Figure - uploaded by Anna Franceschini
Content may be subject to copyright.
Results of logistic regression analyses, persons without sexual dysfunction (reference category) vs. persons with sexual dysfunction, unadjusted and controlling for age (except for the age effect).
Source publication
Opioid maintenance treatment (OMT) is the most widespread therapy for both females and males opioid addicts. While many studies have evaluated the OMT impact on men's sexuality, the data collected about the change in women's sexual functioning is still limited despite the fact that it is now well-known that opioids-both endogenous and exogenous-aff...
Citations
... Sexual dysfunction is also a side effect of opioid drugs and medications -including OAT and MMT -and can occur in both men and women. [20][21][22][23] Sexual dysfunction causes a variety of deleterious symptoms, including abnormalities in sexual desire, arousal, and satisfaction, 13 and sometimes resulting in ED for men. 24 Sexual dysfunction and/or ED may have various underlying causes, including those of a physiologic, social, and/or psychological etiology. ...
Opioid agonist and methadone maintenance therapies are essential medical interventions for effectively managing opioid use disorder. However, side effects, including constipation and erectile dysfunction can compromise treatment adherence and increase the risk of relapse. No studies or guidelines describing the clinical effectiveness or recommendations for the use of laxatives or erectile dysfunction medications in the treatment of constipation or erectile dysfunction in patients undergoing OAT or MMT were identified. Research is needed to understand the clinical effectiveness and inform guidance concerning the treatment of constipation with laxatives and the use of medications indicated for erectile dysfunction.
... The risk of menopause and menstruation abnormalities was seen to be increased in long-term female opioid users and methadone maintenance clients (Richardson et al., 2018). A recent study found that 56.6% of the women receiving at least three months of opioid substitution treatment showed sexual dysfunction (Zamboni et al., 2019). Another study that examined patients on maintenance therapy and its effect on sex hormones and sexual function found that in those treated with buprenorphine, 23% reported reduced libido and 12% reported reduced potency, while those on methadone, 83% reported reduced libido and 72% reported reduced potency. ...
Opioid dependence is the commonest drug dependence
after cannabis worldwide. Physiologically, opioids, by their
acute effects, cause enhanced sexual performance while
used chronically; they cause sexual dysfunction primarily by
influencing the hypothalamo-pituitary-adreno-gonadal
axis. Men with opioid use had a significantly increased risk
of erectile dysfunction with a relative risk of 1.96. Decrease
in sexual desire/libido, anorgasmia, premature ejaculation,
loss of ability to attain an erection, decreased sexual
satisfaction after intercourse, amenorrhoea, anovulation
are the critical effects of long-term opioid usage on sexual
health. Such effects are also prominent in those on opioid
substitution therapy with buprenorphine and methadone.
Hence sexual assessment should be an essential part of the
evaluation of those on long-term opioids. Also, the sexual
dysfunction due to long-term opioid usage should be
adequately addressed.
... The prevalence of sexual dysfunction varies across the population, ranging from as low as 14% to as high as 93% in men on methadone maintenance treatment (MMT) [4][5][6][7][8]. In contrast, the data in women on MMT is limited, but the available report indicates a prevalence of 56.6% [9]. Hypoactive sexual desire disorder in men and arousal impairment in women are the common sexual dysfunction in the MMT population. ...
... Hypoactive sexual desire disorder in men and arousal impairment in women are the common sexual dysfunction in the MMT population. Moreover, the impairments are significantly higher in the MMT population compared to patients on buprenorphine maintenance treatment (BMT), another OST alternative [9,10]. On the contrary, the most common sexual dysfunctions in the general population are hypoactive sexual desire disorder and premature ejaculation in women and men, respectively [3]. ...
Sexual dysfunction is a common condition in the opioid substitution therapy (OST) population. We aimed to determine the efficacy and safety of treatment for sexual dysfunction in the OST population. We searched for interventional studies from Medline, PubMed, and Scopus. Three independent authors conducted a risk-of-bias assessment (RoB 2). A total of seven studies (five randomized-controlled trials, two quasi-experimental), including 473 patients with sexual dysfunction, were identified. Among these, three bupropion (n=207), one trazodone (n=75), two rosa Damascena (n=100), and one ginseng (n=91) studies had reported significantly improve various sexual functioning domains in both genders. In a meta-analysis, bupropion significantly increased male sexual function with standardized mean difference of 0.53; 95% confidence interval of 0.19-0.88; P < 0.01; I2=0. The adverse effects were minor for all agents, and no significant difference between treatment and placebo groups in randomized-controlled trials. These agents have a promising future as therapy for sexual dysfunction in the OST population. However, given the limited sample size and number of studies, further studies should be conducted to confirm the use of these agents.
... 19 For patients engaged in opioid agonist treatment, sexual dysfunction has been reported as side effect of opioid agonist therapy. 20 To date, most studies have assessed either sexual dysfunction or risky sexual behavior among patients with opioid use disorder. While potentially related to hypersexuality, risky sexual behavior does not always include cognitive/affective components and distress or impairment. ...
Background and Objectives
Patients receiving opioid agonist therapies have high rates of psychiatric comorbidity. Some data suggest that comorbidity is associated with poorer treatment outcomes. The current study assessed predictors of multiple putative addictive behaviors among patients receiving opioid agonist therapies.
Methods
Adults (N = 176) recruited from an outpatient clinic providing opioid agonist therapy completed self‐report measures of depression, anxiety, impulsivity, adverse childhood events, and the Recognizing Addictive Disorders (RAD) scale, which includes seven subscales assessing symptoms related to alcohol use, drug use, tobacco use, gambling, binge‐eating, hypersexual behavior, and excessive video‐gaming. Linear regression and hurdle models identified significant predictors of RAD subscales. Hurdle models included logistic regression estimation for the presence/absence of symptoms and negative binomial regression for estimation of the severity of symptoms.
Results
Most patients did not report significant symptoms beyond drug or tobacco use. However, 7% to 47% of participants reported some symptoms of other addictive behaviors (subscale score > 0). Higher impulsivity predicted the presence and/or increased severity of symptoms of drug use, gambling, binge‐eating, and hypersexuality. Higher depression significantly predicted increased severity of drug use and binge‐eating symptoms. Increased anxiety predicted lower severity of alcohol use and binge‐eating and higher severity of smoking symptoms.
Conclusion and Scientific Significance
A broader range of potentially addictive symptoms may be present among patients engaged in treatment for opioid use disorder. Few studies have assessed symptoms of binge‐eating, hypersexuality, and excessive video‐gaming among patients receiving opioid agonist therapy. This study contributes to preliminary findings and highlights important future directions. (Am J Addict 2021;00:00–00)
Background:
Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes.
Methods:
We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109).
Findings:
We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use).
Interpretation:
Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses.
Funding:
Australian National Health and Medical Research Council.
