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Fewer Patients Started on Medications for Opioid Use Disorder During COVID-19

  • David R. Little, MD
  • Melissa Gaisser, MS
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The number of patients receiving first-time prescriptions for Medications for Opioid Use Disorder (MOUD) decreased by over 30% in the spring of 2020 when compared to trends observed in EHR data from January 2017 to May 2020. This finding suggests that patients at risk for opioid use disorder (OUD) and overdose are increasingly vulnerable during the COVID-19 pandemic. This risk is further demonstrated by reports from the American Medical Association of increases in opioid-related mortality reported in more than 30 states1 over this time period.

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Figure 1. First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020.

Since January 2017, the number of patients receiving buprenorphine, methadone, or naltrexone for the first time has progressively increased but fell from a predicted 1,155 to 794 in May 2020. Predictions were made via linear regression using data from January 2017 to February 2020 and can be viewed in Figure 1. Week-by-week data demonstrate that the number of patients remained fairly steady until mid-March 2020, when a precipitous drop occurred, as seen in Figure 2. The declining numbers affected all medications. Buprenorphine has been the most frequently prescribed OUD medication since 2018, and exhibited the largest decline, falling 39% from the predicted figure in May. A similar, but less pronounced decrease was observed with naltrexone (31%).

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Figure 2. First-time MOUD patients by week in 2020.

First-time methadone patients declined by 15% in May 2020. The methadone figure is less dramatic, most likely because methadone is prescribed for pain management and OUD, whereas buprenorphine and naltrexone are prescribed primarily for OUD.

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Figure 3. First-time methadone patients over time. Solid colored capsule shows the last observed value. Dashed outline capsule shows the predicted value for May 2020.

These data provide evidence that patients at risk for opioid use disorder and overdose have received less care during the COVID-19 pandemic. This may reflect limitations in access to care or reluctance of patients to seek treatment in response to COVID-19. The AMA-reported increases in opioid-related mortality emphasize the importance of the need to provide MOUD treatment.1 The reduction in MOUD initiation further illustrates the loss of preventive services available to patients during the pandemic, including reductions in cancer screening2 and pediatric immunizations.3


Data are pooled from 16 healthcare organizations that span 11 states and cover 11.1 million patients.

1. American Medical Association Advocacy Resource Center. (2020). Issue Brief: Reports of increases in opioid-related overdose and other concerns during COVID pandemic. Chicago: American Medical Association.

2. “Delayed Cancer Screenings.” Epic Health Research Network. (May 4, 2020). Retrieved from https://ehrn.org/delays-in-preventive-cancer-screenings-during-covid-19-pandemic/.

3. “Pediatric Immunizations Drop in the Wake of COVID-19.” Epic Health Research Network. (May 19, 2020). Retrieved from https://ehrn.org/pediatric-immunizations-drop-in-the-wake-of-covid-19/.

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