The effects of illicit drug use and HIV infection on sex hormone levels in women
ABSTRACT Drug use and HIV infection may affect sex hormone levels in women. One hundred and ninety-six women with and without a history of illicit drug use (50 HIV-negative and 148 HIV-infected), with regular menses, who never used antiretrovirals, were evaluated. Luteinizing hormone levels were significantly higher in women with a CD4 cell count <200/microl (p < 0.002). Current methadone use was associated with lower levels of total testosterone (p = 0.03) and higher levels of prolactin (p = 0.002); mean estradiol levels were 43% lower in women who used intravenous drugs (p < 0.001). Alcohol and crack cocaine use was not associated with sex hormone levels. Age, race, body mass index and degree of HIV immunosuppression were also associated with differences in sex hormone levels.
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ABSTRACT: City life has long been associated with the dangers of consumption. Here we focus on the consumption of opioids by Australian urban women and its effects on their sexual and reproductive functioning. We interviewed 109 Australian women with HCV (Hepatitis C) from two urban centres about contraception and their sexual and reproductive health needs. These interviews alerted us to a potential health consequence of drug use that appears to be under-researched: it appears that opioid use may reduce women's estrogen levels which in turn has consequences for their health more broadly. Here, we bring together qualitative evidence from interviews with women opioid users and from research literature to argue that women's opioid use may reduce their estrogen levels and lead to serious health consequences. At present, however, we are unaware of research that has empirically tested this proposition. This research urgently needs to be conducted, and if our theory is supported then treatment protocols and services for opioid-using women should be modified accordingly. Drug consumption, such as opioid use, and its sequelae are but one form of the hyper-consumption and ill-health that cities spawn. This paper loosely follows what Rhodes and others (2005) call the "interplay" among micro, meso, and macro factors that shape health risk environments. Cities provide the macro environment in which factors such as discrimination and economic disadvantage operate. Increasingly, place and space are recognized as important elements in understanding risk environments (Bryant, 2005; Tempalski & McQuie, 2009). However, this paper is also concerned at the micro level with women's hormonal response to opioids and at the meso level with how sexual and reproductive consequences play out for them in social environments. The research was conducted in two Australian cities. Canberra, the Australian capital, has a population of 340,000. Despite its high average income due to the preponderance of public servants and university staff, it contains pockets of social and economic disadvantage. Melbourne has a population of over three million and contains extremes of wealth and poverty. An extensive literature review and the interviews we conducted with women who use opioids alerted us to a potential health consequence of drug use that appears to be under-researched: the effects of opioid use appears to reduce women's estrogen levels. We examine some of the possible health consequences, especially for urban women with Hepatitis C Virus (HCV). Furthermore, as we illustrate, women connect their experiences across the micro, macro and meso levels when they discuss how their reproductive and sexual functioning interacts with the social and economic features of their lives. These health problems are contextualized by their social marginalization and (dis)location within cities. Cities & Consumption
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ABSTRACT: Summary Opioid substitution is the most widespread and well-researched treatment mo- dality for opioid dependence. Methadone and buprenorphine are currently the most commonly used pharmacotherapeutic agents. Sexual dysfunction has been reported as an adverse effect of opioids including methadone and buprenorphine. The current article describes proposed mechanisms for sexual dysfunction as an adverse effect of methadone and buprenorphine, summarizes research conducted on subjects on these agents, and explores appropriate evaluation and intervention in the management of the types of sexual dysfunction most commonly encountered during opioid substitution treatment (libido, erectile, and orgasm dysfunction).
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ABSTRACT: Summary Opioid pharmacotherapy can provide the stability necessary to initiate lifestyle changes, obtain steady employment and function in society. Thus, a critical question is the extent to which pharmacotherapy is associated with impairment in psychomotor and cognitive performance that might affect functioning. In this article, I review human laboratory studies of the effects of the most com- mon opioid pharmacotherapies, methadone and buprenorphine, on psychomotor and cognitive performance (both observational group comparison and experi- mental drug administration studies) and the effects of withdrawal from opioid pharmacotherapy on performance. I then outline some recommendations for further study in this area.