Effect of Long-Term Opioid Therapy on Sexual Dysfunction in Pain Patients

This single-center, retrospective chart review aims to estimate the incidence of opioid-induced hypogonadism (OIH) among chronic pain patients treated with long-term opioid therapy and determine whether the incidence differs between patients receiving buprenorphine versus those receiving full-agonist opioid agents. The primary endpoint was a composite of plasma testosterone less than 300 ng/dL, initiation of medications for testosterone replacement therapy or erectile dysfunction (ED), or a new diagnosis of ED or hypogonadism. Adult male Veterans were included if they received at least 90 d' supply of an opioid during the study period with a preceding 90-d opioid-free interval. Forty-five patients were included in the buprenorphine group and 55 in the full-agonist opioid group. There was no significant difference between groups in baseline characteristics. Fewer patients in the buprenorphine group met the primary composite endpoint as compared to the full-agonist opioid group (13.3% vs. 29.1%, p = 0.058), and patients in the buprenorphine group had fewer diagnoses of ED or hypogonadism post-treatment initiation (0% vs. 12.7%, p = 0.013). These findings support the use of buprenorphine as a treatment option when endocrine-related side effects are a concern.