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Impact of COVID-19 on MOUD retention in a sample of rural primary care patients: A secondary analysis of electronic health records

Year: 2024

Type: article

Abstract: Introduction: The declaration of a public health emergency on March 13, 2020, marked the onset of the COVID-19 pandemic in the United States. This event led to substantial changes and disruptions in primary care clinic operations that affected the delivery of medications for opioid use disorder (MOUD) treatment. The aim of this study was to explore how the onset of the COVID-19 pandemic impacted MOUD retention in a sample of 563 rural primary care patients with a MOUD prescription documented in their medical records prior to COVID-19. Methods: We conducted a secondary analysis of electronic health records data collected as part of a NIDA Clinical Trials Network study (CTN-0102). The main independent variable was the number of days between the patient’s first MOUD prescription date during the pre-COVID observation period (October 1, 2019 to March 13, 2020) and the start of the COVID-19 pandemic. The dependent variable was retention on MOUD, defined as the time from the first MOUD prescription documented during the pre-COVID observation period to the first break in consecutive MOUD prescriptions (right censored at 180 days). Cox regression model was applied to examine if COVID-19 was related to treatment retention, controlling for demographics, clinic, insurance type, and other diagnoses. Results: Patients included in this study averaged 39 years of age, 56% were male, and 92% were White. The findings demonstrated that there was a reduced risk of a prescription break for every 10-day increase in the time from the first documented MOUD prescription to the onset of the COVID-19 pandemic (HR = 0.96, 95% CI = 0.92-0.99; p = 0.011). Conclusions: Starting a MOUD prescription near the beginning of the COVID-19 pandemic appeared to be associated with increased retention challenges. This underscores the importance for clinics to establish comprehensive contingency plans for future emergencies that limit in-person visits with clinicians. These plans should encompass strategies aimed at ensuring uninterrupted MOUD treatment and support, particularly for individuals in the early stabilization phase of their recovery.

Source: Drug and Alcohol Dependence Reports

DOI: 10.1016/j.dadr.2024.100276