Risks of opioid overdose among New York State Medicaid recipients with chronic pain before and during the COVID-19 pandemic

• Published in: Preventive medicine 2023-12, Vol.177, p.107789-107789, Article 107789
• Main Authors: Mannes, Zachary L, Wheeler-Martin, Katherine, Terlizzi, Kelly, Hasin, Deborah S, Perry, Allison, Pamplin, 2nd, John R, Crystal, Stephen, Cerdá, Magdalena, Martins, Silvia S
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - adverse effects; Chronic Pain - drug therapy; COVID-19; Drug Overdose - drug therapy; Drug Overdose - epidemiology; Humans; Medicaid; New York - epidemiology; Opiate Overdose - drug therapy; Opiate Overdose - epidemiology; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Pandemics; United States - epidemiology
• ISSN: 0091-7435; 1096-0260; 1096-0260
• DOI: 10.1016/j.ypmed.2023.107789

The COVID-19 pandemic contributed to healthcare disruptions for patients with chronic pain. Following initial disruptions, national policies were enacted to expand access to long-term opioid therapy (LTOT) for chronic pain and opioid use disorder (OUD) treatment services, which may have modified risk of opioid overdose. We examined associations between LTOT and/or OUD with fatal and non-fatal opioid overdoses, and whether the pandemic moderated overdose risk in these groups. We analyzed New York State Medicaid claims data (3/1/2019-12/31/20) of patients with chronic pain (N = 236,391). We used generalized estimating equations models to assess associations between LTOT and/or OUD (neither LTOT or OUD [ref], LTOT only, OUD only, and LTOT and OUD) and the pandemic (03/2020-12/2020) with opioid overdose. The pandemic did not significantly (ns) affect opioid overdose among patients with LTOT and/or OUD. While patients with LTOT (vs. no LTOT) had a slight increase in opioid overdose during the pandemic (pre-pandemic: aOR:1.65, 95% CI:1.05, 2.57; pandemic: aOR:2.43, CI:1.75,3.37, ns), patients with OUD had a slightly attenuated odds of overdose during the pandemic (pre-pandemic: aOR:5.65, CI:4.73, 6.75; pandemic: aOR:5.16, CI:4.33, 6.14, ns). Patients with both LTOT and OUD also experienced a slightly reduced odds of opioid overdose during the pandemic (pre-pandemic: aOR:5.82, CI:3.58, 9.44; pandemic: aOR:3.70, CI:2.11, 6.50, ns). Findings demonstrated no significant effect of the pandemic on opioid overdose among people with chronic pain and LTOT and/or OUD, suggesting pandemic policies expanding access to chronic pain and OUD treatment services may have mitigated the risk of opioid overdose.