Using electronic health records of patients, researchers have found a strong link between opioid intake and erectile dysfunction (ED).
Depression, smoking, age, or opioid-related hypogonadism due to low testosterone levels are predominantly seen in men with erectile dysfunction attributed to chronic pain, and related prescription medications.
Almost 4.3 million adult Americans regularly use opioids, the most commonly prescribed being hydrocodone, oxycodone, and morphine. The US Centers for Disease Control and Prevention (CDC) data suggest that prescription opioid use in the United States has quadrupled between 1999 and 2010. Nearly three out of four prescription drug overdoses are attributed to prescription painkillers or opioid pain relievers, according to CDC data. These drugs resulted in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. The improper use of prescription painkillers drove more than 475,000 patients to emergency room visits in 2009, a number that nearly doubled in just five years. More than 12 million people reported using prescription painkillers nonmedically in 2010, with 2 million people reported using prescription painkillers nonmedically for the first time within the last year, almost 5,500 a day, according to the CDC statistics.
Evidence suggests that that extended use of opioids can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, and reduced hormone production. Researchers now report that men who take opioid pain killers for an extended period of time have the highest risk of ED.
Reporting in the 15 May online issue of the journal Spine, Richard A. Deyo, an investigator with the Kaiser Permanente Center for Health Research, and also Professor of Evidence-based Family Medicine at Oregon Health & Science University, and colleagues, found the link by analyzing electronic health records of over 11,000 men enrolled in a health plan. They looked into the records of 11,327 men in Oregon and Washington enrolled in the Kaiser Permanente health plan who visited their doctor with back pain complaints in 2004. The researchers examined if men taking prescription painkillers were also the ones most likely to be prescribed testosterone replacement or medications for ED.
If indeed there was a patient who matched their search criteria, they also looked at his pharmacy records covering six months prior and six months after the back pain visit, for any opioids and testosterone replacement, or ED medication prescriptions.
The investigators found that more than 19% of men who took high-dose opioids (more than 120 mg of morphine-equivalent) for at least four months were also undergoing testosterone replacement therapy or using medications for ED. In contrast, only 7% who received ED prescriptions did not take opioids. They also found that 12% of the men who took low-dose opioids for at least four months, also received prescribed testosterone replacement or medications for ED.
Deyo and colleagues found that age above 60, depression or other illnesses, or sleeping pills were all independently linked to ED. In fact, men aged 60 to 69 were 14 times more likely to be receiving prescriptions for ED medications than men aged below 30.
However, patients taking high-dose opioids were still 50% more likely to be prescribed medicine for ED than men who were not on the painkillers.
The data do not necessarily establish that prescription painkillers for back pain actually cause ED, but it is a strong possibility, according to Dr.Deyo cited in a recent news report.
