COVID-19 Pandemic Hurt OUD Services and Urine Drug Testing Access, Study Results Show

The COVID-19 pandemic did not disrupt access to buprenorphine but did affect access to opioid use disorder (OUD) treatment services and urine drug testing, according to the results of a new study published in JAMA Health Forum.¹

The findings showed that access to buprenorphine did not change in the early or later part of the pandemic while drug testing and opioid treatment services initially decreased and partially recovered later during the pandemic.¹

The study included 6453 individuals, including 3986 adults without children. About 89% were younger than aged 50 years, 78% were white, 53.2% were women, and 22% were members of ethnic or racial minority groups. Individuals were all Medicaid beneficiaries with OUD.¹

In the study, 44.3% of individuals received buprenorphine, 45.4% received opioid treatment services, 78% received urine drug testing, and during the study period.¹

Additionally, 79.1% of individuals either filled a buprenorphine prescription or received opioid treatment services during the study period.¹

Furthermore, buprenorphine possession remained stable at about 28% during the pre-public health emergency and during the public health emergency.¹ Investigators used continuous enrollment between December 1, 2018, and September 20, 2020, and the Wisconsin Medicaid administrative, enrollment, and claims data.¹

The study was categorized into 3 periods: pre-public health emergency, between December 1, 2018, and March 15, 2020; early public health emergency, between March 16, 2020, and May 15, 2020; and later public health emergency, between May 16, 2020, and September 30, 2020.¹

The early study period started the day after the governor of Wisconsin declared a public health emergency in response to the COVID-19 pandemic.¹

Investigators used logistic regression to determine differences in the outcomes of each study period.¹ Investigators noted that the cohort excluded individuals who had inconsistent enrollment, including those with housing or job instability.¹

They also said that further investigations are needed to determine which access to medications for opioid treatment services changed during the pandemic. This would include telehealth services and whether the shifts to alternative care models and/or reducing on-site services affected outcomes, such as overdoses or relapses.¹

They urge policymakers to consider permanent changes in response to preventing opioid overdoses based on lessons learned from the pandemic.¹

In the 12-month period ended in May 2020, more than 81,000 drug overdose deaths occurred in the United States, according to the CDC. That is the highest reported numbed of overdose deaths in a 12-month period.²

Overdose deaths were already increasing prior to the COVID-19 pandemic. However, this update suggests that overdose deaths heavily increased during the pandemic. Synthetic opioids were the primary driver of the increase in overdose deaths, with an increase of 38.4% of synthetic drug users between the 12-month period leading up to June 2019 and the 12-month period before May 2020.²

References

1. Tilhou AS, Dague L, Saloner B, Beemon D, Burns M. Trends in engagement with opioid use disorder treatment among Medicaid beneficiaries during the COVID-19 pandemic. JAMA Health Forum. 2022;3(3):e220093. doi:10.1001/jamahealthforum.2022.0093
2. Overdose deaths accelerating during COVID-19. CDC. News release. December 17, 2020. Accessed March 16, 2022. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html