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Lo JO, Hedges JC, Chou WH, Tager KR, Bachli ID, Hagen OL, Murphy SK, Hanna CB, Easley CA. Influence of substance use on male reproductive health and offspring outcomes. Nat Rev Urol 2024:10.1038/s41585-024-00868-w. [PMID: 38664544 DOI: 10.1038/s41585-024-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/30/2024]
Abstract
The prevalence of substance use globally is rising and is highest among men of reproductive age. In Africa, and South and Central America, cannabis use disorder is most prevalent and in Eastern and South-Eastern Europe, Central America, Canada and the USA, opioid use disorder predominates. Substance use might be contributing to the ongoing global decline in male fertility, and emerging evidence has linked paternal substance use with short-term and long-term adverse effects on offspring development and outcomes. This trend is concerning given that substance use is increasing, including during the COVID-19 pandemic. Preclinical studies have shown that male preconception substance use can influence offspring brain development and neurobehaviour through epigenetic mechanisms. Additionally, human studies investigating paternal health behaviours during the prenatal period suggest that paternal tobacco, opioid, cannabis and alcohol use is associated with reduced offspring mental health, in particular hyperactivity and attention-deficit hyperactivity disorder. The potential effects of paternal substance use are areas in which to focus public health efforts and health-care provider counselling of couples or individuals interested in conceiving.
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Affiliation(s)
- Jamie O Lo
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA.
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA.
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
| | - Jason C Hedges
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Wesley H Chou
- Department of Urology, Oregon Heath & Science University, Portland, OR, USA
| | - Kylie R Tager
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Ian D Bachli
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
| | - Olivia L Hagen
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Carol B Hanna
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Charles A Easley
- Department of Environmental Health Science, University of Georgia College of Public Health, Athens, GA, USA
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2
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[Adverse effects of opioids, antidepressants and anticonvulsants on sex hormones : Often unnoticed but clinically relevant]. Schmerz 2022; 36:293-307. [PMID: 35831621 DOI: 10.1007/s00482-022-00655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/08/2022]
Abstract
Androgen insufficiency under treatment with opioids, antidepressants and anticonvulsants in chronic pain diseases is a side effect with a high prevalence. It can lead to clinical metabolic alterations, adynamia, stress intolerance, anemia or osteoporosis and has a significant impact on the quality of life. Opioids, antidepressants and anticonvulsants affect the hypothalamic-pituitary-gonadal axis of sex hormones. A urologist, andrologist or endocrinologist should be involved in the treatment at an early stage. The recommendation of a differential therapeutic selection of certain substances is only indicative and does not meet evidential criteria. The indications for androgen substitution must be individualized and in consideration of the risk-benefit profile. Awareness of this side effect of an otherwise lege artis medicinal pain therapy must be sharpened and compulsory included in the differential diagnostic considerations.
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Kotlińska-Lemieszek A, Żylicz Z. Less Well-Known Consequences of the Long-Term Use of Opioid Analgesics: A Comprehensive Literature Review. Drug Des Devel Ther 2022; 16:251-264. [PMID: 35082488 PMCID: PMC8784970 DOI: 10.2147/dddt.s342409] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The adverse effects of short-term opioid analgesics are well known and acknowledged; however, the spectrum of the sequelae of long-term use seems less clear. Some effects may remain undetected but still have the potential to cause harm and reduce patients' quality of life. OBJECTIVE To review the literature on the adverse effects of long-term opioid therapy. METHODS We performed a quasi-systematic search, analyzing articles published in the MEDLINE database between January 2000 and March 2021 that identified adverse effects of opioids used for chronic pain treatment. RESULTS Growing evidence indicates that there are multiple serious adverse effects of opioid treatment. Long-term opioid use may have significant effects on the endocrine, immune, cardiovascular, respiratory, gastrointestinal, and neural systems. Studies show that long-term opioid treatment increases the risk of fractures, infections, cardiovascular complications, sleep-disordered breathing, bowel dysfunction, overdose, and mortality. Opioids may potentially affect cancer development. Most consequences of the long-term use of opioids have been identified in studies of patients with non-malignant pain. CONCLUSION Studies indicate that long-term use of opioids increases the risk of drug-related events in a significant number of patients. Clinicians should be aware of these complications associated with prescribing opioids, discuss them with patients, prevent complications, if possible, and diagnose them early and manage adequately. More human studies are needed to assess the risk, including trials with individual opioids, because they have different adverse effect profiles.
