How Did School Closures During COVID-19 Affect Children's Medication Use?

What you need to know

• School closures during the COVID-19 pandemic were associated with significant decreases in the use of ADHD medications among children and adolescents aged 10-19.
• Use of antidepressant and anti-anxiety medications increased steadily among this age group during and after school closures.
• Declines in ADHD medication use may have contributed to academic performance issues observed during pandemic lockdowns.
• Future public health crisis responses involving school closures should consider strategies to maintain access to important medications for children.

Understanding the impact of school closures on medication use

When the COVID-19 pandemic hit, schools across the United States closed their doors to in-person learning. By late March 2020, nearly all public schools had shifted to remote instruction, with many remaining closed until January 2022. While these closures were intended to protect public health, they had wide-ranging effects on children’s lives - from their social interactions to their mental health and academic performance.

A team of researchers set out to investigate another potential impact of school closures that hadn’t been closely examined before: how they affected children’s use of prescription medications. Their study, published in BMJ Paediatrics Open, analyzed changes in prescription fills for children and adolescents aged 10-19 during different phases of school closures between October 2019 and September 2022.

How the study was conducted

The researchers used data from IQVIA’s National Prescription Audit, which captures information on prescription fills from 92% of retail and mail-order pharmacies in the US. This allowed them to estimate the monthly volume of prescriptions dispensed for children and adolescents aged 10-19 years.

They looked at overall prescription trends, as well as specific commonly used drug classes:

• ADHD (attention deficit hyperactivity disorder) medications
• Antidepressants and anti-anxiety medications
• Short-acting beta-agonists (like albuterol inhalers used for asthma)

To analyze how these trends related to school closures, the researchers divided the study period into four time frames:

1. Pre-pandemic (October 2019 - February 2020)
2. Complete school closures (March 2020 - August 2020)
3. Partial re-openings/closures (September 2020 - December 2021)
4. Complete re-openings/no closures (January 2022 - September 2022)

They also examined prescription trends for adults aged 20-39 and 40-59 as comparison groups, since these age ranges weren’t directly affected by school closures.

Key findings on medication use during school closures

Overall prescription trends

The study found a substantial decline in overall prescriptions filled for children and adolescents during the period of complete school closures. This decline was most pronounced in April and May 2020. Prescription fills then began to increase steadily during the period of partial school closures in early 2021, eventually reaching pre-pandemic levels by late 2021.

ADHD medication trends

One of the most striking findings was related to ADHD medications. During the period of complete school closures, monthly ADHD prescription fills for 10-19 year-olds declined by about 20% compared to the pre-pandemic period. The average monthly fills dropped from 2,342,406 to 1,884,897.

ADHD medication use then began to increase during periods of partial school closures and complete re-openings, but didn’t quite return to pre-pandemic levels by the end of the study period.

Importantly, this decline was only observed in the 10-19 age group. Adults aged 20-39 and 40-59 actually saw increases in ADHD medication use during the same time periods.

Antidepressant and anti-anxiety medication trends

In contrast to ADHD medications, the use of antidepressants and anti-anxiety medications among 10-19 year-olds increased steadily starting in June 2020. This increase continued throughout periods of partial and complete school re-openings in 2021 and 2022, eventually exceeding pre-pandemic levels.

Asthma medication trends

The study also found significant declines in the use of short-acting beta-agonists (like albuterol inhalers) among 10-19 year-olds during complete school closures. This trend was similar to what was observed with ADHD medications.

Understanding the implications

These findings raise several important points for consideration:

ADHD medication access and academic performance

The substantial decrease in ADHD medication use during school closures is concerning. ADHD medications help many children focus, manage impulsivity, and succeed academically. The researchers suggest that reduced use of these medications may have contributed to the declines in academic performance observed during pandemic lockdowns, particularly for children with learning disabilities.

There are several possible reasons for this decline:

• Remote learning may have reduced the perceived need for ADHD medication in some families.
• Disrupted routines may have made it harder to maintain regular medication schedules.
• Some families may have had difficulty accessing healthcare providers to obtain prescription refills.

Mental health impacts

The steady increase in antidepressant and anti-anxiety medication use aligns with other studies showing worsening mental health among children and adolescents during the pandemic. School closures likely played a role in this trend by disrupting social connections, routines, and access to school-based mental health support.

Asthma management

The decline in asthma medication use (short-acting beta-agonists) is interesting. It may reflect reduced exposure to certain asthma triggers when children were not in school buildings. However, it’s also possible that some children weren’t receiving optimal asthma management during this time.

Conclusions and future considerations

• School closures during the COVID-19 pandemic were associated with significant changes in medication use patterns among children and adolescents.
• The decline in ADHD medication use is particularly noteworthy and may have contributed to academic challenges during remote learning.
• Increases in antidepressant and anti-anxiety medication use highlight the pandemic’s toll on youth mental health.
• Future public health responses involving school closures should consider strategies to maintain access to important medications and healthcare services for children.

This study provides valuable insights into an often-overlooked aspect of how the pandemic affected children’s health and well-being. It underscores the complex relationship between school attendance, medication use, and overall health management for young people.

As we continue to navigate the long-term impacts of the pandemic on children, this research suggests several areas for further investigation and potential policy considerations:

• Developing better systems to ensure children can access necessary medications during disruptions to normal routines.
• Exploring how remote learning environments can be optimized to support children with ADHD and other learning differences.
• Strengthening mental health support systems for children and adolescents, both in and out of school settings.
• Investigating the long-term academic and health outcomes for children who experienced changes in medication use during the pandemic.

By understanding these patterns, healthcare providers, educators, and policymakers can work to develop more comprehensive strategies to support children’s health and academic success during future public health crises or other situations that might disrupt normal school operations.