Leveraging prescription monitoring program data to evaluate the implementation of buprenorphine telehealth flexibilities: An interrupted time series analysis in Texas

Whanhui Chi; Chijioke Okeke; Douglas Thornton; Hua Chen; Abofazl Sadeghi; Tyler J Varisco

doi:10.1016/j.dadr.2024.100222

Leveraging prescription monitoring program data to evaluate the implementation of buprenorphine telehealth flexibilities: An interrupted time series analysis in Texas

Drug Alcohol Depend Rep. 2024 Feb 22:10:100222. doi: 10.1016/j.dadr.2024.100222. eCollection 2024 Mar.

Authors

Whanhui Chi^{1

2}, Chijioke Okeke^{1

2}, Douglas Thornton^{1

2}, Hua Chen^{2

3}, Abofazl Sadeghi², Tyler J Varisco^{1

2}

Affiliations

¹ The Prescription Drug Misuse Education and Research Center, College of Pharmacy, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA.
² Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA.
³ Center for Population Health Outcomes and Pharmacoepidemiology Education and Research, College of Pharmacy, University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA.

Abstract

Background: In March 2020, policy changes by the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration aimed to maintain access to office-based opioid treatment services by easing telehealth buprenorphine prescribing restrictions. However, the effectiveness of these changes remains largely unmeasured. The objective of this study was to measure the effectiveness of COVID-19-related telehealth flexibilities in an all-payer cohort from the Texas Prescription Monitoring Program.

Methods: Using Texas Prescription Monitoring Program data, we identified oral buprenorphine and buprenorphine/naloxone prescriptions dispensed in Texas between September 1, 2019, and September 26, 2020. Weekly counts of prescriptions, prescribing physicians, and dispensing pharmacies were analyzed. An autoregressive integrated moving average (ARIMA) model estimated changes in prescription volume between pre-implementation (September 1, 2019 - February 15, 2020) and post-implementation (April 12, 2020 - September 26, 2020) periods.

Results: Pre-flexibility, an average of 8898 (SD: 342) buprenorphine prescriptions were dispensed to 7829 (SD: 326) patients weekly. This declined to 8360 (SD: 247) prescriptions and 7661 (SD: 229) patients post-flexibility. Adjusted for seasonality, this represented a statistically significant average decline of -257.27 (95% CI: -426.06, -88.49) patients and -647.01 (95% CI: -856.67, -437.36) prescriptions per week.

Discussion: Our results suggest a modest decline in buprenorphine dispensing volume early in the COVID-19 pandemic. While difficult to assess its significance, it can be assumed that telehealth flexibilities mitigated a potentially larger decline. Future research should explore system and individual-level barriers to telehealth utilization.

Keywords: COVID-19; Interrupted Time Series Analysis; Opiate substitution treatment; Opioid-Related Disorders; Prescription Drug Monitoring Programs; Telemedicine.