Department of Emergency Medicine, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA.
Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY 10016, USA.
Prev Med. 2023 Dec;177:107789. doi: 10.1016/j.ypmed.2023.107789. Epub 2023 Nov 26.
The COVID-19 pandemic contributed to healthcare disruptions for patients with chronic pain. Following initial disruptions, national policies were enacted to expand access to long-term opioid therapy (LTOT) for chronic pain and opioid use disorder (OUD) treatment services, which may have modified risk of opioid overdose. We examined associations between LTOT and/or OUD with fatal and non-fatal opioid overdoses, and whether the pandemic moderated overdose risk in these groups.
We analyzed New York State Medicaid claims data (3/1/2019-12/31/20) of patients with chronic pain (N = 236,391). We used generalized estimating equations models to assess associations between LTOT and/or OUD (neither LTOT or OUD [ref], LTOT only, OUD only, and LTOT and OUD) and the pandemic (03/2020-12/2020) with opioid overdose.
The pandemic did not significantly (ns) affect opioid overdose among patients with LTOT and/or OUD. While patients with LTOT (vs. no LTOT) had a slight increase in opioid overdose during the pandemic (pre-pandemic: aOR:1.65, 95% CI:1.05, 2.57; pandemic: aOR:2.43, CI:1.75,3.37, ns), patients with OUD had a slightly attenuated odds of overdose during the pandemic (pre-pandemic: aOR:5.65, CI:4.73, 6.75; pandemic: aOR:5.16, CI:4.33, 6.14, ns). Patients with both LTOT and OUD also experienced a slightly reduced odds of opioid overdose during the pandemic (pre-pandemic: aOR:5.82, CI:3.58, 9.44; pandemic: aOR:3.70, CI:2.11, 6.50, ns).
Findings demonstrated no significant effect of the pandemic on opioid overdose among people with chronic pain and LTOT and/or OUD, suggesting pandemic policies expanding access to chronic pain and OUD treatment services may have mitigated the risk of opioid overdose.
新冠疫情导致慢性疼痛患者的医疗服务中断。在最初的中断之后，出台了国家政策，以扩大长期阿片类药物治疗（LTOT）的机会，用于慢性疼痛和阿片类药物使用障碍（OUD）的治疗服务，这可能改变了阿片类药物过量的风险。我们研究了 LTOT 和/或 OUD 与致命和非致命阿片类药物过量之间的关联，以及疫情是否改变了这些人群的过量风险。
我们分析了纽约州医疗补助计划（3/1/2019-12/31/20）的慢性疼痛患者（N=236391）的数据。我们使用广义估计方程模型来评估 LTOT 和/或 OUD（既不是 LTOT 也不是 OUD[参考]、仅 LTOT、仅 OUD 和 LTOT 和 OUD）与疫情（2020 年 3 月至 12 月）之间的关联与阿片类药物过量。
疫情并没有显著影响 LTOT 和/或 OUD 患者的阿片类药物过量。虽然 LTOT 患者（与没有 LTOT 的患者相比）在疫情期间阿片类药物过量略有增加（疫情前：aOR：1.65，95%CI：1.05，2.57；疫情期间：aOR：2.43，CI：1.75，3.37，无统计学意义），但 OUD 患者在疫情期间阿片类药物过量的可能性略有降低（疫情前：aOR：5.65，CI：4.73，6.75；疫情期间：aOR：5.16，CI：4.33，6.14，无统计学意义）。同时患有 LTOT 和 OUD 的患者在疫情期间阿片类药物过量的几率也略有降低（疫情前：aOR：5.82，CI：3.58，9.44；疫情期间：aOR：3.70，CI：2.11，6.50，无统计学意义）。
研究结果表明，疫情对慢性疼痛患者、LTOT 和/或 OUD 患者的阿片类药物过量没有显著影响，这表明扩大慢性疼痛和 OUD 治疗服务机会的疫情政策可能降低了阿片类药物过量的风险。
