Disparities in filled opioid use disorder prescriptions linked to COVID-19 pandemic

The COVID-19 pandemic was a likely cause for worsened disparities in buprenorphine and naltrexone access for opioid use disorder among minority groups compared with white patients, per a study published in JAMA Network Open.

“Despite some progress in [medications for opioid use disorder] use, pre-pandemic evidence suggested that it was associated with frequent exposure to high out-of-pocket costs and inequitable distribution, with greater access for white individuals and communities with primarily white populations,” Thuy Nguyen, PhD, of the University of Michigan’s School of Public Health, and colleagues wrote.

Researchers sought to investigate whether disruptions in filled buprenorphine and naltrexone prescriptions could be attributed to race and ethnicity, as well insurance status or payer type.

The cross-sectional study examined retail pharmacy claims from the Symphony Health database from May 2019 to June 2021 to identify more than 1.5 million individuals who filled buprenorphine prescriptions (42.7% white, 6.1% Black, 3.6% Hispanic, 0.3% Asian) and more than 127,000 individuals who filled extended-release naltrexone prescriptions (41.6% white, 6.4% Black, 4.2% Hispanic, 0.3% Asian).

Nguyen and colleagues used interrupted time series to estimate levels and trends of dispensed buprenorphine and naltrexone prescriptions before and after pandemic onset. They also calculated weekly dispensary rates for buprenorphine and extended-release naltrexone prescription fills per 1,000 patients, as well as the proportion of buprenorphine prescription fills (supply 14 days). Investigators analyzed data from July 2021 to March 2022 and categorized results according to patient race and ethnicity and by insurance status and payer type for white and Black patients.

Results showed that pre-pandemic increases in buprenorphine fill rate plateaued for all groups after COVID-19 onset compared with pre-pandemic trends, with significant level decreases observed for members of underrepresented groups but not white patients (ranging from 2.5% for Black patients to 4% for Hispanic patients).

In addition, at pandemic onset the rate of buprenorphine fills decreased in level for Medicare and cash-paying patients but with greater decreases for Black patients (Medicare, 10%; cash, 20%) compared with white patients (Medicare, 3.5%; cash, 15%). No decreases were found among Medicaid patients. “We found that COVID-19 may have been associated with negative outcomes among numerous policy efforts aimed at curbing the opioid epidemic over the past decade, along with worsened disparities in buprenorphine and [extended release] naltrexone pharmacy dispensing fills,” Nguyen and colleagues wrote.