuals already receiving OUD medications, with 74.47% using buprenorphine in 2019. These numbers were 18,068 treated patients in 2020, 74.19% using buprenorphine.

Overall, more individuals filled at least 1 prescription in 2020 than in 2019 (67.99% vs 65.37%; difference, –2.62%; 95% CI, –3.62% to –1.62%). The percentage receiving at least 1 OUD visit in March through May was not significantly different in 2020 and 2019 (26.85% vs 27.20%; difference, 0.35%; 95% CI, –0.59% to 1.30%), while the percentage receiving at least 1 urine test was lower in 2020 (10.56% vs 13.81%; difference, 3.25%; 95% CI, 2.55-3.94%).

Within the study period in 2020, telemedicine visits increased from 0.48% in week 1 to 23.53% in week 13.

For patients not receiving medication in January or February (n = 6,127,513 in 2019; n = 5,970,239 in 2020), the percentage receiving at least 1 fill in March through May in 2020 was lower than 2019 (0.12% vs 0.16%; difference, 0.03%; 95% CI, 0.03-0.04%).

In addition, the percentage of patients receiving at least 1 OUD visit in March through May (0.13% vs 0.14%; difference, 0.01%; 95%CI, 0.004-0.01%]\) and the percentage receiving at least 1 urine test (0.08% vs 0.12%; difference, 0.03%; 95% CI, 0.03-0.04%) were lower in 2020.

“During the first 3 months of the pandemic, among patients already receiving OUD medication, there was no decrease in medication fills or clinician visits,” the authors wrote. “However, fewer individuals initiated OUD medications, and there was less urine testing across all patients. In recent research, OUD clinicians described that they could maintain care with existing patients via telemedicine during the pandemic but were uncomfortable initiating new patients with medication.”