(130) School Closures and Prescription Medication Use Among Children and Adolescents Before and During the COVID-19 Pandemic in the United States, 2019-2022

Background: Despite evidence that the COVID-19 pandemic and school closures had led to worsening mental health, including suicidality and poor academic performance, the association between school closures and the use of prescription medications, particularly attention deficit hyperactivity disorder (ADHD) medications, is not known.

Objectives: In this study, we analyzed changes in the use of prescription medications alongside patterns of school closures in the U.S. We hypothesized that the use of ADHD medications has declined during periods of complete school closures, when compared to periods during the COVID-19 pandemic where schools partially or completed re-opened.

Methods: We analyzed data from IQVIA's National Prescription Audit (NPA) to estimate monthly volume for prescriptions dispensed for children and adolescents ages 10-19 years between October 2019 through September 2022 in the United States. Data on school closures for in-person instruction for public schools during the COVID-19 pandemic were publicly available through Burbio's School Opening Tracker. We used descriptive statistics to quantify changes in mean number of prescriptions filled per month overall and by drug class during the four time periods of school closures and for older age groups (20-39, 40-59 years) that were not affected by school closures.

Results: A substantial decline in all prescriptions was observed during the period of complete school closures between starting in April 2020 and May 2020 before increasing steadily during the period of partial school closures in early 2021 and reaching a plateau at pre-pandemic levels beginning in late 2021. Initial declines during periods of complete school closures were largely driven by ADHD medications; the number of ADHD prescriptions filled declined by ~20% from the pre-pandemic period to the period of complete school closures (from 2,342,406 to 1,884,897 mean monthly fills; p< 0.01) and then steadily increased during the periods of partial closures (mean 2,132,864) and complete re-openings (mean 2,220,449) of schools. Declines in ADHD prescription fills during the period of complete school closures was only observed among ages 10-19 years; a significant increase was observed in older age groups.

Conclusions: In this study, we found complete school closures were associated with declines in the use of ADHD medications in school aged children and adolescents 10 to 19 years in the U.S. These findings suggest that the underuse of ADHD medications may be an overlooked contributor to declines in academic performance observed during the COVID-19 pandemic lockdown. This information may inform future strategies and response efforts in the context of public health crises, specifically policies regarding school closures.