Prescription fill patterns for benzodiazepine and opioid drugs during the COVID-19 pandemic in the United States

Background: COVID-19 and resulting mitigation measures in the United States (US) brought about limited access to medical care that has been linked to increases in mental health problems, excessive substance use, and drug overdoses. The increase in co-prescription of benzodiazepines and opioids may indicate population-level changes in health behaviors that can be exacerbated by limited access, hence necessitating the tracking of these drugs during COVID-19. We evaluated the impact of the declaration of COVID-19 as a US national emergency on prescription patterns in 2020. Methods: Prescriptions of benzodiazepines and opioids were analyzed using data aggregated on a weekly basis across 38 states over the January 2019-December 2020 period. Data were from Bamboo Health Prescription Drug Monitoring Program and covered all individuals regardless of insurance status. Generalized additive models estimated the effects of the March 13, 2020 declaration on proportion of prescriptions to all controlled substances by comparing volumes before to after the week of March 13 in 2020 (range: January 27-May 24) and comparing this trend to its 2019 counterpart. Results: When comparing the January 27-March 9 period to the March 16-May 24 period in 2020, there was a statistically significant 2.0% increase in the proportion of benzodiazepine dispensations to all controlled substances, and a significant 1.7% mean decrease in proportion of opioid dispensations to all controlled substances. A significant return approaching pre-declaration levels was observed only for opioids (beginning week of May 18, 2020). Conclusions: The results suggest significant impacts of the COVID-19 pandemic on dispensations of benzodiazepines and opioids across the US. Continued monitoring of prescription trends and maintenance of adequate and accessible access to mental healthcare are important for understanding public health crises related to substance use.