Concordance between high antibiotic prescribing and high opioid prescribing among primary care physicians: a cross-sectional study

Abstract

R ising antimicrobial resistance is an urgent public health threat. Most antibiotics are prescribed in the outpatient setting, which acts as an important driver for antibiotic resistance in the community. 1 In the United States alone, antibiotic-resistant infections claim 23 000 lives annually. 2 At the same time, another drug-related public health crisis looms. The epidemic of opioid overuse is evolving rapidly, and, in the US, prescription opioids are associated with 17 000 overdose-related deaths annually. 3 Although deaths related to nonprescribed opioids are increasing, prescription opioids still account for at least 25% of opioid-related deaths. 4 Despite their obvious differences, these 2 public health threats have notable commonalities. In North America, both antibiotic overuse and opioid overuse are largely iatrogenic in origin owing to overprescribing behaviour. 5 There is wide variability in prescribing practices for both of these drug classes that is not fully explained by differences in practice settings and patient populations. 6-8 In addition, both patients of high prescribers of antibiotics and patients of high prescribers of opioids are more likely to experience harm than patients of low prescribers, 6,8 which provides an impetus for urgent intervention. Understanding overlap in overprescribing can help identify unique prescriber populations in which antibiotic and opioid stewardship can be focused and support aligned efforts to improve the use of these agents and reduce harm. Our objective was to evaluate the association between being a high prescriber of antibiotics and a high prescriber of opioids in the primary care setting.