Prescription Trends Between 2019 and 2022 Show the Rise of Telehealth

Ashwini Nagappan, MBE

Credit: UCLA, Clinical and Translational Science Institute

A trend study saw an uptick in stimulants, antidepressants, and opioids prescribed through telehealth during the COVID-19 pandemic.¹

“These findings align with existing research highlighting the shift toward telehealth and the rise in stimulant and opioid telehealth prescribing during the pandemic,” wrote investigators, led by Ashwini Nagappan, MBE, from Fielding School of Public Health at UCLA.

Telehealth grew in popularity during the COVID-19 pandemic, with patients receiving prescriptions of controlled substances from the safety of their own homes. Patients could receive these prescriptions through telehealth due to temporary public health emergency policies, which began in March 2020 and are set to continue until December 2024.

Many people took advantage of receiving prescriptions through telehealth. With this option available to patients, stimulant prescriptions and opioid e-prescribing expanded, as discovered by several earlier studies.²

Yet, investigators noted the need for a comprehensive understanding of national trends across medication trends and the difference in prescription trends among demographic characteristics, such as sex and rurality.¹ The team sought to describe in-person and telehealth prescribing patterns for stimulants, antidepressants, or opioids from 2019 to 2022.

Investigators conducted a cross-sectional study of 55.3 million participants (mean age: 45.6 years; 61.1% females) using the Trilliant Health national all-payer claims database. This database contained quarterly medical and pharmacy claims from January 2019 to December 2022 for all 50 states and the District of Columbia, along with the medical visit associated with the pharmacy fill. The team identified the quarterly number of prescriptions for stimulants, antidepressants, and opioids and categorized them as prescribed either in-person or via telehealth.

From 2019 to 2022, stimulant and antidepressant prescriptions increased by 37.5% and 20.9%, respectively. Both stimulants and antidepressants had increases in telehealth prescriptions during this period.

Stimulants prescribed through telehealth appointments grew from 1.4% to 38.1%. In the second quarter of 2020, telehealth prescriptions accounted for 51.8% of stimulant prescriptions, and the quantity of stimulant telehealth prescriptions increased to 62% in 2022. Despite the increase, the prescriptions stayed below the pre-PHE average of 97.6%.

As for antidepressants, telehealth prescription fills increased from 1.5% in 2019 to 31.4% in 2022. Prescriptions reached its peak in the second quarter of 2020, accounting for 46.7% of antidepressant prescription volume.

Unlike stimulants and antidepressants, investigators observed the opposite trend for opioid prescriptions. From 2019 to 2022, the prescription volume for opioids dropped 17.2% from 2019 to 2022. Opioid prescriptions started declining before the second quarter of 2020.

Although most opioids were prescribed in person, the pandemic introduced the option of having opioid prescriptions filled through telehealth appointments. Telehealth opioid prescriptions increased from 0% in 2019 to 8.4% in 2022. Opioid prescriptions via telehealth reached 24.1% in the second quarter of 2020.

Investigators observed telehealth prescribing rose among females and males for stimulants (increased by 47% vs 28.1%, respectively), antidepressants (26.6% vs 21.5%), and opioids (158.4% vs 150%, but females showed a greater rate of increase across all 3 medication types.

“Female individuals demonstrated a growing reliance on telehealth compared with male individuals, especially for stimulants, possibly reflecting sex differences in prescription needs or access preferences,” investigators wrote.”

Furthermore, rural telehealth prescriptions rose for stimulants (12.2%), antidepressants (7.3%), and opioids (79.5%) but decreased over time. Participants in nonrural locations had greater increases in telehealth prescriptions for stimulants (38%), antidepressants (26.4%), and opioids (159.6%).

“…while more prescriptions were being written via telehealth, rural areas were not keeping pace with the growth seen in nonrural areas,” investigators wrote.

Investigators wrote the findings were limited by not capturing prescriptions issued by direct-to-customer companies and those paid for with out-of-pocket spending.

“As telehealth policies continue to evolve post-PHE, balancing access to prescriptions with mitigating potential risks, such as misuse, is crucial,” investigators concluded. “Future research should compare telehealth based and in-person prescribing appropriateness.”

References

1. ^{Nagappan, A, Miller, A, Jain, S, et al. Stimulant, Antidepressant, and Opioid Telehealth Prescription Trends Between 2019 and 2022. JAMA Network Open. 2024;7(9):e2433334. doi:10.1001/jamanetworkopen.2024.33334}
2. ^{Derman, C. Telemedicine Reduced After COVID-19 Peak, Mental Health Video Visits on Rise. HCPLive. January 24, 2024. https://www.hcplive.com/view/telemedicine-reduced-after-covid-19-peak-mental-health-video-visits-rise. Accessed September 13, 2024.}