May 22, 2013
Opioid Use Increases Likelihood of Erectile
Dysfunction Prescription

Portland, OR—Here’s another good reason why male patients may want alternatives to long-term use of prescription painkillers: Opioids are associated with a higher risk of erectile dysfunction (ED) in men.

For the study, published online recently in the journal Spine, researchers examined the health records of more than 11,000 men with back pain to determine if those using opioids were also more likely to also receive prescriptions for testosterone replacement or ED.

They found that while fewer than 7% of men who did not take opioids received those prescriptions, more than 19% of men who took high-dose opioids for at least 4 months also received medications associated with ED.

Men older than 60 were much more likely to receive ED prescriptions. Even after adjusting for age and other factors, however, men taking high-dose opioids were still 50% more likely to receive ED prescriptions than men who did not take prescription painkillers, the researchers found.

“Men who take opioid pain medications for an extended period of time have the highest risk of ED,” said lead author Richard A. Deyo, MD, MPH, investigator with the Kaiser Permanente Center for Health Research and Professor of Evidence-based Family Medicine at Oregon Health & Science University.

“This doesn’t mean that these medications cause ED, but the association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain,” Deyo added.

The study involved 11,327 men in Oregon and Washington enrolled in the Kaiser Permanente health plan who visited their doctors for back pain during 2004. Pharmacy records for 6 months before and after the back pain visit were examined to find out if the men had filled prescriptions for opioids and for ED or testosterone replacement.

Opioid use was categorized as:

• “None” for men who did not receive a prescription for opioids;
• “Acute” for men who took opioids for 3 months or less;
• “Episodic” for men who took opioids for more than 3 months, but less than 4 months and with fewer than 10 refills; and
• “Long-term” for men who took opioids for at least 4 months or for more than 3 months with 10 or more refills.

High-dose use was defined as anything more than 120 mg of morphine equivalent.

While the likelihood of a concurrent ED medication prescription was greatest for those who took high-dose opioids for at least 4 months, it also was increased for those taking low-dose opioids (under 120 mg) for 4 months or longer. The percentage of those men treated with possible erectile dysfunction drugs or testosterone was 12% compared to less than 7% of men not taking opioids.

In addition to age—men 60 to 69 were 14 times more likely to receive prescriptions for ED medication than men 18 to 29—depression, health conditions other than back pain, and use of sedative hypnotics, such as benzodiazepines, also increased the likelihood that men would receive ED prescriptions, study authors noted.

U.S. Pharmacist Social Connect