The effect of prescribing antibiotics with opioids on the development of opioid use disorder: a national database study

Abstract

The goal of this study was to examine the impact of inpatient- or emergency department- prescribed antibiotic treatment in combination with opioids on the risk of developing opioid use disorder 12 months following discharge from the hospital. The authors conducted a propensity score-matched cohort study with data from the TriNetX Research Network database to identify adult subjects (18–65 years old) with no previous history of an opioid use disorder. Three cohorts were defined for the analyses: subjects who were prescribed an opioid, opioid in combination with an antibiotic, or an antibiotic while in the emergency department or inpatient unit, from the years 2012 to 2018. The diagnosis of an Opioid Related Disorder (F11.10–F11.20) 12 months following discharge from the emergency department or inpatient unit was then observed within the cohorts following the index event as identified by the ICD-10 procedural coding system. Primary analysis (propensity-score matched on age and sex) showed that opioids prescribed in combination with antibiotics had a protective effect against the development of opioid use disorder. This effect was consistent throughout all of the years included in this study with the smallest protective effect observed in 2018 (2012 risk ratio = 1.27 (95% CI: 1.23, 1.32); 2018 risk ratio: 1.03 (95% CI: 1.01, 1.05). These findings suggest that opioids prescribed in combination with antibiotics in the hospital setting are protective against the development of OUD at later time points following hospital discharge.

Keywords:

• Opioid use disorder
• opioid
• antibiotic
• prescription
• microbiome
• emergency department
• inpatient unit
• TriNetX

Acknowledgements

We thank Dr. Diane McCloskey for edits and comments. Access and support for the use of TriNetX was provided through a National Center for Advancing Translational Sciences Clinical and Translational Science Award.

Author contributions

ZGF, JAK, TK, and NMG designed the retrospective chart review. ZGF and JAK performed data acquisition through TriNetX. TK performed statistical analyses. ZGF, JAK, and NMG wrote the manuscript.

Declaration of interest

The authors have no financial or non-financial competing interests to declare.