Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment

Introduction. Use of opiates/opioids is associated with hypoactive sexual desire, erectile and orgasmic dysfunction. Aim. To determine prevalence and investigate etiology of sexual dysfunction in men on methadone or buprenorphine maintenance treatment (MMT, BMT). Main Outcome Measures. International Index of Erectile Function (IIEF), hormone assays, Beck Depression Inventory. Methods. A total of 103 men (mean age 37.6±7.9) on MMT (N=84) or BMT (N=19) were evaluated using the IIEF, hormone assays, Beck Depression Inventory, body mass index (BMI), demographic, and other substance use measures. Results. Mean total IIEF scores for partnered men were lower for MMT (50.4±18.2; N=53) than reference groups (61.4±16.8; N=415; P <0.0001) or BMT (61.4±7.0; N=14; P=0.048). Among partnered men on MMT, 53% had erectile dysfunction (ED) compared with 24% of reference groups; 26% had moderate to severe ED, 12.1% in under 40s and 40.0% among those 40+ years. On multiple regression, depression, older age, and lower total testosterone were associated with lower IIEF and EF domain; on multivariate analysis, there were no significant associations between IIEF or EF and free testosterone, opioid dose, cannabis or other substance use, viral hepatitis, or BMI. Total testosterone accounted for 16% of IIEF and 15% of EF variance. Men without sexual partners had lower Desire and Erection Confidence scores and less recent sexual activity, suggesting potentially higher prevalence of sexual dysfunction in this group. Conclusion. Men on MMT, but not BMT, have high prevalence of ED, related to hypogonadism and depression. Practitioners should screen for sexual dysfunction in men receiving opioid replacement treatment. Future studies of sexual dysfunction in opioid-treated men should examine the potential benefits of dose reduction, androgen replacement, treatment of depression, and choice of opioid.