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Affiliation(s)
- Aleksandra Kotlińska-Lemieszek
- Chair and Department of Palliative Medicine, Pharmacotherapy in Palliative Care Laboratory, Poznan University of Medical Sciences, Poznan, Poland.,Heliodor Święcicki University Hospital, Poznan, Poland
| | - Zbigniew Żylicz
- Institute of Medical Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
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Gadelha MR, Karavitaki N, Fudin J, Bettinger JJ, Raff H, Ben-Shlomo A. Opioids and pituitary function: expert opinion. Pituitary 2022; 25:52-63. [PMID: 35066756 DOI: 10.1007/s11102-021-01202-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Opioids are highly addictive potent analgesics and anti-allodynics whose use has dramatically increased in recent decades. The precipitous rise in opioid dependency and opioid use disorder is an important public health challenge given the risks for severely adverse health outcomes. The long-term opioid impact on hypothalamic-pituitary axes is particularly underappreciated among both endocrinologists and primary care physicians. We review the effects of opioids on hypothalamic-pituitary-target gland function and their implications for clinical practice. METHODS Experts in hypothalamic-pituitary disorders and opioid pharmacology reviewed recently published literature and considered strategies for diagnosing and managing these opioid-induced endocrine effects. RESULTS Opioid suppression of hypothalamic-pituitary axes can lead to hypogonadotropic hypogonadism, central adrenal insufficiency, and hyperprolactinemia. These important clinical manifestations are often under-estimated, poorly evaluated, and typically either untreated or not optimally managed. Data on biochemical testing for diagnosis and on the effect of hormone replacement in these patients is limited and prospective randomized controlled studies for guiding clinical practice are lacking. CONCLUSIONS Patients should be informed about risks for hypogonadism, adrenal insufficiency, and hyperprolactinemia, and encouraged to report associated symptoms. Based on currently available evidence, we recommend clinical and biochemical evaluation for potential central adrenal insufficiency, central hypogonadism, and/or hyperprolactinemia in patients chronically treated with opioids as well as the use of current expert guidelines for the diagnosis and treatment of these conditions.
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Affiliation(s)
- Mônica R Gadelha
- Endocrine Unit and Neuroendocrinology Research Center, Medical School and Hospital Universitário Clementino Fraga Filho - Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Unit - Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, Brazil
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeffrey Fudin
- President, Remitigate Therapeutics, Delmar, NY, USA
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
- Department of Pharmacy Practice, Western New England University College of Pharmacy, Springfield, MA, USA
- Department of Pharmacy and Pain Management, Stratton VA Medical Center, Albany, NY, USA
| | - Jeffrey J Bettinger
- Pain Management and Addiction Medicine, Saratoga Hospital Medical Group, Saratoga Springs, NY, USA
| | - Hershel Raff
- Division of Endocrinology and Molecular Medicine, Departments of Medicine, Surgery, and Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Endocrine Research Laboratory, Aurora St. Luke's Medical Center, Advocate Aurora Research Institute, 2801 W KK River Pky Suite 260, Milwaukee, WI, 53215, USA.
