Opiates seem to reduce the libido, it’s a common complaint in opiate users and those on replacement treatment. They seem to do this through suppressing testosterone and other key hormones. SMMGP reviews a couple of papers on the association between opioid replacement therapy (ORT) and sexual dysfunction. In the first, relatively small, Indian study, 60 sexually active men on buprenorphine or naltrexone (30 on each) were asked about symptoms including low libido, erectile dysfunction, loss of libido, premature ejaculation and the odd symptom of ‘weakness due to semen loss.’ So was there sexual dysfunction on ORT?
83% of the men on buprenorphine had at least one of these symptoms as did 90% of the men on naltrexone.
In the second paper, a meta-analysis involving almost 1,600 participants the incidence of dysfunction was 52%. Men were four times more likely to have problems on methadone than on buprenorphine.
As always, I’m left with lots of questions. What’s the incidence of erectille dysfunction in populations still using illicit opiates? What’s the effect of circumstances/lifestyle? What’s the incidence in recovering populations? What’s the effect of antidepressants? I haven’t accessed the full papers and perhaps some of these questions are addressed there. The findings are conflicting, but there may be a case for buprenorphine offering advantages. The commentary does mention the challenge of moving people from methadone to buprenorphine (higher doses of methadone don’t covert easy to buprenorphine). There are also the disappointing findings of poor retention in buprenorphine maintenance treatment.
Once more I come back to how honest we are in telling people about outcomes and side effects with medication used in addiction treatment. Does our faith in pharmacology blind us to the downsides? Osteoporosis in men on long term maintenance is not mentioned to clients and emerging concerns about sight impairment in babies born to mums on ORT isn’t on the radar either. We have a strong evidence base for the use of ORT in reducing harm, but we need to be honest about the balance of risks too before initiating clients on prescriptions.