Appalachian Node

Project Summary/Abstract The COVID-19 pandemic caused by SARS-CoV-2 has resulted in social distancing measures, the total consequences of which, particularly as they relate to substance use and drug overdose deaths, are unknown. News reports and early studies have suggested increases in opioid overdose deaths. In addition, the pandemic has also changed how medicine is practiced, with decreased face-to-face visits and a commensurate, albeit slower, rise in telemedicine. Given that opioid overdose deaths are on the rise in the United States and access to medications for opioid use disorder (MOUD) was already limited before the pandemic, ensuring access to addiction treatment is more urgent now than ever. The IQVIA Longitudinal Prescription (IQVIA LRx) database contains 92% of all prescriptions dispensed nationwide, including buprenorphine formulations. We seek to utilize this database to understand the impact of COVID-19-related social distancing measures, MOUD regulatory changes around telemedicine, and unemployment on access to buprenorphine across the entire US. Our first aim seeks to understand how access to buprenorphine was affected by several policy changes occurring at specific timepoints, including implementation of social distancing measures and changes in federal MOUD prescribing guidelines related to telemedicine. We will achieve this by conducting an interrupted time series with segmented regression analysis to understand the time-varying relationship between buprenorphine access and events at specific time points. Our second aim seeks to address the impact of insurance coverage on access to treatment. From March to May 2020, at least 40 million people filed for unemployment in the US. Given that most people with health insurance receive it through their employer, we anticipate significant reductions in access to employer-based health insurance coverage. As a result, we hypothesize that patients with commercial health insurance will have more disruptions in their access to MOUD, specifically buprenorphine, compared to patients with public insurance (Medicaid/Medicare). These findings will be among the first to characterize the changes to MOUD prescribing in the setting of COVID-19. In subsequent research, we will seek to utilize additional datasets to determine the relationship between changes in MOUD access and opioid-related morbidity and mortality outcomes, including fatal and nonfatal overdoses. Understanding these relationships will inform best practices for MOUD prescribing to reduce patient harm in the setting of a pandemic.