Changes in buprenorphine visits in frontier and remote locations: Effects of the SARS-CoV-2 pandemic

Abstract

Background: The pandemic has changed many aspects of healthcare, including the treatment of people with opioid use disorder with buprenorphine. Prior to the pandemic, rural health disparities existed in the accessibility of this treatment. Rural and frontier areas of the United States, particularly the Great Plains, had few or no providers of this evidence-based treatment. This study aimed to investigate how access to buprenorphine changed in the Great Plains during the pandemic.

Methods: This retrospective observational study compared the number of weekly patient appointments resulting in a buprenorphine prescription for 55 weeks before the start of the SARS-CoV-2 pandemic and 55 weeks after. Electronic health records of the largest rural health provider in the Great Plains were queried. Patients were categorized as coming from a frontier location or a non-frontier location based on the home address provided at the visit. The USDA defines frontier as communities that are small and distant from urban centers. Time series analysis was utilized to understand changes in weekly visits during this period.

Results: A significant increase in weekly buprenorphine visits occurred after the pandemic's start. Further, females and people from frontier locations had significantly higher numbers of buprenorphine visits.

Conclusions: In an area of the country with low pre-existing access to buprenorphine treatment for opioid use disorder, increases in buprenorphine visits were found after the pandemic began. This was particularly true of females who reside in frontier areas. Pandemic-related changes may have reduced barriers to this critical treatment, especially among rural populations.

Keywords: Buprenorphine; Opioid use disorder; Pandemic; Rural health disparities.

Fig. 1

Weekly buprenorphine visits. The number of patient visits where buprenorphine was prescribed was assessed 55 weeks prior to the start of the pandemic (dashed verticle line) and 55 weeks after. Female patients saw a greater increase in visits (upper graph) compared to males (lower graph). Frontier patients (blue circles) saw a greater increase compared to non-frontier patients (red circles). Dashed blue and red horizontal lines indicate the predicted values of patient visits. Shaded areas represent the 95% confidence interval of the predicted values.