Papers of the Week

The COVID-19 pandemic led to severe disruptions in healthcare and a relaxation of rules surrounding opioid prescribing-changes which led to concerns about increased reliance on opioids for chronic pain and a resurgence of opioid-related harms. Although some studies found that opioid prescriptions increased in the first six months of the pandemic, we know little about longer term effects of the pandemic on opioid prescriptions. Further, despite the prevalence of pain in veterans, we know little about patterns of opioid prescriptions in the Veterans Health Administration (VA) associated with the pandemic. Using a retrospective cohort of VA patients with chronic low back pain, we examined the proportion of patients with an opioid prescription and mean morphine-milligram equivalents (MME) over a three-year period-one year prior to and two years after the pandemic’s onset. Analyses revealed that both measures fell during the entire observation period. The largest decrease in odds of filling an opioid prescription occurred in the first quarter of the pandemic, but this downward trend continued throughout the observation period, albeit at a slower pace. Clinically meaningful differences in opioid prescriptions and dose over time did not emerge based on patient race or rurality; however, differences emerged between female and male veterans, with decreases in opioid prescriptions slowing more markedly for women after pandemic onset. These findings suggest that the pandemic was not associated with short- or long-term increases in opioid prescriptions or dose in the VA. PERSPECTIVE: This article examines opioid prescribing over a three-year period-one year prior to and two years after the onset of the COVID-19 pandemic-for VA patients with chronic low-back pain. Results indicate that, despite disruptions to healthcare, opioid prescriptions and dose decreased over the entire observation period.