Data suggest that the number of opioid prescriptions filled by opioid-naive patients declined early in the COVID-19 pandemic, but previous improvements in access to buprenorphine were also reversed due to the early part of the pandemic, limiting access to necessary treatment for opioid use disorder. This is according to research published in JAMA Network Open.

In a cross-sectional study, researchers set out to evaluate how prescribing practices for opioid analgesics for pain management and buprenorphine for opioid use disorder management changed from 2018 to 2020. Investigators assumed that due to the COVID-19 pandemic, new patients would experience the greatest changes in prescribing practices.

Data were drawn from the IQVIA LRx US database, which encapsulates 2 billion yearly prescriptions and included 452,691,261 prescriptions for opioid analgesics and buprenorphine across 90,420,353 unique patients (56% women; mean age, 49±20 years). Investigators calculated values for 2 prescribing periods: March 18 to May 19 (Period 1) and May 20 to September 1 (Period 2).


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Between March 18 and May 19, 2020, weekly opioid analgesic prescriptions decreased; the maximum was 2,733,260 prescriptions in the first week to a minimum of 2,324,923 prescriptions during the week of April 15. Although total prescribed milligrams of morphine equivalents (MMEs) remained flat (102% of projected levels; 95% PI, 94% to 111%), this is because mean MMEs and mean number of dispensed units per prescription increased (actual and projected, 799 and 698 vs 66.7 and 60.0, respectively).

A small decrease was seen in weekly prescription measures for buprenorphine for opioid use disorder of 95% (311,467 projected vs 294,848 actual; 95% PI, 90% to 100%) between March 18 and May 19. The total number of units remained flat in both periods, with stability in the prescribed quantity likely due to an increase in the mean number of units per prescription (35 actual vs 32 projected; 108%; 95% PI, 106% to 110%).

There was a small decrease in the number of existing patients filling prescriptions for opioid analgesics during the first period, and no change in total prescribed MMEs during either the first or second period. Within the group of opioid-naïve patients, the number of those who filled opioid analgesics in the first period decreased to 66% of the projected levels; in the second period, there were 558,293 new patients weekly vs the 559,040 that were projected.

There were slight decreases in the number of filled prescriptions during both the first and second periods among existing patients. During the second period, 97% of projected patients filled prescriptions (95% PI, 94% to 100%); no change was noted in the total number of units of buprenorphine prescribed to existing patients.

Comparatively, the number of new patients receiving buprenorphine was at 82% of projected levels during the first period, and 90% of the projected levels during the second period (95% PI, 76% to 99% and 83% to 97%, respectively).

Study limitations include the exclusion of medications that do not flow through retail pharmacies and an inability to assess whether some medications were being prescribed for alcohol use disorder rather than opioid use disorder.

“The results suggest that existing patients taking opioid analgesics experienced little disruption in access during the COVID-19 pandemic,” the researchers concluded. “Clinicians adjusted the size of prescriptions to compensate for reductions in the number of prescriptions filled…. Estimates imply that 1.75 million fewer opioid-naïve patients received prescriptions [between] March 18 and May 19, 2020. Given the decreasing trends in opioid prescribing before the pandemic, some of these patients may never receive opioids, thereby reducing future use.”

Reference

Currie JM, Schnell MK, Schwandt H, Zhang J. Prescribing of opioid analgesics and buprenorphine for opioid use disorder during the COVID-19 pandemic. JAMA Netw Open. 2021;4(4):e216147. doi:10.1001/jamanetworkopen.2021.6147