Prevalence and predictors of prescription opioids among United States adults with long COVID

Long COVID may occur in some patients after contracting COVID-19. Opioids are employed as one of many management and treatment strategies for this relatively new condition. However, the frequency of opioid prescribing and the characteristics of patients with long COVID prescribed an opioid are currently unknown. The objective of this exploratory study was to determine the prevalence and predictors associated with being prescribed an opioid among United States (US) adults with long COVID. This cross-sectional study included US adults (≥18 years) alive through 2023 with a diagnosis of long COVID. The 2023 Medical Expenditure Panel Survey (MEPS) full-year consolidated dataset and prescribed medication dataset were used. A multivariable logistic regression model assessed associations between the independent variables and the dependent variable (prescribed opioid vs no prescribed opioid). Independent variables were organized according to the Andersen Behavioral Model and included age, sex, race, ethnicity, marital status, education, employment, income, insurance, chronic conditions, health status, mental health status, functional limitations, pain interference, exercise, smoking status, and COVID-19 vaccination. The complex MEPS data structure was maintained, and a weighting variable was included to calculate nationally representative estimates. The alpha value (determined a priori) was 0.05. The study included 877 (weighted n = 2,17,73,754) US adults with long COVID. Of these, 144 (weighted n = 32,04,534) were prescribed an opioid while 733 (weighted n = 1,85,69,220) were not prescribed an opioid. Characteristics associated with increased odds of being prescribed an opioid included poor/low versus middle/high income (adjusted odds ratio [AOR] = 1.8, 95% confidence interval [CI] = 1.0, 3.0), having quite a bit/extreme versus no pain interference (AOR = 4.3, 95% CI = 2.1, 8.7), and being nonsmokers versus smokers (AOR = 2.7, 95% CI = 1.2, 6.2). In conclusion, the characteristics associated with being prescribed an opioid among US adults with long COVID in this MEPS database study may help inform the appropriate management of this condition. Future research is needed to establish if the prescribed opioids are being used to manage symptoms of long COVID and to ascertain the diagnoses and prescribing patterns for opioids in this population.