A retrospective, observational, cross-sectional study found that early in the COVID-19 pandemic, there was increased opioid prescriptions and that prescription durations were longer with higher doses when compared with prepandemic trends. These findings were published in JAMA Network Open.
Data were sourced from Optum’s deidentified Clinformatics Data Mart Database which included 20% of the commercially insured and 24% of the Medicare Advantage populations in all 50 states in the United States and Washington DC. Claims between 2019 and 2020 were assessed for trends in opioid dispensation and nonpharmacologic therapy for pain management.
Stratified by the first 3 quarters of 2019 (prepandemic; n=21,430,339) and 2020 (early pandemic; n=20,759,788) patient populations comprised individuals aged mean 48.6 (standard deviation [SD], 24.0) and 47.0 (SD, 23.8) years, 51.1% and 51.5% were women, 52.2% and 48.5% were White, 10.6% and 9.5% Hispanic, 7.9% and 7.3% Black, and 4.2% and 3.8% Asian, respectively.
The number of patients who received a diagnosis of pain was slightly higher during the first 3 months of 2020 compared with 2019 (mean difference [MD], 0.4%; 95% CI, 0.5%-0.5%). In March of 2020, there was a substantial decline in diagnoses (MD, -15.9%; 95% CI, -16.1% to -15.8%), remaining lower until August, and rebounding to 2019 levels in September.
The patients who received opioids for pain in the first few months of the COVID-19 pandemic decreased compared with 2019 (MD, -1.4%; 95% CI, -1.5% to -1.2%) and increased starting in April (MD, 3.5%; 95% CI, 3.3%-3.7%).
Fewer patients received nonpharmacologic therapies early in the pandemic compared with 2019 (MD, -6.0%; 95% CI, -6.3% to -5.8%).
Early in the pandemic, patients were given longer opioid prescriptions (MD, 1.07; 95% CI, 1.02-1.1 days) with higher doses (MD, 0.96; 95% CI, 0.76-1.20 morphine milligram equivalents [MME]).
Compared with 2019, patients who received no treatment during the current visit in 2020 were more likely to receive opioids only during the next visit (MD, 0.74%) and less likely to receive nonpharmacologic therapy only (MD, -2.47). Patients who received opioids only during the current visit were more likely to receive opioids only during the next visit (MD, 5.75%) and less likely to receive nonpharmacologic therapy only (MD, -2.47). Receiving nonpharmacologic therapy in the current visit associated with receiving opioids only in the next (MD, 0.36%).
This study may have been limited by not having access to data about whether the patient consumed prescribed medications.
The study authors concluded that during the COVID-19 pandemic, there was an apparent substitution of nonpharmacologic therapies with opioids among patients with a diagnosis of pain. These factors may be contributing negatively to the current opioid epidemic in the US. Additional initiatives to increase access to nonpharmacological therapies are needed.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Lee B, Yang K-C, Kaminski P, et al. Substitution of nonpharmacologic therapy with opioid prescribing for pain during the covid-19 pandemic. JAMA Netw Open. 2021;4(12):e2138453. doi:10.1001/jamanetworkopen.2021.38453