Changes in transmucosal buprenorphine utilization for opioid use disorder treatment during the COVID-19 pandemic in Kentucky

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Purpose: With surging opioid-involved overdoses, maintaining access to opioid use disorder (OUD) treatment is critical during the COVID-19 pandemic. We examined changes in transmucosal buprenorphine prescribing for OUD treatment in Kentucky after the national COVID-19 emergency declaration, with a focus on rural-urban differences. Methods: Using 2019-2020 prescription monitoring data, we performed segmented regression analysis for an interrupted time series design to evaluate changes in weekly rates (per 100,000 residents) of dispensed prescriptions, unique individuals with dispensed prescriptions, and average days’ supply for dispensed prescriptions of transmucosal buprenorphine. Findings: The weekly rates of dispensed prescriptions and unique individuals with dispensed prescriptions were higher for rural residents than urban residents. After the national COVID-19 emergency declaration, rural and urban residents experienced similar immediate drops in the rate of dispensed prescriptions (rural –33.4; urban –24.3) and unique patients with dispensed prescriptions (rural –25.0; urban –17.1), followed by similar sustained increases. Both measures surpassed the prepandemic levels in mid-June 2020. Patients residing in urban areas received averagely longer prescriptions at baseline (urban: 11.0 days; rural: 10.5 days). The average weekly days’ supply increased in the week after the national emergency declaration, but the estimated increase was higher (P =.004) for urban (0.8 days) versus rural (0.5 days) residents. Conclusions: Transmucosal buprenorphine utilization increased during the COVID-19 pandemic after experiencing interruption during the initial weeks of the pandemic. Future studies should evaluate the contribution of the relaxed telemedicine buprenorphine prescribing regulations during the COVID-19 national emergency on initiation and maintenance of buprenorphine treatment.

Original languageEnglish
JournalJournal of Rural Health
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
This study was supported by funding from the US Bureau of Justice Assistance (BJA) via grant 2017‐PM‐BX‐K026, awarded to the Kentucky Injury Prevention and Research Center as bona fide agent for the Kentucky Department for Public Health. The BJA is a component of the Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. This study was also supported by funding from the US Food and Drug Administration (FDA) under Broad Agency Announcement No. 17–00123. Points of view or opinions in this document are those of the authors and do not necessarily represent the official position or policies of the US Department of Justice nor the US FDA. Funding information

Publisher Copyright:
© 2022 National Rural Health Association.


  • COVID-19 pandemic
  • buprenorphine
  • interrupted time series
  • opioid use disorder
  • rural-urban difference

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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