Americans filled roughly the same number of prescriptions for opioid use disorder (OUD) medication before the onset of the COVID-19 pandemic and after, according to the first research using national prescription data representing all payer sources, co-conducted by Indiana University and IUPUI faculty members who are part of IU’s Addictions Grand Challenge.
But while prescriptions for buprenorphine plateaued after March 2020, prescriptions for other drugs show a troubling decline, suggesting more flexible use of telemedicine through new federal buprenorphine guidelines played a vital role in keeping those suffering from OUD on their prescribed medication. The share of prescriptions paid by Medicaid rose, pointing to the protective role of Medicaid during economic distress.
The study, co-conducted by the O’Neill School of Public and Environmental Affairs’ Kosali Simon and IUPUI Department of Economics’ Sumedha Gupta, examined prescription data from a U.S. database that includes 92 percent of the country’s retail pharmacy claims (as part of the COVID-19 Research Database, a pro-bono cross-industry collaborative). It appears today in JAMA Internal Medicine.
They counted the number of individuals who filled prescriptions each week between May 1, 2019 and June 28, 2020 and compared the trends before and after the transition—the week of March 16. That’s when the federal government relaxed longstanding guidelines on telemedicine, allowing authorized practitioners greater flexibility to prescribe medication for OUDs during the COVID-19 crisis. Rather than relying on in-person visits, practitioners were able to host virtual appointments that made it easier for some patients to keep their prescriptions current.
The ability for practitioners to continue prescribing OUD medications via nontraditional ways may have helped retain patients who might have otherwise discontinued treatment, Simon said.
“Between March 2019 and March 2020, the Centers for Disease Control and Prevention reported a 9.1 percent increase in drug overdose deaths indicating that the opioid crisis was far from over as we entered the new COVID-19 crisis,” she said. “Many patients who rely on medications for opioid use disorder might not have been able to continue seeking treatment for buprenorphine. The relaxation of federal guidelines to allow practitioners to prescribe that medication through virtual visits or other digital methods most likely saved lives.”
The researchers, including the University of Michigan’s Thuy D. Nguyen, also looked at the number of all prescriptions for any medication over the same period. There was much slower growth (just under nine percent) between May 2019 and March 2020 for all prescriptions compared to the 26 percent increase for buprenorphine. But from March through June 2020, there was an abrupt and significant decrease in the number of all prescriptions issued.
“Relaxing the telemedicine guidelines, in a timely response to the pandemic, worked to retain continuity of buprenorphine treatment, one of the most effective treatments for opioid use disorder,” Nguyen said. The authors noted that there was no way to identify whether a prescription was new, or the continuation of an already-prescribed treatment.
The study also found that the number of patients who paid for prescriptions with cash significantly declined after the pandemic, while prescriptions paid for by Medicaid remained steady. Dr. Brendan Saloner from Johns Hopkins University mentioned, “if you look by payer, Medicaid holds much steadier than other sources, suggesting that Medicaid may be more of a stopgap in a period of economic dislocation.”
The study was co-authored by Simon, Gupta, Nguyen, and Engy Ziedan (Tulane University), G. Caleb Alexander (Johns Hopkins University), Brendan Saloner (Johns Hopkins University), and Bradley D. Stein (RAND Corporation).