Access to overdose-reversing drugs declined during pandemic, researchers find

While overall emergency department visits have decreased during the pandemic, nonfatal opioid overdose visits have more than doubled. However, few patients who overdosed on opioids had received a prescription for naloxone, a medication designed to block the effects of opioids on the brain and rapidly reverse opioid overdose.

In a new study, clinician-researchers at Beth Israel Deaconess Medical Center (BIDMC) analyzed naloxone prescription trends during the COVID-19 pandemic in the United States and compared them to trends in opioid prescriptions and to overall prescriptions. The team's findings, published in the journal JAMA Health Forum, suggest patents with opioid misuse disorders may be experiencing a dangerous decrease in access to the overdose-reversing drug.

"In March of 2020, we saw a sharp reduction in the average number of individuals filling naloxone prescriptions each week, which far exceeded the decline in the number of people filling prescriptions for any medication," said corresponding author Ashley O'Donohue, Ph.D., an economist in the Center for Healthcare Delivery Science at BIDMC. "And since March 2020, there's been no statistically significant recovery in naloxone prescriptions, indicating that the number of individuals filling naloxone prescriptions has remained low throughout the pandemic."

Using data from a national pharmacy insurance claims database that includes claims from national retail pharmacies, mail-order pharmacies and specialty pharmacies, O'Donoghue and colleagues analyzed weekly trends in the number of patients filling naloxone prescriptions, opioid prescriptions and all prescriptions between May 2019 and December 2020.

The team found that the number of individuals filling prescriptions for any medication fell by 14 percent in the early months of the COVID-19 pandemic, while the number of individuals filling opioid prescriptions fell by just 9 percent. However, the number of people filling naloxone prescriptions fell by more than 25 percent, and the number of individuals with Medicare and commercial coverage filling naloxone prescriptions declined by nearly a third. Meanwhile, among patients with Medicaid coverage or patients who paid in cash, there was no statistically significant change in the number of individuals filling naloxone prescriptions.

"Our study identifies an urgent gap in necessary access to lifesaving medication for individuals covered by Medicare and commercial insurance during the pandemic," said senior author Jennifer P. Stevens, MD, MS, Director of the Center for Healthcare Delivery Science at BIDMC. "Continuing to distribute naloxone in densely populated areas and through community-based organizations could help mitigate some of the reductions in naloxone distribution via pharmacies and could also reduce some of the increases in fatal opioid overdose is during the COVID-19 pandemic."