The effect of the COVID-19 pandemic on the prescribing of opioid and opioid use disorder medications within an academic medical center in California

IntroductionThe COVID-19 pandemic impacted healthcare operations affecting many patients with chronic pain and substance use disorder. Our study aimed to evaluate the effects of the COVID-19 pandemic on opioid and opioid use disorder (OUD) medication prescribing practices within a large academic health system in southern California. MethodsThis retrospective cohort study included patients who received a prescription for chronic opioids or therapy for OUD between November 1, 2019 and September 1, 2020. The date range was divided into five specific time periods during the pandemic: November through December 2019 (pre-COVID and reference period), January through February 2020 (early COVID), March through April 2020 (policy/guidance change period), May through June 2020 (early post-guidance period), and July through August 2020 (late post-guidance period). The primary outcome was change in morphine milligram equivalents (MME) prescribed. Secondary outcomes included encounter type, mode of prescription ordering, naloxone prescriptions, and urine drug screen obtainment. ResultsThe cohort included 100 patients divided among the designated time periods. Seventy-percent of patients received opioids for chronic non-malignant pain and 10% received therapy for OUD. Although there were numerical increases in MMEs prescribed, no significant changes were seen in the MMEs prescribed at any timepoint relative to the pre-COVID timeframe despite reduced in-person visits, increased video and telephone encounters and increased electronic prescription utilization. Subgroup analyses of those with chronic pain only or OUD had similar findings. ConclusionIt appears that, generally, prescribing practices were sustained despite the various phases of the pandemic including transitions to and from telemedicine.