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

INTRODUCTION: The 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. METHODS: This 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. RESULTS: The 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. CONCLUSION: It appears that, generally, prescribing practices were sustained despite the various phases of the pandemic including transitions to and from telemedicine.