| | - Anat Ben-Shlomo
- Pituitary Center, Division of Endocrinology, Diabetes and Metabolism, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Multidisciplinary Adrenal Program, Departments of Medicine and Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Haunschild R, Bornmann L, Potnis D, Tahamtan I. Investigating dissemination of scientific information on Twitter: A study of topic networks in opioid publications. QUANTITATIVE SCIENCE STUDIES 2022. [DOI: 10.1162/qss_a_00168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
While previous research has mostly focused on the “number of mentions” of scientific research on social media, the current study applies “topic networks” to measure public attention to scientific research on Twitter. Topic networks are the networks of co-occurring author keywords in scholarly publications and networks of co-occurring hashtags in the tweets mentioning those publications. We investigate which topics in opioid scholarly publications have received public attention on Twitter. Additionally, we investigate whether the topic networks generated from the publications tweeted by all accounts (bot and nonbot accounts) differ from those generated by nonbot accounts. Our analysis is based on a set of opioid publications from 2011 to 2019 and the tweets associated with them. Results indicated that Twitter users have mostly used generic terms to discuss opioid publications, such as “Pain,” “Addiction,” “Analgesics,” “Abuse,” “Overdose,” and “Disorders.” A considerable amount of tweets is produced by accounts that were identified as automated social media accounts, known as bots. There was a substantial overlap between the topic networks based on the tweets by all accounts (bot and nonbot accounts). This result indicates that it might not be necessary to exclude bot accounts for generating topic networks as they have a negligible impact on the results. This study provided some preliminary evidence that scholarly publications have a network agenda-setting effect on Twitter.
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Affiliation(s)
- Robin Haunschild
- Max Planck Institute for Solid State Research, Stuttgart, Germany
| | - Lutz Bornmann
- Division for Science and Innovation Studies, Administrative Headquarters of the Max Planck Society, Munich, Germany
| | - Devendra Potnis
- School of Information Sciences, College of Communication and Information, University of Tennessee, Knoxville, TN, USA
| | - Iman Tahamtan
- School of Information Sciences, Communication, and Information, University of Tennessee, Knoxville, TN, USA
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Li T, Cunningham JL, Gilliam WP, Loukianova L, Donegan DM, Bancos I. Prevalence of Opioid-Induced Adrenal Insufficiency in Patients Taking Chronic Opioids. J Clin Endocrinol Metab 2020; 105:5899818. [PMID: 32866966 PMCID: PMC7470471 DOI: 10.1210/clinem/dgaa499] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023]
Abstract
CONTEXT Chronic opioid use may lead to adrenal insufficiency because of central suppression of the hypothalamic-pituitary-adrenal axis. However, the prevalence of opioid-induced adrenal insufficiency (OIAI) is unclear. OBJECTIVE To determine the prevalence of OIAI and to identify predictors for the development of OIAI in patients taking opioids for chronic pain. DESIGN Cross-sectional study, 2016-2018. SETTING Referral center. PATIENTS Adult patients taking chronic opioids admitted to the Pain Rehabilitation Center. MAIN OUTCOME MEASURE Diagnosis of OIAI was considered if positive case detection (cortisol < 10 mcg/dL, ACTH < 15 pg/mL, and dehydroepiandrosterone sulfate < 25 mcg/dL), and confirmed after endocrine evaluation. Daily morphine milligram equivalent (MME) was calculated. RESULTS In 102 patients (median age, 53 years [range, 22-83], 67% women), median daily MME was 60 mg (3-840), and median opioid therapy duration was 60 months (3-360). Abnormal case detection testing was found in 11 (10.8%) patients, and diagnosis of OIAI was made in 9 (9%). Patients with OIAI were on a higher daily MME (median, 140 [20-392] mg vs 57 [3-840] mg, P = 0.1), and demonstrated a 4 times higher cumulative opioid exposure (median of 13,440 vs 3120 mg*months, P = 0.03). No patient taking <MME of 20 mg/day developed OIAI (sensitivity of 100% for MME > 20 mg); however, specificity of MME cutoff >20 mg was only 19%. After opioid discontinuation, 6/7 patients recovered adrenal function. CONCLUSION The prevalence of OIAI was 9%, with MME cumulative exposure being the only predictor for OIAI development. Patients on MME of 20 mg/day and above should be monitored for OIAI.
