The temporal relationship between antibiotic and opioid prescription on the risk of developing an opioid use disorder: A national database study

Background: Previously, we discovered that subjects co-prescribed both antibiotics and opioids on the same day in a hospital setting displayed an increased risk of developing an opioid use disorder (OUD) 12 months following hospital discharge. The goal of this study was to examine whether prescribing antibiotics in the inpatient or emergency department setting at various time points before or after an opioid prescription impacted the risk OUD.Methods: A propensity score matched cohort study was conducted to identify subjects (18–65 years old) with no previous history of OUD. Two cohorts were defined: subjects who were prescribed antibiotics 0–1, 2–4, 5–7, 8–10, 11–12 months before or after the date of an opioid prescription while in the emergency department or inpatient setting, from the years 2010–2019. 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.Results: Primary analysis showed that subjects prescribed an antibiotic 0–1 month or 8–10 months before an opioid prescription showed a modest risk of developing an OUD 12 months following an opioid prescription (0.04% and 0.20%, respectively). Similarly, subjects prescribed an antibiotic 0–1 month, 5–7 months, or 8–10 months after an opioid prescription displayed a modest risk of developing OUD 12 months after an opioid prescription (0.02% risk, 0.14% risk, and 0.16% risk, respectively).Conclusions: These findings suggest that there is little to no effect on the risk of developing OUD when antibiotics are prescribed at various time points before or after opioid prescription.