Anderson Heather D, Patterson Vanessa Paul, Wright Garth, Rawlings Julia E, Moore Gina D, Leonard Jim, Page Ii Robert L
Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA.
Colorado Department of Health Care Policy and Financing, Denver, CO, USA.
Ther Clin Risk Manag. 2023 Sep 18;19:745-753. doi: 10.2147/TCRM.S424961. eCollection 2023.
COVID-19, coinciding with the opioid epidemic in the United States, has had significant impacts on health-care utilization. While mixed, early analyses signaled a potential resurgence in opioid use following the pandemic. The primary study objective was to assess the association of the COVID-19 pandemic with opioid utilization among Health First Colorado (Colorado's Medicaid Program) members and a non-Medicaid managed care cohort who did not have a diagnosis of cancer or sickle cell disease.
Using an interrupted time series and segmented regression analysis, this population-level study assessed the association of the COVID-19 pandemic on prescribed utilization of long- and short-acting opioid analgesics among Health First Colorado members and a random sample of non-Medicaid managed care members. Pharmacy claims data for both cohorts were assessed between October 1, 2018, and September 30, 2021, with April 2020 identified as the interruption of interest. We evaluated the following monthly opioid use measures separately for short-acting and long-acting opioids: number of members filling an opioid, total fills, and total days supplied.
Short- and long-acting opioid utilization was significantly decreasing among Health First Colorado members in the 18 months prior to the start of COVID-19. After the onset of the pandemic, utilization stabilized and slopes were not significantly different from zero. Among the non-Medicaid managed care cohort, short- and long-acting opioid utilization significantly decreased in the 18 months leading up to the onset of the pandemic. After the onset of the pandemic, utilization of long-acting opioids stabilized, while utilization of short-acting opioids significantly increased.
While we observed an increase in opioid utilization measures post-pandemic in the non-Medicaid managed care cohort, a similar increase was not observed in Health First Colorado members suggesting that thoughtful opioid policies put in place pre-pandemic may have been effective at controlling potential inappropriate opioid utilization.
新冠肺炎疫情在美国与阿片类药物流行同时发生，对医疗保健利用产生了重大影响。尽管分析结果不一，但早期分析表明，疫情后阿片类药物使用可能会再度增加。主要研究目的是评估新冠肺炎疫情与科罗拉多州健康第一计划（科罗拉多州的医疗补助计划）成员以及未被诊断患有癌症或镰状细胞病的非医疗补助管理式照护队列中阿片类药物使用之间的关联。
本项基于人群的研究采用中断时间序列和分段回归分析，评估新冠肺炎疫情与科罗拉多州健康第一计划成员以及非医疗补助管理式照护成员随机样本中长效和短效阿片类镇痛药处方使用之间的关联。对两个队列2018年10月1日至2021年9月30日期间的药房报销数据进行评估，将2020年4月确定为感兴趣的中断点。我们分别针对短效和长效阿片类药物评估了以下每月阿片类药物使用指标：开具阿片类药物的成员数量、总配药量和总供应天数。
在新冠肺炎疫情开始前的18个月里，科罗拉多州健康第一计划成员中短效和长效阿片类药物的使用量显著下降。疫情开始后，使用量趋于稳定，斜率与零无显著差异。在非医疗补助管理式照护队列中，在疫情开始前的18个月里，短效和长效阿片类药物的使用量显著下降。疫情开始后，长效阿片类药物的使用量趋于稳定，而短效阿片类药物的使用量显著增加。
虽然我们观察到非医疗补助管理式照护队列在疫情后阿片类药物使用指标有所增加，但在科罗拉多州健康第一计划成员中未观察到类似增加，这表明疫情前制定的审慎阿片类药物政策可能在控制潜在的不适当阿片类药物使用方面有效。
