Introduction
The COVID-19 pandemic brought many unexpected changes to our lives. Access to health care changed drastically due to the pandemic. For example, a large number of elective procedures were postponed or cancelled, and patients avoided visits to physician offices, outpatient facilities and hospitals. Access to controlled substance prescriptions also changed significantly. In this post, I describe past concerns around the prescribing and use of controlled substances, including opioids and benzodiazepines, the impact of COVID-19 on access to health care and prescription drugs, and recommendations from a study using data in Texas.
Growing concerns over the use of opioids and other controlled substances
Over the last decade, there have been growing concerns about the use of opioids and other controlled substance prescriptions. There have been various efforts to curb the overuse of such medications including the distribution of naloxone among communities, expanding pain management options, providing substance use consultations and medical treatments in the criminal justice system, and improving access to evidence-based treatment for opioid use disorder. Many states implemented and expanded Prescription Drug Monitoring Programs (PDMPs), which are electronic databases that track the prescriptions of controlled substances. The purpose of PDMPs is to monitor the distribution of controlled substance prescriptions and potentially reduce misuse of such medications. Over the years, we observe declining trends in the prescriptions of opioids.
While controlled substance prescriptions can have dangerous negative impacts, they still remain an integral component for the treatment of certain conditions because alternative options may be limited and expensive. For example, opioids and benzodiazepines are still the staple treatment for pain, anxiety and sleep disorders. Potential alternatives such as nerve blocks, acupuncture, and physical therapy may not be accessible or feasible for many patients.
The impact of COVID-19 on prescriptions for opioids and benzodiazepines
Before the COVID-19 pandemic, prescriptions for opioids and benzodiazepines are usually given during routine office visits. However, COVID-19 made elective health care visits, including routine outpatient visits, infeasible for many. Many states issued executive orders to restrict elective medical procedures. Meanwhile, there were efforts to expand patients’ access to telehealth or telemedicine services. For example, the Department of Health and Human Services (HHS) provided lexibility in terms of HIPAA requirements, and reduced or waived beneficiary cost-sharing paid by federal healthcare programs. The Centers for Medicare & Medicaid Services (CMS) expanded Medicare coverage for telehealth visits. However, there are still concerns regarding the accessibility of controlled substance prescriptions.
What can be learned from a study of prescriptions in one state?
Our recent paper using the Texas PDMP database examined the filling of opioids and benzodiazepines before and after the executive order by the Texas governor to limit elective medical procedures due to COVID-19. My co-authors and I found a significant drop in both the number of unique patients and unique prescribers filling and prescribing new opioid and benzodiazepine prescriptions. This suggests that even though there were efforts to expand access to health care through telehealth, there are still barriers for patients to receive new opioid and benzodiazepine prescriptions. Patients may have poor computer literacy, lack internet access or have privacy concerns, while prescribers may not feel comfortable prescribing controlled substances without physically observing the patients.
Recommendations for the future
It is important to continuously monitor the trends in controlled substance prescriptions and help patients who are in need of such medications gain access and at the same time minimize the risk of misuse. Even though the HHS allowed some HIPAA flexibility, providers should still strive to protect patient confidentiality and ensure that patients’ concerns are addressed. Collaborations between state government agencies, such as PDMP system and clinical researchers, should be encouraged to conduct timely studies that can inform policymakers, patients and providers.