Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy

Surendra K Mattoo; Abhishek Ghosh; B N Subodh; Debasish Basu; Ashirbad Satapathy; Sambhu Prasad; Mahendra Prakash Sharma

doi:10.4103/psychiatry.IndianJPsychiatry_195_19

Sexual dysfunction in men on buprenorphine - naloxone-based substitution therapy

Indian J Psychiatry. 2020 Jan-Feb;62(1):66-72. doi: 10.4103/psychiatry.IndianJPsychiatry_195_19. Epub 2020 Jan 3.

Authors

Surendra K Mattoo¹, Abhishek Ghosh¹, B N Subodh¹, Debasish Basu¹, Ashirbad Satapathy², Sambhu Prasad³, Mahendra Prakash Sharma⁴

Affiliations

¹ Department of Psychiatry, Drug De-Addiction and Treatment Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India.
² Department of Psychiatry, Government Medical College, Balangir, Odisha, India.
³ Department of Psychiatry, All India Institute of Medical Sciences, Patna, Bihar, India.
⁴ Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, Odisha, India.

PMID: 32001933
PMCID: PMC6964450
DOI: 10.4103/psychiatry.IndianJPsychiatry_195_19

Abstract

Background: The literature on sexual dysfunction in patients on buprenorphine-naloxone (BNX) substitution is limited.

Materials and methods: This research aimed to study the prevalence and correlates of sexual dysfunction in men on BNX substitution therapy. We recruited consecutive forty men from BNX clinic, who had received BNX for at least 6 months, who were free from any recent illicit drug use (confirmed by urine chromatographic immune assay), and who were either married or had a stable sexual partner. Men with other psychiatric and substance use disorders (except tobacco) were excluded from the study. Data for the control group were obtained from a published study (with similar selection criteria) from our center. We assessed sexual dysfunction with two cross-culturally validated instruments: Arizona Sexual Experience Scale (ASEX) and International Index of Erectile Function.

Results: The sample had a mean age of 31.6 (±8) years; the mean duration of BNX treatment was 9 (±4.2) months and the mean BNX dose was 4.5 (±1.6) mg. ASEX showed the prevalence of sexual dysfunction to be 40%. The IIEF demonstrated intercourse dissatisfaction (95%) and hypoactive sexual desire (92.5%) as almost universal, while 77.5% of the participants reported erectile dysfunction. In comparison to the published data, these figures were significantly more than among the controls. We found no correlation of sexual dysfunction with marital status, age, duration or dose of BNX, duration of illicit opioid use, the severity of opioid dependence, and tobacco dependence.

Conclusion: All men on BNX maintenance therapy must be screened for sexual dysfunction. With the rapid scaling up of office-based BNX substitution, assessment and management of sexual dysfunction ought to be incorporated in the training curriculum.

Keywords: Buprenorphine; erectile dysfunction; naloxone; opioid substitution therapy; premature ejaculation.