Use of buprenorphine for those with employer-sponsored insurance during the initial phase of the COVID-19 pandemic

Abstract

Objective: To quantify weekly rates of use of buprenorphine for those with employer-based insurance and whether the rate differs based on county-level measures of race, historical fatal drug overdose rate, and COVID-19 case rate.

Methods: We used 2020 pharmaceutical claims for 4.8 million adults from a privately insured population to examine changes in the use of buprenorphine to treat opioid use disorder in 2020 during the onset of the COVID-19 pandemic. We quantified variation by examining changes in use rates across counties based on their fatal drug overdose rate in 2018, number of COVID-19 cases per capita, and percent nonwhite.

Results: Weekly use of buprenorphine was relatively stable between the first week of January (0.6 per 10,000 enrollees, 95%CI = 0.2 to 1.1) and the last week of August (0.8 per 10,000 enrollees, 95%CI = 0.4 to 1.3). We did not find evidence of any consistent change in use of buprenorphine by county-level terciles for COVID-19 rate as of August 31, 2020, age-adjusted fatal drug overdose rate, and percent nonwhite. Use was consistently higher for counties in the highest tercile of county age-adjusted fatal drug overdose rate when compared to counties in the lowest tercile of county age-adjusted fatal drug overdose rate.

Discussion: Our results provide early evidence that new federal- and state-level policies may have steadied the rate of using buprenorphine for those with employer-based insurance during the pandemic.

Keywords: Buprenorphine; COVID-19; Disparities; Medications for opioid use disorder.

Fig. 1

Panel A: Change in weekly use of buprenorphine for adults 19 years of age or older between January 1, 2020 and August 31, 2020^a. ^aRegression model only includes week fixed effects where the baseline for all comparisons is the ninth week, when COVID-19 was declared a national public health emergency. Error bars represent 95% confidence interval. Panel B: Change in weekly use of buprenorphine for adults 19 years or older stratified by county COVID-19 cases per capita^a. ^aTerciles are based on number of COVID-19 cases on August 31st, 2020 per 10,000 population from USAFacts (https://usafacts.org/issues/coronavirus/). Each line represents a separate regression model that only includes week fixed effects where the baseline for all comparisons is the ninth week, the week prior to COVID-19 being declared a national public health emergency.

Fig. 2

Panel A: Change in weekly use of buprenorphine for adults 19 years stratified by county age-adjusted fatal drug overdose rate^a. ^aCounty-level age-adjusted fatal drug overdose rate is used to create each tercile and the underlying data are from Centers for Disease Control and Prevention data in 2018 (https://data.cdc.gov/NCHS/NCHS-Drug-Poisoning-Mortality-by-County-United-Sta/rpvx-m2md). Each line represents a separate regression model that only includes week fixed effects where the baseline for all comparisons is the ninth week, the week prior to COVID-19 being declared a national public health emergency. Panel B: Change in weekly use of buprenorphine for adults 19 years or older stratified by percent of the county that is non-white^a. ^a Based on share of U.S. county (percent) that is not white in the American Community Survey (https://api.census.gov/data/2018/acs/acs5/profile/groups/DP05.html). Each line represents a separate regression model that only includes week fixed effects where the baseline for all comparisons is the ninth week, the week prior to COVID-19 being declared a national public health emergency.