A new study reinforces the link between erectile dysfunction and chronic opioid use. The study was conducted by physicians and pharmacists in Kaiser Permanente’s Northwest (KPNW) region. Prior to the study, other investigators also suggested that erectile dysfunction and chronic opioid use were related, but there were disagreements about this. Even among those in agreement with the possibility of a link, there were questions as to whether opioids might be causing erectile dysfunction through hypogonadism (a condition involving lowered hormone levels) or through some other cause.
For this study, KPNW physicians and pharmacists reviewed the electronic medical notes of 11,327 men (average age 48 years) who reported back pain that was caused by something other than trauma. The investigators also reviewed the patients’ prescription records during the period of six months before and six months after back pain diagnosis. As expected, increased age, depression, smoking, and use of sedatives were all associated with increased reports of erectile dysfunction. However, after taking those conditions into consideration, an independent association between erectile dysfunction and chronic opioid use were also found, especially at high doses.
For purposes of the study, “chronic” was defined as use for longer than 120 days (or use greater than 90 days with at least 10 refills). High dose was defined as at least 120 mg of morphine (or morphine equivalents of other narcotic medications) each day. Erectile dysfunction medications were defined as Viagra, Cialis, and Levitra.
The review found a greater than 50% increase in erectile dysfunction with chronic opioid use at high doses. Of those reporting erectile dysfunction, it was several times more likely that they would receive an erectile dysfunction medication compared to testosterone replacement for hypogonadism. Understand that physicians measure testosterone levels and will not give testosterone supplements to patients having normal levels. Additionally, it is inadvisable to use testosterone supplements without physician supervision.
The investigators in the KPNW study reported that the association between erectile dysfunction and chronic opioid use may be even more significant than their study suggests. This is because some men are uncomfortable about discussing erectile dysfunction with their physicians. Additionally, other researchers have found erectile dysfunction rates that were higher than those reported in the KPNW study.
As this was a chart review, rather than a design-controlled, prospective research study, the reader is warned that it can only show an association between erectile dysfunction and chronic opioid use (“observation” type studies do not have the power to prove that a factor caused an outcome).
The medical literature indicates that treatment of erectile dysfunction decreases depression and this may result in lower opioid use. It is therefore advisable to discuss any erectile dysfunction issues with your doctor. Finally, if you need opioid medication to control your pain, do not stop taking it because of this study. If you have concerns, discuss them with your physician.
Here is a link to calculator that will convert your opioid medication to a “morphine equivalent”dose.
Read more in our Prostate Cancer Health Center.
Deyo RA et al. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine 203 May 15; 38(11): 909-15
Kim ED. Erectile dysfunction: practice essentials. Medscape drugs diseases & procedures. Medscape 2013 Jun 3.