Erectile Dysfunction Among Male Heroin Addicts Receiving Methadone Maintenance Treatment in Guangdong, China

From the Faculty of Medical Statistics and Epidemiology (WC, Xin L, LL, YX, JC), School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
Journal of Addiction Medicine (Impact Factor: 1.76). 05/2012; 6(3):212-8. DOI: 10.1097/ADM.0b013e318259b2c4
Source: PubMed


: Erectile dysfunction (ED) is common among methadone-maintained patients and reduces their quality of life. This study reports the prevalence of ED among male heroin addicts receiving methadone maintenance treatment (MMT) in China and describes factors that may contribute to ED.
: Seventy-four male heroin addicts enrolled in 4 MMT clinics for the first time were interviewed about general baseline characteristics. Scales for assessing erectile function and psychological disorders were completed monthly. Blood was drawn for serum hormone-level measurement at the baseline and at a 3-month follow-up. Daily methadone dosages were recorded by physicians.
: Erectile dysfunction was reported in 75.7%, 88.7%, 80.8%, and 80.9% of the patients at the baseline, 1-, 2-, and 3-month follow-ups, respectively. No significant differences in the prevalence of ED were found during the course of treatment. About two-thirds of the patients who had ED at the 3-month follow-up had had the condition while on heroin. The delayed erectile function was significantly associated with duration of treatment (odd ratio, OR1-month vs baseline = 1.86, P = 0.021; OR2-month vs baseline = 1.67, P = 0.066) and methadone dosage (OR = 1.02, P = 0.038). Ongoing substance, serum hormone levels, and psychological disorders were not associated with ED.
: The prevalence of ED among male methadone-maintained patients in China is very high and individuals with altered erectile function while on heroin represent a high-risk group for the development of ED upon initiation of MMT. In the setting of delayed erectile function after receiving methadone, a trial of dosage reduction and symptomatic treatments may be a reasonable initial approach.

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Available from: Wen Chen, Dec 13, 2015
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    • "IDUs also report significantly more suppressed sexual drive than non-IDUs. Erectile and other sexual dysfunctions are commonly found among MMT participants with intensive drug use [46,47]. This is consistent with the study finding of an inverse association between risk of HIV infection and having had sex in the past three months. "
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    ABSTRACT: Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants. A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants' demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections. Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G(2)=10.86, p=0.013) and higher proportion of having had sex in the past three months (G(2)=30.22, p<0.001) than their male counterparts. Among injecting drug users, females also inject (χ(2)=16.15, p=0.001) and share syringes (χ(2)=13.24, p=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities. Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.
    Full-text · Article · Oct 2013 · PLoS ONE
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    • "Interestingly, unlike two longitudinal studies in men receiving methadone maintenance, our study found that ED symptoms significantly improved over time. Brown et al. (2005) and Chen et al. (2012). found that ED prevalence increased and the severity of symptoms worsened over time when men initiated methadone for opioid dependence treatment. "
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    ABSTRACT: Aims The aim of this study is to describe the change in erectile dysfunction (ED) symptoms in the first 12weeks of outpatient buprenorphine therapy. Erectile dysfunction is highly prevalent in men who use illicit opioids when compared with the general population. To date, no study has examined ED symptoms over time in men initiating buprenorphine therapy for opioid dependence. A randomized, double blind, placebo-controlled trial was conducted to determine whether escitalopram treatment of depressive symptoms begun 1week prior to buprenorphine induction would improve treatment retention. Male patients completed the International Index of Erectile Function scale at baseline prior to induction and monthly thereafter. A score of 25 or less on the erectile function domain (range 1-30) is considered indicative of erectile dysfunction. A total of 111 male subjects enrolled: mean age 38.5 (±9.7) years, 80.1% non-Hispanic Caucasian; 67.3% reported heroin as their opioid of choice. Mean IIEF at baseline was 20.4 (±10.5). At baseline, 44.1% of the entire cohort had erectile dysfunction; among those who identified as sexually active at baseline, 26.1% had ED. Baseline erectile function was inversely and significantly correlated with age (r=-.27, p=.006), but was not associated significantly with race, heroin use, years of opioid use, smoking, or hazardous use of alcohol. Compared to baseline, mean erectile function was significantly improved (p=.001) at 3months, and sexual desire (p=.002) improved significantly at both 2- and 3-month assessments. Erectile dysfunction is highly prevalent in depressed males using illicit opioids. Men who remain in buprenorphine treatment for 3months show improvement in erectile function and sexual desire.
    Full-text · Article · Jul 2013 · Journal of substance abuse treatment
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    ABSTRACT: Methadone maintenance treatment (MMT) has been successfully scaled up nationally in China. However, the program faces problems of poor attendance and high rates of continued drug use. We assessed whether a contingency management (CM) intervention implemented by MMT clinic staff could improve treatment attendance and drug abstinence. Eight MMT clinics in Guangdong province were randomly selected and divided into two groups. A total of 126 participants (55 in urban clinics and 71 in rural clinics) received CM during a 12-week trial, 120 participants (83 in urban clinics and 37 in rural clinics) received usual treatment (UT). Participants in the CM group had the opportunity to draw for prizes contingent on attending treatment daily and testing negative for morphine. Clinic- and individual-level outcomes were compared between the intervention and control groups. The retention rate and negative urine testing rate were 14.2% (P=0.010) and 10.7% (P<0.001) higher in the CM group compared to the UT group, respectively. Compared with participants who received UT, CM participants missed on average 7.3 fewer (P=0.008) visits and were 1.91 (95% CI: 1.53-2.39) times more likely to submit a negative urine sample. All clinic- and individual- level effects of the intervention were observed at rural clinics, but the difference in retention rate between urban CM and UT clinics was not significant. Although the frequency of monitoring and value of the incentives in this study was lower than in previous studies, the CM intervention significantly improved attendance and reduced drug use in China.
    Full-text · Article · Jul 2013 · Drug and alcohol dependence
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