Sexual dysfunctions in male opiate users: A comparative study of heroin, methadone, and buprenorphine

OBJECTIVE: The aim of this study was to compare sexual dysfunctions in male patients dependent on heroin and those on methadone or buprenorphine treatment for opiate dependence. METHODS: Ninety-one patients (30 in the heroin group, 33 in the methadone group, and 28 in the buprenorphine group) were recruited from outpatient attendees at a community drug team in Birmingham, UK. The "Loyola University Clinic-special history sheet for men" was administered to assess sexual functioning (self-reports), and the Brief Psychiatric Rating Scale was used to assess psychopathology. RESULTS: A wide range of sexual dysfunctions was reported by these patients (n=90): low sex drive (n=38; 41.8%), loss of sexual fantasy life (n=17; 18.7%), loss of morning erection (n=25; 27.5%), premature ejaculation (n=54; 59.3%), and ejaculation with soft penis (n=67; 73.6%). Fewer patients on buprenorphine (as compared with those on heroin and methadone) reported loss of sexual fantasy, loss of sexual desire, loss of erection with movement, premature ejaculation, and loss of angulation of penis (all P<0.05). CONCLUSIONS: The results of this study indicate that sexual dysfunctions are common in male opiate misusers and that buprenorphine is significantly less likely than methadone or heroin to induce this side effect. Further research is needed to explore the pathophysiology and treatment implications of these findings. From a clinical perspective, it is imperative that patients misusing opiates and those treated with methadone or buprenorphine are routinely asked about their sexual functioning and appropriate investigations and treatment planned if indicated.