Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic.
Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic.
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在19009年大流行期间，处方阿片类镇痛药和丁丙诺啡的阿片类药物使用障碍。
DOI：
10.1001/jamanetworkopen.2021.6147
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Zhang J
中科院分区：
文献类型：
--
作者：
Currie JM;Schnell MK;Schwandt H;Zhang J
在整个COVID-19大流行期间，阿片类镇痛药和丁丙诺啡用于阿片类药物使用障碍的处方发生了哪些变化？这项横断面研究分析了90，420，353名患者的处方，发现从2020年3月18日至5月19日，向现有患者开具的阿片类镇痛药的总吗啡毫克当量遵循大流行前的趋势;阿片类药物初治患者的处方比预计水平低34%，但到2020年8月反弹。阿片类药物使用障碍的丁丙诺啡处方遵循现有患者的流行前趋势，而新患者的处方比预计水平低18%，到2020年8月反弹至预计水平的90%。这项研究表明，在COVID-19大流行期间，阿片类镇痛药和丁丙诺啡用于阿片类药物使用障碍的处方在新的但不是现有的患者中减少。COVID-19大流行扰乱了医疗保健，影响了阿片类镇痛药和丁丙诺啡用于阿片类药物使用障碍的处方。了解这些模式可以帮助解决护理障碍。评估在整个COVID-19大流行期间，阿片类镇痛药和丁丙诺啡治疗阿片类药物使用障碍的处方在新患者和现有患者中的变化。在这项横断面研究中，使用2018年1月1日至2020年3月3日的全国零售处方数据库，预测了2020年3月18日至9月1日期间阿片类镇痛药和丁丙诺啡用于阿片类药物使用障碍的情况。将所有患者、现有患者和新患者的实际处方与预计水平进行比较。这些数据包括独立于保险状态或类型的患者处方，涵盖90%的零售处方，70%的邮购处方和70%的养老院处方。阿片类镇痛药和丁丙诺啡治疗阿片类药物使用障碍的处方。结果包括处方总数、总吗啡毫克当量、每张处方的平均吗啡毫克当量、每张处方的平均分配单位和填写处方的患者数量。共分析了90，420，353例患者（50，921，535例女性患者[56%];平均[SD]年龄，49 [20]岁）的452，691，261张阿片类镇痛药和丁丙诺啡治疗阿片类药物使用障碍的处方。从2020年3月18日至5月19日，每周处方阿片类镇痛药的总吗啡毫克当量为18.77亿，预计为18.43亿，比例为102%（95%预测区间[PI]，94%-111%; P = .71）。每周接受阿片类药物治疗的阿片类药物初治患者人数为370 051人，预计为564 929人，占预计人数的66%（95% PI，63%-68%; P < .001）。丁丙诺啡的处方与现有患者的预期一致，而每周接受丁丙诺啡的新患者数量为9865 vs 12008，或82%（95% PI，76%-88%; P < .001）。从2020年5月20日至9月1日，新患者的阿片类药物处方恢复到预期的100%（95% PI，96%-104%; P = .95），而每周接受丁丙诺啡的新患者数量为10436 vs 11613，或90%（95% PI，83%-97%; P = .009）。在这项横断面研究中，在COVID-19大流行期间，接受阿片类镇痛药和丁丙诺啡治疗阿片类药物使用障碍的现有患者通常可以继续获得这些药物。阿片类药物初治患者的阿片类药物处方短暂减少，然后反弹，而截至2020年8月，丁丙诺啡的启动率仍较低。治疗入组的减少可能与用药过量死亡的增加有关。这项横断面研究使用了一个全国零售处方数据库，以评估在整个COVID-19大流行期间，阿片类镇痛药和丁丙诺啡治疗阿片类药物使用障碍的处方在新患者和现有患者中的变化。
How has prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic? This cross-sectional study analyzed prescriptions from 90 420 353 patients and found that from March 18 to May 19, 2020, total morphine milligram equivalents of opioid analgesics prescribed to existing patients followed prepandemic trends; prescriptions to opioid-naive patients were 34% below projected levels but rebounded by August 2020. Prescribing of buprenorphine for opioid use disorder followed prepandemic trends for existing patients, while prescriptions to new patients were 18% below projected levels, rebounding to 90% of projected levels by August 2020. This study suggests that prescriptions for opioid analgesics and buprenorphine for opioid use disorder decreased among new, but not existing, patients during the COVID-19 pandemic. The COVID-19 pandemic disrupted medical care, impacting prescribing of opioid analgesics and buprenorphine for opioid use disorder. Understanding these patterns can help address barriers to care. To evaluate how prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic among both new and existing patients. In this cross-sectional study, use of opioid analgesics and buprenorphine for opioid use disorder from March 18 to September 1, 2020, was projected using a national database of retail prescriptions from January 1, 2018, to March 3, 2020. Actual prescribing was compared with projected levels for all, existing, and new patients. The data include prescriptions to patients independent of insurance status or type and cover 90% of retail prescriptions, 70% of mail-order prescriptions, and 70% of nursing home prescriptions. Prescriptions for opioid analgesics and buprenorphine for opioid use disorder. Outcomes included total number of prescriptions, total morphine milligram equivalents, mean morphine milligram equivalents per prescription, mean dispensed units per prescription, and number of patients filling prescriptions. A total of 452 691 261 prescriptions for opioid analgesics and buprenorphine for opioid use disorder were analyzed for 90 420 353 patients (50 921 535 female patients [56%]; mean [SD] age, 49 [20] years). From March 18 to May 19, 2020, 1877 million total morphine milligram equivalents of opioid analgesics were prescribed weekly vs 1843 million projected, a ratio of 102% (95% prediction interval [PI], 94%-111%; P = .71). The weekly number of opioid-naive patients receiving opioids was 370 051 vs 564 929 projected, or 66% of projected (95% PI, 63%-68%; P < .001). Prescribing of buprenorphine was as projected for existing patients, while the number of new patients receiving buprenorphine weekly was 9865 vs 12 008 projected, or 82% (95% PI, 76%-88%; P < .001). From May 20 to September 1, 2020, opioid prescribing for new patients returned to 100% of projected (95% PI, 96%-104%; P = .95), while the number of new patients receiving buprenorphine weekly was 10 436 vs 11 613 projected, or 90% (95% PI, 83%-97%; P = .009). In this cross-sectional study, existing patients receiving opioid analgesics and buprenorphine for opioid use disorder generally maintained access to these medications during the COVID-19 pandemic. Opioid prescriptions for opioid-naive patients decreased briefly and then rebounded, while initiation of buprenorphine remained at a low rate through August 2020. Reductions in treatment entry may be associated with increased overdose deaths. This cross-sectional study used a national database of retail prescriptions to evaluate how prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic among both new and existing patients.
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