Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention

Abstract

Background During the COVID pandemic, overall buprenorphine treatment appeared to remain relatively stable, despite some studies suggesting a decrease in patients starting buprenorphine. There is a paucity of empirical information regarding patterns of buprenorphine treatment during the pandemic. Objective To better understand the patterns of buprenorphine episodes during the pandemic and how those patterns compared to pre-pandemic patterns. Design Pharmacy claims representing approximately 92% of all prescriptions filled at retail pharmacies in all 50 US states and the District of Columbia. Participants Individuals filling buprenorphine prescriptions indicated for treatment of opioid use disorder. Main Measures The number of active, starting, and ending buprenorphine treatment episodes March 13 to December 1, 2020, and the expected number of such episodes in 2020 based on the growth in treatment episodes from March 13 to December 1, 2019. Key Results The observed number of active buprenorphine episodes in December 2020 was comparable to the expected number, but new treatment episodes starting between March 13 and December 1, 2020, were 17.2% fewer than expected based on the 2019 experience. Similarly, the number of episodes that ended between March 13 and December 1, 2020, was 16.0% fewer than expected. Decreases from expected episode starts and ends occurred throughout the period but were greatest in the 2 months after the declaration of the public health emergency. Conclusions and Relevance Beneath the apparent stability of buprenorphine patient numbers during the pandemic, the flow of individuals receiving buprenorphine treatment changed substantially. Our findings shed light on how policy changes meant to support buprenorphine prescribing influenced prescribing dynamics during that period, suggesting that while policy efforts may have been successful in maintaining existing patients in treatment, that success did not extend to individuals not yet in treatment.

Trends in Buprenorphine Initiation and Retention in the United States, 2016-2022

“…This flattening occurred prior to the COVID-19 pandemic, suggesting that factors other than the pandemic were involved. Throughout the study period, including in 2021-2022, only 1 in 5 patients who initiated buprenorphine were retained in therapy for at least 180 days, a rate similar to that found in a prior study examining data through the end of 2020 …”

“…Prior studies have examined buprenorphine initiation and retention rates through the end of 2020 . However, buprenorphine access may have since improved owing to the implementation of policies to increase use, such as the elimination of training requirements for buprenorphine waivers in April 2021.…”

Real-World Dispensing of Buprenorphine in California during Prepandemic and Pandemic Periods

“…In contrast to Texas [41], our examination of PDMP data did not reveal a significant declining trend in patient numbers or prescription volumes during the pandemic. A one-year study [42] following the pandemic from national claims data showed that the observed number of active buprenorphine episodes in December 2020 was comparable to the expected number. Our study extended the timeline to December 2021 and still found a remarkably different pattern in California.…”

Measuring time in buprenorphine treatment stages among people with HIV and opioid use disorder by retention definition and its association with cocaine and hazardous alcohol use

“…Second, 180 days of continuous treatment without a > 30-day prescription gap. The 30-day gap to define a new treatment episode has been used previously to evaluate buprenorphine treatment durations [ 20 ]. Third, 90 days of continuous treatment without a > 7-day gap.…”