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Affiliation(s)
- Taoran Li
- Division of Endocrinology, Diabetes and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Medicine, Mount Sinai St. Luke’s-Roosevelt Hospital, New York, New York
| | | | - Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Larissa Loukianova
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Diane M Donegan
- Division of Endocrinology, Diabetes and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Division of Endocrinology, Diabetes and Metabolism, Indiana University, Indianapolis, Indiana
| | - Irina Bancos
- Division of Endocrinology, Diabetes and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Correspondence and Reprint Requests: Irina Bancos, Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA. E-mail:
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Akhigbe R, Ajayi A. Testicular toxicity following chronic codeine administration is via oxidative DNA damage and up-regulation of NO/TNF-α and caspase 3 activities. PLoS One 2020; 15:e0224052. [PMID: 32168344 PMCID: PMC7069647 DOI: 10.1371/journal.pone.0224052] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Codeine, a 3-methylmorphine, and other related opioids have been implicated in androgen suppression, although the associated mechanisms remain unclear. AIM Therefore, the objective of the current study was to elucidate the in vivo molecular mechanisms underlying codeine-induced androgen suppression. METHODS This study made use of twenty-one healthy male rabbits, distributed into three groups randomly, control and codeine-treated groups. The control had 1ml of normal saline daily p.o. The codeine-treated groups received either 4mg/kg b.w of codeine or 10mg/kg b.w of codeine p.o. for six weeks. Reproductive hormonal profile, testicular weight, testicular enzymes, oxidative and inflammatory parameters, testicular DNA fragmentation, histological examination and apoptosis marker were evaluated to examine the effects of codeine use. KEY FINDINGS Oral administration of codeine resulted in testicular atrophy and alterations in testicular histomorphology, elevated testicular enzymes, and suppression of circulatory and intra-testicular testosterone. These changes were associated with a marked rise in oxidative markers and decline in the activities of testicular enzymatic antioxidants, as well as oxidative DNA damage, inflammatory response, testicular DNA fragmentation, and caspase-dependent apoptosis (p<0.05). SIGNIFICANCE In conclusion, chronic codeine use resulted in testicular degeneration and testosterone suppression, which is attributable to TNF-α/nitric oxide-/oxidative stress-mediated caspase-dependent apoptotic testicular cell death and loss of testicular function.
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Affiliation(s)
- Roland Akhigbe
- Department of Physiology, College of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
| | - Ayodeji Ajayi
- Department of Physiology, College of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria
- * E-mail:
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de Vries F, Bruin M, Lobatto DJ, Dekkers OM, Schoones JW, van Furth WR, Pereira AM, Karavitaki N, Biermasz NR, Zamanipoor Najafabadi AH. Opioids and Their Endocrine Effects: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2020; 105:5568226. [PMID: 31511863 PMCID: PMC7054712 DOI: 10.1210/clinem/dgz022] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/24/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT The increased use of opioids has resulted in an unprecedented opioid epidemic. Chronic opioid use causes hypogonadism, but its frequency, as well as the effects of opioids on other hypothalamo-pituitary-end organ hormone axes, remains unclear. OBJECTIVE The aim of this systematic review and meta-analysis was to assess the effects of opioid use on pituitary function. METHODS Eight electronic databases were searched for articles published up to May 8, 2018. Fixed or random effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals (CI). This study is reported following the PRISMA and MOOSE guidelines. DATA SYNTHESIS 52 studies (22 low risk of bias) were included describing 18 428 subjects, consisting of patients with chronic pain (n = 21 studies) or on maintenance treatment for opioid addiction (n = 9) and healthy volunteers (n = 4). The most frequently used opioid was methadone (n = 13 studies), followed by morphine (n = 12). Prevalence of hypogonadism was 63% (95% CI: 55%-70%, 15 studies, 3250 patients, 99.5% males). Prevalence of hypocortisolism relying on dynamic and nondynamic testing was 15% (95% CI: 6%-28%, 5 studies, 205 patients, 57.5% males) and including only studies using the insulin tolerance tests 24% (95% CI 16%-33%, 2 studies, n = 97 patients). In 5 out of 7 studies, hyperprolactinemia was present. No clear effects on the somatotropic and hypothalamo-pituitary-thyroid axes were described. CONCLUSIONS Hypogonadism occurs in more than half of male opioid users, and hypocortisolism in approximately one-fifth of all patients. Periodical evaluation of at least the gonadal and adrenal axes is therefore advisable.
