Fewer people initiated OUD treatment in early months of COVID-19 pandemic

Although clinical visits and refills among patients already receiving opioid use disorder medication did not decrease during the early months of the COVID-19 pandemic, fewer people initiated new treatment, according to research published in JAMA Network Open.

“It is encouraging to see that people who were engaged in treatment for opioid use disorder before the pandemic kicked in were still getting needed care during the early months of social distancing and shutdowns,” Haiden A. Huskamp, PhD, a professor of health care policy in the Blavatnik Institute at Harvard Medical School, said in a press release. “But it's concerning that new patients who needed help might not have been getting it and that important follow-up tools such as urine testing were not being used as often.”

Huskamp and colleagues evaluated data from OptimLabs Data Warehouse, including claims from patients with commercial insurance and Medicare Advantage beneficiaries aged 18 to 64 years who had continuous medical, behavioral health and pharmacy benefits from 2019 and January through May 2020.

The researchers divided patients into two cohorts based on whether they were receiving OUD treatment in January or February of each year and compared outcomes between both groups in each year.

The demographics of individuals included in the study were similar in both years.

A total of 16,128 patients in 2019 and 18,068 patients in 2020 were already receiving OUD medications from March through May. Huskamp and colleagues found that among these patients, more filled an OUD prescription from March through May in 2020 (67.99%) than during the same period in 2019 (65.37%; difference = –2.62%; 95% CI, –3.62% to –1.62%).

They also found that there was not a significant difference between 2019 and 2020 in the percentage of patients already receiving OUD treatment who had an OUD visit from March through May. The percentage of these patients who received a urine test during this time was lower in 2020 compared with 2019 (10.56% vs 13.81%; difference = 3.25%; 95% CI, 2.55%-3.94%).

A total of 6,127,513 individuals in 2019 and 5,970,239 individuals in 2020 were not receiving OUD medication in January or February.

Huskamp and colleagues found that among these patients, the percentage of those who had a least one OUD prescription filled from March through May decreased from 0.16% in 2019 to 0.12% in 2020 (difference = 0.03%; 95% CI, 0.03%-0.04%).

Among these patients, the researchers determined that the percentage of those who received at least one OUD visit from March through May was lower in 2020 than in 2019 (0.13% vs. 0.14%; difference = 0.01%; 95% CI, 0.004%-0.01%).

They also found that the percentage of patients who received a urine test from March through May also decreased from 2019 to 2020 (0.08% vs 0.12%; difference = 0.03%; 95% CI, 0.03%-0.04%).

Among patients who were already receiving OUD medications, the percentage of OUD visits conducted through telemedicine in 2020 increased from 0.48% in the week of March 1 to 23.53% at the end of May. In patients who had not already been receiving OUD treatment, the percentage of OUD visits held via telemedicine increased from 0.60% to 31.82% during the same period.

“Going forward, we need to do a better job of making sure that patients can safely receive all of the follow-up care they need, including adequate monitoring of their opioid use disorder through periodic urine drug testing, which is an important component of care that can inform a patient's treatment,” Huskamp said in the press release. “We also need to make sure that new patients aren't falling through the cracks.”

References:

• Huskamp HA, et al. JAMA Netw Open. 2020;doi:10.1001/jama.2020.21512.
• Eurekalert. Analysis finds gaps in care in treating opioid use disorders during pandemic shutdowns. https://www.eurekalert.org/pub_releases/2020-12/hms-afg121420.php. Accessed January 4, 2021.