Why Doctors Continue to Overprescribe Antibiotics and Opioids

The health risks of antibiotics and opioid painkillers often outweigh their benefits, which is why doctors aren’t supposed to prescribe them unless absolutely necessary. Yet according to new study published in the Annals of Internal Medicine, both are among the drugs most frequently doled out to patients who likely won’t benefit but can easily be harmed. 

In a recent survey, the American College of Physicians asked 5,000 member doctors to name the top two treatments commonly prescribed that do not deliver “high-value care.” Twenty-seven percent of doctors listed antibiotics. These drugs are prescribed primarily for upper-respiratory infections, which are usually caused by viruses, meaning antibiotics wouldn’t work in the first place. Instead, they often cause nausea, stomach pain, and diarrhea and sometimes headaches, rashes, hives, or labored breathing.

“Every single antibiotic comes with side effects,” says Dr. Amir Qaseem, lead study author and vice president of clinical policy at ACP. “But in many cases, antibiotics are not going to have any benefit. It will take 10 days for you to get better with or without an antibiotic. And the biggest problem now is they contribute to antibiotic resistance.”

Qaseem cites several reasons why antibiotics get prescribed too liberally. For one, it’s possible some practitioners are still unclear on appropriate prescribing guidelines. “Another piece of this is patient expectations,” he says. “People take time off work to see their doctor about an upper-respiratory infection, so they hope to be prescribed something.” Compounding the problem, doctors today are often crunched for time. “They may have only 10 minutes with each patient,” Qaseem says. “So it’s easier to just write an antibiotics script than to explain why a patient really doesn’t need one.”

Similar issues likely explain such rampant overprescribing of opioid painkillers, which also ranked high on the survey. “If you have lower back pain and have trouble sitting at work or driving your car, and you make an effort to see your doctor, you want some sort of treatment to come out of it,” Qaseem says. But if you’re not careful, you could get a painkiller that won’t ease your pain anyway—and could hurt you. The biggest issue with opioids is the high potential for dependency, says Qaseem, but they also cause side effects like constipation, nausea, bloating, and liver damage.

Dietary supplements also took a top spot on the survey, although they’re a slightly different beast. Doctors don’t prescribe fish oil, calcium, or multivitamins, per se, but more and more are recommending them to patients for preventative health maintenance. Qaseem’s main concern with supplements is the lack of research showing that they work. “The bottom line here is efficacy,” he says. “Along with some supplements possibly interacting with certain medications, the primary issue is they’re found in almost every pharmacy and health food store but there’s little to no evidence that they’re effective.”

Although health experts have expressed ample concern about overprescribing low-value treatments, it’s clearly still happening. To fix the problem, Qaseem believes clinicians need more education around the importance of providing evidence-based care and choosing treatments that truly can improve health outcomes.

But patients aren’t off the hook, either. Qaseem insists it’s equally important for you to advocate for your own health. “Patients need to start taking charge and realize that not every care provided is good care,” he says. “With any of these drugs, it’s really important for both doctors and patients to think about the value equation.” That means discussing the total package of benefits, harms, and costs of a given treatment.

Too determine whether a drug is a good fit, Qassem suggests learning as much about it as possible beforehand and then hitting your doctor hard with questions. “Ask what the benefit will be if you get this treatment and what adverse consequences may occur,” he says. “Also ask if you’ll be OK if you don’t get that treatment. The more questions you ask, the better care you’ll usually receive.”