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Affiliation(s)
- Friso de Vries
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Mees Bruin
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Daniel J Lobatto
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Amir H Zamanipoor Najafabadi
- Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
- Correspondence and Reprint Requests: Amir H. Zamanipoor Najafabadi, Department of Neurosurgery, Clinical Epidemiology, Center for Endocrine Tumor Leiden, and Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands. E-mail:
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Baillargeon J, Raji MA, Urban RJ, Lopez DS, Williams SB, Westra JR, Kuo YF. Opioid-Induced Hypogonadism in the United States. Mayo Clin Proc Innov Qual Outcomes 2019; 3:276-284. [PMID: 31485565 PMCID: PMC6713891 DOI: 10.1016/j.mayocpiqo.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023] Open
Abstract
Objective To examine the incidence of screening, diagnosis, and treatment of hypogonadism among men treated with opioids in the United States. Patients and Methods Using one of the nation's largest commercial insurance databases, we identified 53,888 men aged 20 years or older who had 90 or more days of opioid prescriptions in a single 12-month period between January 1, 2010, and December 31, 2017, with no history of hypogonadism or testosterone therapy in the preceding 12 months. We matched this cohort to 53,888 men with 14 or fewer days of opioid prescriptions based on age, opioid initiation date, opioid indication, and comparable exclusion criteria. We assessed whether men, 14 or fewer days after initiation of opioid treatment, received a serum testosterone test, a diagnosis of hypogonadism, or a prescription for testosterone therapy. All men were followed up until they lost coverage from the commercial insurance plan, experienced one of the study outcomes, or the end of study (December 31, 2017). Results In the multivariable analyses-adjusting for age, year of opioid initiation, region, comorbid disease, glucocorticoid use, and health care utilization-the 53,888 prolonged opioid users, in comparison with 53,888 short-term users, had an increased incidence of serum testosterone screening (5991 [17.15%; 95% CI, 16.70%-17.61%] vs 3514 [11.55%; 95% CI, 11.11%-12.01%] at 5 years; hazard ratio [HR], 1.46; 95% CI, 1.38-1.55), hypogonadism diagnosis (3125 [9.44%; 95% CI, 9.09%-9.80%] vs 1421 [4.85%; 95% CI, 4.55%-5.16%; HR, 1.74; 95% CI, 1.60-1.90]), and receipt of testosterone therapy (1919 [5.76%; 95% CI, 5.49%-6.05%] vs 631 [2.21%; 95% CI, 2.04%-2.43%; HR, 2.41; 95% CI, 2.13-2.74]). Each of these findings persisted across multiple sensitivity analyses. Conclusion Prolonged opioid exposure was associated with increased rates of screening, diagnosis, and treatment for opioid-induced hypogonadism, but these rates were much lower than expected based on previous serum-based studies.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Randall J Urban
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - David S Lopez
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Stephen B Williams
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Surgery, Division of Urology, University of Texas Medical Branch, Galveston
| | - Jordan R Westra
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
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10
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Coluzzi F, Billeci D, Maggi M, Corona G. Testosterone deficiency in non-cancer opioid-treated patients. J Endocrinol Invest 2018; 41:1377-1388. [PMID: 30343356 PMCID: PMC6244554 DOI: 10.1007/s40618-018-0964-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/30/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The use of opioids in patients with chronic non-cancer pain is common and can be associated with opioid-induced androgen deficiency (OPIAD) in men. This review aims to evaluate the current literature regarding the prevalence, clinical consequence and management of OPIAD. METHODS A database search was performed in Medline, Embase and Cochrane using terms such as "analgesics", "opioids" and "testosterone". Relevant literature from January 1969 to March 2018 was evaluated. RESULTS The prevalence of patients with OPIAD ranges from 19 to 86%, depending on the criteria for diagnosis of hypogonadism. The opioid-induced suppression of gonadotropin-releasing and luteinizing hormones represents the main important pathogenetic mechanisms. OPIAD has significant negative clinical consequences on sexual function, mood, bone density and body composition. In addition, OPIAD can also impair pain control leading to hyperalgesia, which can contribute to sexual dysfunction and mood impairment. CONCLUSIONS OPIAD is a common adverse effect of opioid treatment and contributes to sexual dysfunction, impairs pain relief and reduces overall quality of life. The evaluation of serum testosterone levels should be considered in male chronic opioid users and the decision to initiate testosterone treatment should be based on the clinical profile of individuals, in consultation with the patient.
