Impact of COVID-19-related regulatory changes on nationwide access to buprenorphine: An interrupted time series design

•Patients received longer prescriptions of buprenorphine.•Overall total milligrams buprenorphine increased post-initial pandemic period.•Stably-treated patients experienced fewer treatment disruptions.•Medicaid patients had improved access to buprenorphine.•Regulatory changes appear to have helped patients maintain access to buprenorphine. The impact of COVID-19-related healthcare changes on access to buprenorphine (BUP) nationwide in the US is unknown. We conducted an interrupted time series with the IQVIA LRx database. The study timeline included BUP prescriptions from 52 weeks before (2/23/19–2/21/20) to 52 weeks after (4/4/20–4/2/21) the initial pandemic period (2/22/20–4/3/20). Segmented regression estimated relative changes in total milligrams (MG) of BUP available per week nationwide at 1, 26, and 52 weeks post-initial-pandemic. We evaluated treatment disruptions in previously stable patients, defined as ≥6 months of BUP prescriptions. A total of 31 617 849 prescriptions were included. Total MG BUP dispensed increased at 1 and 26 weeks and then returned to baseline trends at 52 weeks post-initial pandemic period (4.1% [95% CI: 3.7,4.5], 2.1% [1.5,2.6], 0.1% [-0.6,0.9]). Stably-treated patients saw a decrease in 7-, 14-, and 28-day treatment disruptions at 52 weeks post-initial-pandemic period (-21.6% [-25.6,-17.7]; -10.8% [-16.3,-5.3]; -27.3% [-33.0,-21.6]). Men retained an increase in MG BUP compared to women at 52 weeks (0.7% [0.01,1.4] versus -0.6% [-1.5,0.2]). Younger age groups (18–29 years and 30–39 years) had a decrease in MG BUP at 52 weeks compared to expected baseline trend (-16.6 [-24.2, -9.0]; -1.6 [-3.0, -0.1). Patients with Medicaid demonstrated an increase in MG BUP at 52 weeks (8.3% [6.3,10.3]). MG BUP prescribed by APP prescribing increased by over 140 000 mg per week prior to the pandemic and continued to increase. Regulatory changes around buprenorphine prescribing facilitated patient access to buprenorphine during the pandemic.