Trends of Buprenorphine Prescribing for Opioid Dependence Before and During the Early and Later Part of the COVID-19 Pandemic: A Study From a Large, Publicly Funded Opioid Agonist Treatment Service in India.

OBJECTIVE: The COVID-19 pandemic has affected the availability of and access to medications for opioid dependence (OD). We examined the monthly trends in new buprenorphine/naloxone (BNX) treatment episodes, number of clinical visits for BNX, BNX dispensed per person, and BNX prescription over 56 months, which included the pre-pandemic period and the early and later parts of the pandemic (January 2017 to August 2022).

METHOD: Research data were collected from the pharmacy database of a large publicly funded treatment center in India. A flexible, low-threshold service was adopted in April 2020 in response to the lockdown implemented on March 25, 2020. Change point analyses were performed to examine monthly trends visually and statistically. We used autoregressive integrated moving averages to forecast trends from April to August 2020 and March to August 2022, using January 2017 to March 2020 and March 2020 to February 2022 as training data sets.

RESULTS: A total of 993 patients were started on BNX treatment; 40,452 BNX clinic attendances were made; 1,401,393 BNX tablets were dispensed; and 6,795 new patients with OD were registered. The observed data for clinic attendance for BNX was significantly lower than the projected estimates in April to August 2020; however, observed new treatment episodes and monthly BNX prescriptions were within the 95% projected estimates; BNX dispensed per person was significantly more than the projected estimate. In contrast, observed BNX prescription trends surpassed the upper limit of the 95% confidence interval in March to August 2022.

CONCLUSIONS: A low-threshold and flexible-treatment service could mitigate the unintended consequences of pandemic-induced restrictions.