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Affiliation(s)
- F Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - D Billeci
- Neurosurgical Department, ULSS2 Treviso Hospital, University of Padua, Treviso, Italy
| | - M Maggi
- Department of Experimental and Clinical Biomedical Sciences, Sexual Medicine and Andrology Unit, University of Florence, Florence, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Azienda Usl di Bologna, Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
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11
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Cardia L, Calapai G, Quattrone D, Mondello C, Arcoraci V, Calapai F, Mannucci C, Mondello E. Preclinical and Clinical Pharmacology of Hydrocodone for Chronic Pain: A Mini Review. Front Pharmacol 2018; 9:1122. [PMID: 30327606 PMCID: PMC6174210 DOI: 10.3389/fphar.2018.01122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/13/2018] [Indexed: 02/05/2023] Open
Abstract
Hydrocodone is one of the most prescribed oral analgesic drugs and it is one of the most abused drugs in general population. It is a mu-opioid agonist predominantly metabolized to the O-demethylated product hydromorphone and to the N-demethylated product norhydrocodone. The purpose of the study is to summarize the preclinical and clinical characteristics of hydrocodone. Pharmacokinetic aspect (terminal half-life, maximum serum concentration, and time to maximum serum concentration) of hydrocodone and the influence of metabolic genetic polymorphism in analgesic response to hydrocodone are also illustrated and commented. Literature on experimental preclinical pharmacology investigating analgesic activity in laboratory animals is furtherly discussed. Moreover, the authors discuss and comment on the updated data regarding safety profile and effectiveness of hydrocodone in the treatment of chronic pain. A bibliographic research was carried out (from February 01, 2018 to August 28, 2018) independently by two researchers (blinded to the authors and initially on results) in the major scientific databases and research engines of peer-reviewed literature on life sciences and biomedical topics, starting from January 1990 to August 2018. Analysis of results of clinical studies suggests that abuse-deterrent extended-release (ER) hydrocodone formulations can be effective and they are well tolerated in the treatment of chronic low back pain. Weaker is the evidence of the analgesic effectiveness of ER hydrocodone on other chronic pain syndromes and non-cancer non-neuropathic chronic pain. In these conditions, hydrocodone showed to have positive effects in non-controlled open studies and needs to be further studied to assess the real strength of results.
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Affiliation(s)
- Luigi Cardia
- Anesthesia, Intensive Care and Pain Therapy, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
| | - Gioacchino Calapai
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
| | - Domenico Quattrone
- Pain Therapy Unit, Grande Ospedale Metropolitano Bianchi Melacrino Morelli-Reggio Calabria, Reggio Calabria, Italy
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
| | - Fabrizio Calapai
- Pharma.Ca Research Facility (Centro Studi Pharma.Ca), Messina, Italy
| | - Carmen Mannucci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
| | - Epifanio Mondello
- Anesthesia, Intensive Care and Pain Therapy, Azienda Ospedaliera Universitaria Policlinico "G. Martino" - Messina, Messina, Italy
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Opioid-Related Sexual Dysfunction in Men. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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