Men who use opioid drugs might be at increased risk for erectile dysfunction (ED), according to a recent systematic review and meta-analysis published in the Journal of Sexual Medicine.
For centuries, opioid analgesics have been used to treat chronic pain. More recently, opioid drug use has become more frequent.
The drugs can have some serious side effects, however. Some people become more sensitive to pain (hyperalgesia) and men may develop low testosterone (hypogonadism) or ED. Misuse and abuse of opioids is also a concern.
Past studies of opioids and ED have had mixed results. The authors of the present study noted that, to their knowledge, no reviews or meta-analyses had been conducted on the subject.
Using the PubMed, Cochrane Library, and Embase databases, researchers identified ten relevant studies published between 1995 and 2016. Only studies that used validated instruments to assess ED, such as questionnaires or physical examinations, were considered.
Together, the studies involved 8,829 men with an average age of 41.6 years. About 28% of the men underwent opioid management, and the rest received a placebo or non-opioid intervention. The duration of intervention ranged from 4 months to 9.5 years. Five of the studies were conducted in Asia, two in North America, and one in Australia. Discussed drugs included methadone, heroin, opium, and morphine equivalents with doses ranging from 10 to 200 mg daily.
After analyzing the data, the researchers determined that opioid use was associated with a 96% increase in ED risk.
They added that this association was stronger in men younger than 50 years compared to their older counterparts. Typically, ED becomes more frequent as men age, but in this case, substance abuse among younger men might have played a significant role.
“According to several published reports, men with persistent use of opioids showed an unexpectedly high prevalence of ED at younger ages (mean age = 28-49 years) compared with the general population,” they wrote.
The association was not as strong for methadone, compared to other drugs like opium and heroin. Methadone is sometimes used to treat opioid dependence. Other studies found that buprenorphine, a partial opioid agonist, was associated with even lower ED risk and “might be a therapeutic option if patients had erection difficulty while on opioids or methadone treatment.”
Physiologic factors (such as a decrease in nitric oxide bioavailablity) and psychological factors (such as depression) were suggested reasons behind the link, but more research is needed in this area, the authors said.
They added that the evidence in the included studies was considered “low quality” and that larger, better-quality studies are necessary.
The Journal of Sexual Medicine
Zhao, Shankun, MD, et al.
“Association Between Opioid Use and Risk of Erectile Dysfunction: A Systematic Review and Meta-Analysis”
(Full-text. Published online: September 8, 2017)