Prescribing of Opioids and Buprenorphine for OUD During the COVID-19 Pandemic | Addiction Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
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 prepandemic trends; prescriptions to opioid-naive patients were 34% below projected levels but rebounded by August 2020. Prescribing of buprenorphine for opioid use disorder followed prepandemic trends for existing patients, while prescriptions to new patients were 18% below projected levels, rebounding to 90% of projected levels by August 2020.

Meaning  This study suggests that prescriptions for opioid analgesics and buprenorphine for opioid use disorder decreased among new, but not existing, patients during the COVID-19 pandemic.

Abstract

Importance  The 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 Participants  In 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.

Exposures  The 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 Measures  Prescriptions 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.

Results  A 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 Relevance  In 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 through August 2020. Reductions in treatment entry may be associated with increased overdose deaths.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Accepted for Publication: February 25, 2021.

Published: April 15, 2021. doi:10.1001/jamanetworkopen.2021.6147

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Currie JM et al. JAMA Network Open.

Corresponding Author: Janet M. Currie, PhD, Center for Health and Wellbeing, Princeton University, 185A Jules Romo Rabinowitz Building, Princeton, NJ 08540 (jcurrie@princeton.edu).

Author Contributions: Dr Currie had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Obtained funding: Currie.

Supervision: Currie.

Conflict of Interest Disclosures: Dr Zhang reported that he is an evaluator and federal contractor for the Veterans Health Administration, Office of Mental Health and Suicide Prevention. No other disclosures were reported.

Disclaimer: The statements, findings, conclusions, views, and opinions contained and expressed in this article are based on data obtained under license from IQVIA’s Human Data Science Research Collaborative and use the Longitudinal Prescription LRx TM, January 1, 2018, to September 1, 2020, IQVIA Inc. All Rights Reserved. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA Inc or any of its affiliated or subsidiary entities.

Additional Contributions: We thank Allen Campbell, BS, Washington State University, Customer Support IQVIA, for facilitating access to these data. He received no payment from the authors.

References
1.
Czeisler  MÉ , Marynak  K , Clarke  KEN ,  et al.  Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(36):1250-1257. doi:10.15585/mmwr.mm6936a4 PubMedGoogle ScholarCrossref
2.
American Medical Association. Issue brief: reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. Updated March 3, 2021. Accessed March 10, 2021. https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf
3.
Haley  DF , Saitz  R .  The opioid epidemic during the COVID-19 pandemic.   JAMA. 2020;324(16):1615-1617. doi:10.1001/jama.2020.18543 PubMedGoogle ScholarCrossref
4.
Ochalek  TA , Cumpston  KL , Wills  BK , Gal  TS , Moeller  FG .  Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic.   JAMA. 2020;324(16):1673-1674. doi:10.1001/jama.2020.17477 PubMedGoogle ScholarCrossref
5.
Gifford  K , Lashbrook  A, , Barth  S ,  et al. State Medicaid programs respond to meet COVID-19 challenges: results from a 50-state Medicaid budget survey for state fiscal years 2020 and 2021. Kaiser Family Foundation. Published October 14, 2020. Accessed November 5, 2020. https://www.kff.org/medicaid/report/state-medicaid-programs-respond-to-meet-covid-19-challenges/
6.
Executive Office of the President. Declaring a national emergency concerning the novel coronavirus disease (COVID-19) outbreak. Published March 18, 2020. Accessed March 10, 2021. https://www.federalregister.gov/documents/2020/03/18/2020-05794/declaring-a-national-emergency-concerning-the-novel-coronavirus-disease-covid-19-outbreak
7.
Worldometers. Daily new deaths in the United States, 7-day moving average. Accessed November 6, 2020. https://www.worldometers.info/coronavirus/country/us/
8.
Farmer  SA , Schreiber  M , Horvath  KA .  Slowing the opioid epidemic by controlling a source: disabling the pump.   JAMA Cardiol. 2020;5(8):896-897. doi:10.1001/jamacardio.2020.1468 PubMedGoogle ScholarCrossref
9.
Lin  LA , Fernandez  AC , Bonar  EE .  Telehealth for substance-using populations in the age of coronavirus disease 2019: recommendations to enhance adoption.   JAMA Psychiatry. 2020;77(12):1209-1210. doi:10.1001/jamapsychiatry.2020.1698 PubMedGoogle Scholar
10.
Alexander  GC , Tajanlangit  M , Heyward  J , Mansour  O , Qato  DM , Stafford  RS .  Use and content of primary care office-based vs telemedicine care visits during the COVID-19 pandemic in the US.   JAMA Netw Open. 2020;3(10):e2021476. doi:10.1001/jamanetworkopen.2020.21476 PubMedGoogle Scholar
11.
Jeffery  MM , D’Onofrio  G , Paek  H ,  et al.  Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US.   JAMA Intern Med. 2020;180(10):1328-1333. doi:10.1001/jamainternmed.2020.3288 PubMedGoogle ScholarCrossref
12.
Zhang  VS , Olfson  M , King  M .  Opioid and benzodiazepine coprescribing in the United States before and after US Food and Drug Administration boxed warning.   JAMA Psychiatry. 2019;76(11):1208-1210. doi:10.1001/jamapsychiatry.2019.2563 PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close