Disparities in Naltrexone Prescriptions to Medicaid Enrollees During the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic strained healthcare facilities and the isolation and uncertainty associated with the pandemic compromised mental health around the world. The pandemic has also been associated with an exacerbation of the opioid crisis in the United States (US), and previous studies have reported changing trends in opioid misuse during the pandemic. Our study investigated naltrexone, a prescription drug used to treat alcohol and opioid use disorders by blocking opioid receptors to reduce cravings. We sought to investigate the changes in naltrexone prescriptions issued to Medicaid enrollees in light of the COVID-19 pandemic. MethodsThe total number of naltrexone, generic and brand name, prescriptions across the US were obtained from the Medicaid.gov database, expressed as prescriptions per state corrected for the number of enrollees, and organized into two time periods - the pre-pandemic period from January 2019 to December 2019 and the pandemic period from January 2020 to March 2021. Statistical analyses included a paired t-test, a heat map to depict state level variation, and waterfall figures. Procedures were approved by the IRB of Geisinger. ResultsThere were increases in total naltrexone prescriptions throughout the time frame studied, but a decrease in prescriptions per 100,000 Medicaid enrollees. A paired t-test revealed a significant decrease in naltrexone prescriptions during the pandemic period. There was a 398-fold difference between the highest and lowest states in 2019 Quarter 1 and 424-fold in 2021 Quarter 1. Percent change calculations indicated South Dakota (+141%) and Oregon (+172%) showed a significant increase in total naltrexone prescriptions from pre-pandemic to post-pandemic from the national mean (-23.57%+5.60%). ConclusionsThe results of this study were significant and indicated a relationship between the COVID-19 pandemic and declining naltrexone prescription rates. Naltrexone prescriptions per 100,000 enrollees decreased in most states during the pandemic and fell by over 32% nationally from 2019 to 2021 despite a slight increase in total prescription numbers and an increase in Medicaid enrollees. These data suggest wide variation in access to substance use disorder treatment during the pandemic. Further research with privately insured patients may be beneficial.