A new report from the IQVIA Institute for Human Data Science, a multinational health information technology and research company, provides an overview of trends in opioid prescribing, with special consideration paid to the impacts of the COVID-19 pandemic.
Overall, opioid prescribing is expected to decrease for the ninth consecutive year, with opioid prescriptions dropping 40% since 2011, and with the national MME (morphine milligram equivalents) dropping from 246 billion MME in 2011 to 100 billion in 2020 – a 60% decline.
During 2020, healthcare providers prescribed longer opioid prescriptions to mitigate COVID-19 disruptions, with prescriptions in the 20-50 MME per day range reflecting a 17% increase in early April but returned to baseline by June. However, total opioid prescribing declined 16% at the peak of shutdowns in late April, with significant variations across key specialties.
Pain specialists reported a 5% increase in opioid prescribing, while oral and maxillofacial surgery saw a 55% decrease in opioid prescribing. Very little fluctuation was seen in prescribing among family medicine and internal medicine specialists.
It would seem that while providers worked hard to ensure that patients who legitimately needed opioids still received them throughout the pandemic, overall the pandemic reduced opioid prescribing. It is estimated that the number of new patients starting opioid therapy decreased by 44%. MME declined as well, with 120 billion MME reported in 2019, dropping 17.1% in 2020 to 100 billion MME.
However, not all trends are positive. Medication-assisted treatment (MAT) for opioid use disorder (OUD) was also disrupted in 2020 due to the pandemic, with a 22% drop in new patients starting MAT. These numbers rebounded slightly in June and July as facilities reopened, but then faltered again in September and October.
The report included other key points regarding opioid prescribing, beyond the scope of the COVID-19 pandemic. Brief highlights include:
- The co-prescribing of opioids with benzodiazepines decreased 30% since 2016, but these declines have been less prevalent in patients aged 65+. Over 1.2 million seniors still receive this drug combination
- Abuse-deterrent opioid formulations had minimal impact on safety, as many showed little clinical differentiation and similar side effect profiles, resulting in a diminishing pipeline
- Only three products are in Phase III development for OUD and for opioid overdose
- In 2020 there were 115 products currently in the non-opioid analgesic development pipeline, an increase from only 38 in 2017