Center for Health and Wellbeing, Princeton University, Princeton, New Jersey.
National Bureau of Economic Research, Cambridge, Massachusetts.
JAMA Netw Open. 2021 Apr 1;4(4):e216147. doi: 10.1001/jamanetworkopen.2021.6147.
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.
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.
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.
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.
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).
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.
COVID-19 大流行扰乱了医疗服务，影响了阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的处方。了解这些模式有助于解决护理障碍。
评估在 COVID-19 大流行期间，新患者和现有患者的阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的处方情况发生了怎样的变化。
设计、地点和参与者：在这项横断面研究中，使用了 2018 年 1 月 1 日至 2020 年 3 月 3 日期间全国零售处方数据库的数据，预测了 2020 年 3 月 18 日至 9 月 1 日期间阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的处方情况。实际处方与所有、现有和新患者的预期水平进行了比较。
数据包括独立于保险状况或类型的患者处方，涵盖了 90%的零售处方、70%的邮购处方和 70%的疗养院处方。
阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的处方。结果包括总处方数、总吗啡毫克当量、每处方平均吗啡毫克当量、每处方平均分发单位数和开处方的患者人数。
分析了 90420353 名患者（50921535 名女性患者[56%]；平均[SD]年龄 49[20]岁）的 452691261 份阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的处方。2020 年 3 月 18 日至 5 月 19 日，每周开具的阿片类药物镇痛药总吗啡毫克当量为 1877 百万毫克当量，而预期为 1843 百万毫克当量，比例为 102%（95%预测区间[PI]，94%-111%；P = .71）。每周新接受阿片类药物的阿片类药物初治患者人数为 370051 人，而预期为 564929 人，即预期的 66%（95%PI，63%-68%；P < .001）。丁丙诺啡的处方与现有患者的预期相符，而每周新接受丁丙诺啡的患者人数为 9865 人，而预期为 12008 人，即 82%（95%PI，76%-88%；P < .001）。从 2020 年 5 月 20 日至 9 月 1 日，新患者的阿片类药物处方恢复到预期的 100%（95%PI，96%-104%；P = .95），而每周新接受丁丙诺啡的患者人数为 10436 人，而预期为 11613 人，即 90%（95%PI，83%-97%；P = .009）。
在这项横断面研究中，接受阿片类镇痛药和丁丙诺啡用于治疗阿片类药物使用障碍的现有患者在 COVID-19 大流行期间通常能够继续获得这些药物。阿片类药物初治患者的阿片类药物处方数量短暂减少，然后反弹，而丁丙诺啡的起始率仍保持较低水平，直到 2020 年 8 月。治疗参与人数的减少可能与过量死亡人数的增加有关。
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