Increased Prescribing Flexibility During the COVID-19 Pandemic Was Not Associated With an Increase in Buprenorphine-involved Deaths

To facilitate continued access to buprenorphine for opioid use disorder (OUD) during the COVID-19 pandemic, the US federal government allowed clinicians to initiate buprenorphine remotely, without in-person examinations. This study assessed trends before and during this period of increased flexibility using data from the US Centers for Disease Control and Prevention’s State Unintentional Drug Overdose Reporting System from July 2019 to June 2021 in 31 states and the District of Columbia.

• During the study period, there was a total of 89,111 overdose deaths; 74,474 were opioid-involved and 1955 were buprenorphine-involved (2.2% of total and 2.6% of opioid-involved deaths).
• Among buprenorphine-involved overdose deaths, 93% involved another drug, compared with 67% of other opioid-involved deaths.
• The other drugs involved in buprenorphine-involved deaths included: fentanyl (50%), benzodiazepines (37%), cocaine (21%), methamphetamine (21%), anticonvulsants (primarily gabapentin and pregabalin; 19%), alcohol (16%), and antidepressants (14%).
• The proportion of buprenorphine-involved overdose deaths fluctuated, but did not increase during this time period.

Comments: This study reinforces the relative safety of buprenorphine and supports a move toward patient-centered, low-threshold OUD treatment models.

Darius A. Rastegar, MD

Reference: Tanz LJ, Jones CM, Davis NL, et al. Trends and characteristics of buprenorphine-involved overdose deaths prior to and during the COVID-19 pandemic. JAMA Netw Open. 2023;6(1):e2251856.