Impact of the COVID-19 Pandemic on Health Care Utilization for Insured Individuals with Opioid Use Disorder

Introduction: We sought to examine how COVID-19 affected opioid use disorder (OUD)-specific health care utilization for insured individuals with preexisting OUD during the first year of the pandemic.Methods: This was a retrospective cohort study of adults with preexisting OUD and their treatment during the first year of the COVID-19 pandemic compared with a cohort of adults with a preexisting OUD diagnosis and their treatment during a one-year period prior to the COVID-19 pandemic. We used data from the Merative™ MarketScan® Commercial and Medicare Supplemental Databases and the Multi-State Medicaid Database to examine the number of therapy sessions received in a year, the number of months with medications for opioid use disorder (MOUD) coverage, and the number of inpatient days and emergency department days for each cohort for each payer. We used generalized linear models specifying Gaussian distribution and identity link including all matching variables and additional covariates to control for any residual observable difference between the pandemic and pre-pandemic cohorts.Results: The pandemic cohort had a marginal decrease in the number of therapy sessions per year compared with the pre-pandemic cohort for the commercial sample and a significant decrease in the number of sessions per year for the Medicaid sample. Across both Medicaid and commercial enrollees, we found a significant decrease in months of MOUD for the pandemic cohort compared with the pre-pandemic cohort. For the Medicaid and commercial samples, there was a greater decrease in the number of inpatient days per year in the pandemic cohort compared with the pre-pandemic cohort. We also found a significant decrease in the number of days of emergency department care for the pandemic cohort compared with the pre-pandemic cohort for both commercial and Medicaid enrollees.Conclusions: This study found that adults diagnosed with OUD before the pandemic experienced a decrease in treatment despite efforts by policymakers to counter pandemic-related barriers to care. The policy flexibilities initiated early in the pandemic were laudable in their intent to ensure individuals with OUD maintained access to care, but our findings suggest more is needed to continue to engage this.