Trends in Incident Prescriptions for Behavioral Health Medications in the US, 2018-2022

Abstract

Importance: The COVID-19 pandemic reportedly increased behavioral health needs and impacted treatment access.

Objective: To assess changes in incident prescriptions dispensed for medications commonly used to treat depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and opioid use disorder (OUD), before and during the COVID-19 pandemic.

Design, setting, and participants: This was a cross-sectional study using comprehensive, population-level, nationally projected data from IQVIA National Prescription Audit on incident prescriptions (prescriptions dispensed to patients with no prior dispensing from the same drug class in the previous 12 months) dispensed for antidepressants, benzodiazepines, Schedule II (C-II) stimulants, nonstimulant medications for ADHD, and buprenorphine-containing medication for OUD (MOUD), from US outpatient pharmacies. Data were analyzed from April 2018 to March 2022.

Exposure: Incident prescriptions by drug class (by prescriber specialty, patient age, and sex) and drug.

Main outcomes and measures: Interrupted time-series analysis to compare changes in trends in the monthly incident prescriptions dispensed by drug class and percentage changes in aggregate incident prescriptions dispensed between April 2018 and March 2022.

Results: Incident prescriptions dispensed for the 5 drug classes changed from 51 500 321 before the COVID-19 pandemic to 54 000 169 during the pandemic. The largest unadjusted percentage increase in incident prescriptions by prescriber specialty was among nurse practitioners across all drug classes ranging from 7% (from 1 811 376 to 1 944 852; benzodiazepines) to 78% (from 157 578 to 280 925; buprenorphine MOUD), whereas for patient age and sex, the largest increases were within C-II stimulants and nonstimulant ADHD drugs among patients aged 20 to 39 years (30% [from 1 887 017 to 2 455 706] and 81% [from 255 053 to 461 017], respectively) and female patients (25% [from 2 352 095 to 2 942 604] and 59% [from 395 678 to 630 678], respectively). Trends for C-II stimulants and nonstimulant ADHD drugs (slope change: 4007 prescriptions per month; 95% CI, 1592-6422 and 1120 prescriptions per month; 95% CI, 706-1533, respectively) significantly changed during the pandemic, exceeding prepandemic trends after an initial drop at the onset of the pandemic (level changes: -50 044 prescriptions; 95% CI, -80 202 to -19 886 and -12 876 prescriptions; 95% CI, -17 756 to -7996, respectively). Although buprenorphine MOUD dropped significantly (level change: -2915 prescriptions; 95% CI, -5513 to -318), trends did not significantly change for buprenorphine MOUD, antidepressants, or benzodiazepines.

Conclusions and relevance: Incident use of many behavioral health medications remained relatively stable during the COVID-19 pandemic in the US, whereas ADHD medications, notably C-II stimulants, sharply increased. Additional research is needed to differentiate increases due to unmet need vs overprescribing, highlighting the need for further ADHD guideline development to define treatment appropriateness.

Figure.. Interrupted Time-Series Analysis of Incident Prescriptions^a Dispensed for Selected Drug Classes, April 2018 to March 2022^b

ADHD indicates attention-deficit/hyperactivity disorder; C-II, Schedule II; MOUD, medications for opioid use disorder. ^aIncident prescription is measured by new therapy start prescriptions, defined as prescriptions for a drug dispensed to patients with no prior prescription dispensed for a drug within the same drug class (eg, USC 64300 Antidepressants) in the previous 12 months. ^bData Source: IQVIA National Prescription Audit. April 2018 to March 2022. Extracted March 2023. Limited to oral formulations; other formulations (eg, injection, implants) were not included. Nationally estimated data are provided for drug products labeled for mental health conditions (eg, guanfacine extended-release products labeled for ADHD, buprenorphine products labeled for MOUD treatment). Prescriptions written by veterinary medicine and prescriptions dispensed for unspecified patient age or sex were excluded. ^cBuprenorphine and methadone are approved for MOUD; methadone was not included because methadone for OUD is only available from opioid treatment programs, only methadone for analgesia is available through pharmacies. Only buprenorphine MOUD products (buprenorphine and buprenorphine/naloxone) labeled for the treatment of OUD were included in our analyses.