Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment

Abstract

IntroductionMethadone has long been regarded as an effective treatment for opioid dependence. However, many patients discontinue maintenance therapy because of its side effects, with one of the most common being sexual dysfunction. Buprenorphine is a proven alternative to methadone. This study aimed to investigate sexual dysfunction in opioid-dependent men on buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT). The secondary aim was to investigate the correlation between sexual dysfunction and the quality of life in these patients.MethodsTwo hundred thirty-eight men participated in this cross-sectional study. Four questionnaires were used, the Mini International Neuropsychiatric Interview, Opiate Treatment Index, Malay version of the International Index of Erectile Function 15 (Mal-IIEF-15), and World Health Organization Quality of Life-BREF Scale. Multivariate analysis of covariance was used to examine the relationship between MMT and BMT and the Mal-IIEF 15 scores while controlling for all the possible confounders.ResultsThe study population consisted of 171 patients (71.8%) on MMT and 67 (28.2%) on BMT. Patients in the MMT group who had a sexual partner scored significantly lower in the sexual desire domain (p < 0.012) and overall satisfaction (p = 0.043) domain compared with their counterparts in the BMT group. Similarly, patients in the MMT group without a sexual partner scored significantly lower in the orgasmic function domain (p = 0.008) compared with those in the BMT group without a partner. Intercourse satisfaction (p = 0.026) and overall satisfaction (p = 0.039) were significantly associated with the social relationships domain after adjusting for significantly correlated sociodemographic variables.ConclusionsSexual functioning is critical for improving the quality of life in patients in an opioid rehabilitation program. Our study showed that buprenorphine causes less sexual dysfunction than methadone. Thus, clinicians may consider the former when treating heroin dependents who have concerns about sexual function.

Factors associated with perceived loss of libido in people who inject opioids: Results from a community-based survey in France

“…More specifically, we found that people who mainly injected heroin or morphine sulfate or methadone (whether prescribed or not) were more than twice as likely to report a loss of libido than buprenorphine users (whether prescribed or not). These findings corroborate the results of other studies showing that methadone and heroin have a greater negative impact on sexual functioning than buprenorphine in both men (Al-Gommer et al, 2007;Hallinan et al, 2009;Quaglio et al, 2008;Yee et al, 2016) and women (Giacomuzzi et al, 2009). The choice to take morphine sulfate instead of other OST may be related to its stronger "high" effect and this may be the reason for the greater loss of libido reported in this population.…”

“…Accordingly, semiotics (the meaning of each word inducing an individual interpretation), may have not been adequately examined when generating the questionnaire items and may have led to bias in the answers. Age is also a factor influencing sexuality because it has an impact on erectile function (Nik Jaafar et al, 2013;Yee et al, 2016) but not necessarily on desire. Accordingly, "loss of libido" does not necessarily mean sexual dysfunction, rather a loss of desire, so age was logically not correlated to this variable.…”

“…To date, only four studies on sexual dysfunction have focused on buprenorphine -perhaps because buprenorphine is available in fewer countries than methadone -and only one of these included women. Their results indicated that buprenorphine use is associated with less sexual dysfunction than methadone or heroin (Al-Gommer et al, 2007;Bliesener et al, 2005;Giacomuzzi et al, 2009;Yee et al, 2016). For both buprenorphine and methadone, the dosage action threshold and duration of treatment are still unknown, as are the levels of testosterone for men.…”

“…In sexual relations between steady partners and between occasional partners, reduced libido can lead to conflict due to misunderstanding or frustration, and may have a negative impact on sexual intimacy and self-image (Dunn et al, 1999). Studies have shown that the enjoyment of sexuality is associated with improved quality of life (Teoh et al, 2017;Yee et al, 2016). Despite the importance of this side-effect, people on OST who inject drugs are not frequently asked about their sexual life by health professionals and few services exist to deal with sexual health in this population (Chekuri et al, 2012).…”

Evaluation of Erectile Function and Quality of Life in Patients Undergoing Methadone Maintenance Treatment

“…It is well-known that the majority of patients undergoing chronic MMT experience problems with erectile function, endocrine disturbances and reproduction difficulties [32,33,34]. Analysis of the results from our study definitely proves that the chronic use of methadone leads ED which is in unison with other authors' studies [35,36]. The chronic exposure to methadone results in impairment of all components for assessment of erectile function included in the international survey IIEF.…”