The Impact of the COVID-19 Pandemic on the Frequency of Primary Care Visits for Substance Use in Ontario, Canada

Context: The COVID-19 pandemic has led to increased stress and anxiety as well as maladaptive coping strategies including substance use.

Objective: This study aims to assess the impact of the COVID-19 pandemic on the frequency of primary care visits for substance use including tobacco, alcohol, and other drug use among primary care patients in Ontario, Canada.

Study Design and Analysis: We conducted a longitudinal cohort study of family medicine patients from March 14, 2019, to March 13, 2021. We used generalized linear models to compare the frequency of substance-use related fee and diagnostic codes pre-pandemic and during the pandemic. Logistic regression was used to model the binary outcome of whether a substance-use related visit took place in either period.

Setting or Dataset: Patient data was obtained from the University of Toronto Practice-Based Research Network (UTOPIAN) database with over four hundred contributing family physicians.

Population Studied: The study population included 234,730 and 240,044 adult family medicine outpatients in the pre-pandemic and pandemic periods, respectively.

Intervention/Instrument: The study looked at the impact of the COVID-19 pandemic on the frequency of visits for substance use; March 14-2019-March 13, 2020 was defined as the pre-pandemic period while March 14, 2020-March 13, 2021 was defined as the pandemic period.

Outcome Measures: We used two types of measures to identify patients presenting to family physicians with a substance use-related issue: (1) Ontario Health Insurance Plan (OHIP) service fee codes for primary care visits related to substance use and (2) OHIP diagnostic codes for primary care visits related to substance use.

Results: Relative to the pre-pandemic period, there were decreases during the pandemic in the proportion of patients who had a primary care visit for tobacco-use related reasons from 1411 to 419 per 100,000 patients, and alcohol-use related reasons from 314 to 274 per 100,000 patients. However, the proportion of patients having a primary care visit for other drug-use related reasons increased from 618 to 717 per 100,000 patients.

Conclusions: Substance-use related primary care visits were found to have decreased in the first year of the COVID-19 pandemic relative to the year before. Our results, interpreted in a context of increased substance use prevalence during the COVID-19 pandemic, likely represent an unmet need for patients with substance use disorders during the pandemic.