A retrospective, observational, cross-sectional study found that opioid prescriptions increased at the onset of the COVID-19 pandemic and that prescription duration was longer at higher doses compared to prepandemic trends. These results were published in JAMA Network Open.
The data comes from Optum’s deidentified Clinformatics Data Mart database, which included 20% of the commercial insured and 24% of the Medicare Advantage population in all 50 states of the United States and Washington DC. Applications between 2019 and 2020 were examined for trends in opioid dispensing and non-pharmacological therapy for pain management.
Stratified by the first 3 quarters of 2019 (pre-pandemic; n=21,430,339) and 2020 (early pandemic; n=20,759,788), the patient populations included individuals with a mean age of 48.6 years (standard deviation). [SD], 24.0) and 47.0 (SD, 23.8) years, 51.1% and 51.5% were female, 52.2% and 48.5% were White, 10.6% and 9.5 % Hispanic, 7.9% and 7.3% Black, and 4.2% and 3.8% Asian. or.
The number of patients diagnosed with pain was slightly higher in the first 3 months of 2020 compared to 2019 (mean difference [MD]0.4%; 95% CI, 0.5%-0.5%). There was a significant drop in diagnoses in March 2020 (MD, -15.9%; 95% CI, -16.1% to -15.8%) that remained lower through August and returned to 2019 levels in September returned.
Patients receiving opioids for pain during the first few months of the COVID-19 pandemic decreased compared to 2019 (MD, -1.4%; 95% CI, -1.5% to -1.2% ) and increased from April (MD, 3.5%, 95% CI, 3.3%–3.7%).
Compared to 2019, fewer patients were receiving non-pharmacological therapies at the onset of the pandemic (MD, -6.0%; 95% CI, -6.3% to -5.8%).
At the onset of the pandemic, patients received longer opioid prescriptions (MD, 1.07; 95% CI, 1.02-1.1 days) with higher doses (MD, 0.96; 95% CI, 0.76-1.20 morphine milligram equivalents). [MME]).
Compared to 2019, patients who received no treatment during the current visit in 2020 were more likely to receive only opioids during the next visit (MD, 0.74%) and less likely to receive only non-pharmacological therapy (MD, – 2.47). Patients who received opioids only during the current visit were more likely to receive opioids only during the next visit (MD, 5.75%) and were less likely to receive nonpharmacological therapy only (MD, -2.47). Receiving non-pharmacological therapy at the current visit combined with receiving opioids only at the next visit (MD, 0.36%).
This study may have been limited by not having access to data on whether the patient was taking prescribed medications.
The study authors concluded that there has been an apparent substitution of non-pharmacological opioid therapies in patients with a diagnosis of pain during the COVID-19 pandemic. These factors could be a negative contributor to the current US opioid epidemic. Additional initiatives to improve access to non-pharmacological therapies are needed.
Disclosure: One author stated industry affiliations. For a full list of disclosures, see the original article.
Lee B, Yang KC, Kaminski P, et al. Replacement of non-pharmacological therapy with opioid prescription for pain during the Covid-19 pandemic. JAMA network open. 2021;4(12):e2138453. doi:10.1001/jamanetworkopen.2021.38453
This article originally appeared on Clinical Pain Advisor