Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States

  1. Ashley L. O’Donoghue
  2. Alyse Reichheld
  3. Timothy S. Anderson
  4. Chloe A. Zera
  5. Tenzin Dechen
  6. Jennifer P. Stevens

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Abstract

Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers. To quantify these changes, we examined trends in the number of individuals filling buprenorphine/naloxone prescriptions during the COVID-19 pandemic.

Methods

We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from prepandemic (May 2019 to February 2020) to the pandemic period (April 2020 to December 2020). We estimated changes in the growth rate in the monthly number of individuals filling buprenorphine/naloxone prescriptions in the 6 months preceding a delivery claim, per 100,000 pregnancies, during the COVID-19 pandemic.

Results

We identified 2947 pregnant individuals filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling buprenorphine/naloxone prescriptions (4.83%; 95% confidence interval [CI], 3.82–5.84%). During the pandemic, this monthly growth rate declined for both individuals on commercial insurance and individuals on Medicaid (all payers: −5.53% [95% CI, −6.65% to −4.41%]; Medicaid: −7.66% [95% CI, −10.14% to −5.18%]; Commercial: −3.59% [95% CI, −5.32% to −1.87%]).

Conclusion

The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing, but this growth has been lost during the pandemic.

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  1. Version published to 10.1097/adm.0000000000001228
  2. ScreenIT

    SciScore for 10.1101/2021.10.08.21264760: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This research was classified as exempt by the Beth Israel Deaconess Medical Center institutional review board.
    Sex as a biological variableWe analyzed monthly trends in the number of pregnant patients filling buprenorphine/naloxone prescriptions from May 2019 to December 2020.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We used Stata SE 16 (StataCorp) for statistical analysis, and a p-value < 0.05 was considered statistically significant.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are several limitations to this study. First, our sample size of pregnant patients filling prenatal buprenorphine/naloxone prescriptions is relatively small. Second, we are not able to determine gestation age at time of delivery, and so we defined prenatal buprenorphine/naloxone fills as any fill within the six months prior to delivery. As a result, we could be missing patients who filled buprenorphine/naloxone prescriptions early in a full-term pregnancy and then discontinued treatment during the first trimester. Conversely, we could be including women who delivered at less than six months gestation and filled a buprenorphine/naloxone prescription prior to, rather than during, a pregnancy. Our findings highlight an exacerbated barrier in access to prenatal buprenorphine/naloxone treatment during the COVID-19 pandemic. Future studies could explore whether these declines indicate impaired access to prenatal care, decreased initiation of buprenorphine/naloxone treatment among pregnant patients with OUD, or diminished adherence to treatment during the pandemic. Pregnancy is a critical opportunity to engage women with OUD in treatment, but our findings suggest that we may be missing this chance more often during the pandemic.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.10.08.21264760v1 on medRxiv