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Objective To assess whether chronic pain increases the risk of COVID-19 complications and whether opioid use disorder (OUD) differentiates this risk among New York State Medicaid beneficiaries. Design, Setting, and Subjects This was a retrospective cohort study of New York State Medicaid claims data. We evaluated Medicaid claims from March 2019 through December 2020 to determine whether chronic pain increased the risk of COVID-19 emergency department (ED) visits, hospitalizations, and complications and whether this relationship differed by OUD status. We included beneficiaries 18–64 years of age with 10 months of prior enrollment. Patients with chronic pain were propensity score-matched to those without chronic pain on demographics, utilization, and comorbidities to control for confounders and were stratified by OUD. Complementary log–log regressions estimated hazard ratios (HRs) of COVID-19 ED visits and hospitalizations; logistic regressions estimated odds ratios (ORs) of hospital complications and readmissions within 0–30, 31–60, and 61–90 days. Results Among 773 880 adults, chronic pain was associated with greater hazards of COVID-related ED visits (HR = 1.22 [95% CI: 1.16–1.29]) and hospitalizations (HR = 1.19 [95% CI: 1.12–1.27]). Patients with chronic pain and OUD had even greater hazards of hospitalization (HR = 1.25 [95% CI: 1.07–1.47]) and increased odds of hepatic- and cardiac-related events (OR = 1.74 [95% CI: 1.10–2.74]). Conclusions Chronic pain increased the risk of COVID-19 ED visits and hospitalizations. Presence of OUD further increased the risk of COVID-19 hospitalizations and the odds of hepatic- and cardiac-related events. Results highlight intersecting risks among a vulnerable population and can inform tailored COVID-19 management. [ABSTRACT FROM AUTHOR]

Background: Mandates for prescriber use of prescription drug monitoring programs (PDMPs), databases tracking controlled substance prescriptions, are associated with reduced opioid analgesic (OA) prescribing but may contribute to care discontinuity and chronic opioid therapy (COT) cycling, or multiple initiations and terminations.Objective: To estimate risks of COT cycling in New York City (NYC) due to the New York State (NYS) PDMP mandate, compared to risks in neighboring New Jersey (NJ) counties.Design: We estimated cycling risk using Prentice, Williams, and Peterson gap-time models adjusted for age, sex, OA dose, payment type, and county population density, using a life-table difference-in-differences design. Failure time was duration between cycles. In a subgroup analysis, we estimated risk among patients receiving high-dose prescriptions. Sensitivity analyses tested robustness to cycle volume considering only first cycles using Cox proportional hazard models.Participants: The cohort included 7604 patients dispensed 12,695 prescriptions.Interventions: The exposure was the August 2013 enactment of the NYS PDMP prescriber use mandate.Main Measures: We used monthly, patient-level data on OA prescriptions dispensed in NYC and NJ between August 2011 and July 2015. We defined COT as three sequential months of prescriptions, permitting 1-month gaps. We defined recurrence as re-initiation of COT after at least 2 months without prescriptions. The exposure was enactment of the PDMP mandate in NYC; NJ was unexposed.Key Results: Enactment of the NYS PDMP mandate was associated with an adjusted hazard ratio (HR) for cycling of 1.01 (95% CI, 0.94-1.08) in NYC. For high-dose prescriptions, the risk was 1.16 (95% CI, 1.01-1.34). Sensitivity analyses estimated an overall risk of 1.01 (95% CI, 0.94-1.11) and high-dose risk of 1.09 (95% CI, 0.91-1.31).Conclusions: The PDMP mandate had no overall effect on COT cycling in NYC but increased cycling risk among patients receiving high-dose opioid prescriptions by 16%, highlighting care discontinuity. [ABSTRACT FROM AUTHOR]

Introduction: Special populations, including veterans, pregnant and postpartum women, and adolescents, benefit from opioid use disorder treatment tailored to their specific needs, but access to such services is poorly described. This study identifies the availability of opioid use disorder treatment facilities that use medications and have special programming and contextualizes facilities amid counties' opioid-related overdose mortality.Methods: Data were compiled on 15,945 U.S. treatment facilities using medications for opioid use disorder listed in the Behavioral Health Services Treatment Locator in 2018. Facilities with programs tailored to special populations (veterans, pregnant and postpartum women, and adolescents) were identified and geocoded. Counties with such facilities were characterized. Cold spots (county clusters with poor treatment availability) were identified using Getis-Ord Gi* statistics. Data were extracted in October 2018 and analyzed from October 2018 to May 2019.Results: Of all 3,142 U.S. counties, 1,889 (60.1%) had opioid use disorder treatment facilities. Facilities with tailored programs for veterans, pregnant and postpartum women, and adolescents were located in 701 (22.3%), 918 (29.2%), and 1,062 (33.8%) of the counties, respectively. Specific medications provided for opioid use disorder varied, with only a minority of facilities offering methadone (among facilities with tailored programs for veterans, 6.0%; pregnant and postpartum women, 13.2%; adolescents, 1.3%). Many counties reporting opioid-related overdose deaths lacked programs for special populations (veterans, 72.6%; pregnant and postpartum women, 54.8%; adolescents, 30.6%). Cold spots were located throughout the Midwest, U.S. Southeast, and portions of Texas.Conclusions: Facilities using medications for opioid use disorder with tailored programs for veterans, pregnant and postpartum women, and adolescents are limited. There is a need for improved access to evidence-based programs that address the unique treatment needs of special populations. [ABSTRACT FROM AUTHOR]