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      Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment

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          Abstract

          This study examined whether methadone (hereinafter referred to as MTD) maintenance treatment (MMT) is correlated with sexual dysfunction (SD) in heroin-dependent men. This was conducted to determine the prevalence of sexual dysfunction and if there is a relationship between duration and dose among men on MMT and its impact on the quality of life. The study combined a retrospective and a cross-sectional survey based on the Kinsey Scale, TECVASP, and PRSexDQ-SALSEX clinical interviews of 85 patients who are currently engaged in MMT. Sexual dysfunction in all five PRSexDQ-SALSEX domains (lack of libido, delay in orgasm, inability to orgasm, erectile dysfunction, and tolerance or acceptance of changes in sexual function) was associated with dose and long-term use of heroin. All dimensions of SD were affected by the MTD intake. From the analysis of our sample, we may conclude that dose of MTD and overall score of SD were directly associated. However, no evidence was found to prove that treatment duration and severity of SD were linked. It is notable that only one tenth of the patients spontaneously reported their symptoms of the sexual sphere, but up to a third considered leaving the MMT for this reason.

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          Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

          Richard P. Mattick, Courtney Breen, Jo Kimber … (2014)
          Cochrane Database of Systematic Reviews
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            Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence.

            Richard P. Mattick, Courtney Breen, Jo Kimber … (2009)
            Methadone maintenance was the first widely used opioid replacement therapy to treat heroin dependence, and it remains the best-researched treatment for this problem. Despite the widespread use of methadone in maintenance treatment for opioid dependence in many countries, it is a controversial treatment whose effectiveness has been disputed. To evaluate the effects of methadone maintenance treatment (MMT) compared with treatments that did not involve opioid replacement therapy (i.e., detoxification, offer of drug-free rehabilitation, placebo medication, wait-list controls) for opioid dependence. We searched the following databases up to Dec 2008: the Cochrane Controlled Trials Register, EMBASE, PubMED, CINAHL, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF-VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews; authors of identified RCTs were asked about other published or unpublished relevant RCTs. All randomised controlled clinical trials of methadone maintenance therapy compared with either placebo maintenance or other non-pharmacological therapy for the treatment of opioid dependence. Reviewers evaluated the papers separately and independently, rating methodological quality of sequence generation, concealment of allocation and bias. Data were extracted independently for meta-analysis and double-entered. Eleven studies met the criteria for inclusion in this review, all were randomised clinical trials, two were double-blind. There were a total number of 1969 participants. The sequence generation was inadequate in one study, adequate in five studies and unclear in the remaining studies. The allocation of concealment was adequate in three studies and unclear in the remaining studies. Methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patients in treatment and in the suppression of heroin use as measured by self report and urine/hair analysis (6 RCTs, RR = 0.66 95% CI 0.56-0.78), but not statistically different in criminal activity (3 RCTs, RR=0.39; 95%CI: 0.12-1.25) or mortality (4 RCTs, RR=0.48; 95%CI: 0.10-2.39). Methadone is an effective maintenance therapy intervention for the treatment of heroin dependence as it retains patients in treatment and decreases heroin use better than treatments that do not utilise opioid replacement therapy. It does not show a statistically significant superior effect on criminal activity or mortality.
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              The global epidemiology and burden of opioid dependence: results from the global burden of disease 2010 study.

              D. Hall, D Flaxman, Louisa Degenhardt … (2014)
              To estimate the prevalence and burden of disease attributable to opioid dependence globally, regionally and at country level. Multiple search strategies: (i) peer-reviewed literature searches; (ii) systematic searches of online databases; (iii) internet searches; (iv) consultation and feedback from experts. Culling and data extraction followed protocols. DisMod-MR, the latest version of the generic disease modelling system, a Bayesian meta-regression tool, imputed prevalence by age, year and sex for 187 countries and 21 regions. Disability weight for opioid dependence was estimated through population surveys and multiplied by prevalence data to calculate the years of life lived with disability (YLDs). Opioid dependence premature mortality was computed as years of life lost (YLLs) and summed with YLDs to calculate disability-adjusted life years (DALYs). There were 15.5 million opioid-dependent people globally in 2010 [0.22%, 95% uncertainty interval (UI) = 0.20-0.25%]. Age-standardized prevalence was higher in males (0.30%, 95% UI = 0.27-0.35%) than females (0.14%, 95% UI = 0.12-0.16%), and peaked at 25-29 years. Prevalence was higher than the global pooled prevalence in Australasia (0.46%, 95% UI = 0.41-0.53%), western Europe (0.35%, 95% UI = 0.32-0.39) and North America (0.30%, 95% UI = 0.25-0.36). Opioid dependence was estimated to account for 9.2 million DALYs globally (0.37% of global DALYs) in 2010, a 73% increase on DALYs estimated in 1990. Regions with the highest opioid dependence DALY rates were North America (292.1 per 100,000), eastern Europe (288.4 per 100,000), Australasia (278.6 per 100,000) and southern sub-Saharan Africa (263.5 per 100,000). The contribution of YLLs to opioid dependence burden was particularly high in North America, eastern Europe and southern sub-Saharan Africa. Opioid dependence is a substantial contributor to the global disease burden; its contribution to premature mortality (relative to prevalence) varies geographically, with North America, eastern Europe and southern sub-Saharan Africa most strongly affected. © 2014 Society for the Study of Addiction.
              Article 0 comments Cited 94 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 07 March 2019
                Publication date Collection: March 2019
                Volume: 8
                Issue: 3
                Electronic Location Identifier: 321
                Affiliations
                [1 ]Department of Psychiatry, Complejo Asistencial de Zamora, Zamora 49022, Spain
                [2 ]Department of Psychiatry, Hospital Clínico Universitario de Salamanca, Salamanca 37007, Spain; aialvarez@ 123456saludcastillayleon.es (A.T.Á.); magarzon@ 123456saludcastillayleon.es (M.Á.G.)
                [3 ]Castilla y León Health Authority, Complejo Asistencial de Zamora, Zamora 49022, Spain; mtpastor@ 123456saludcastillayleon.es
                [4 ]Department of Statistics, University of Salamanca, Institute of Biomedical Research of Salamanca IBSAL, Salamanca 37007, Spain; nerea_gonzalez_garcia@ 123456usal.es
                [5 ]Psychiatry, University of Salamanca, Institute of Biomedical Research of Salamanca IBSAL, Salamanca 37007, Spain; amontejo@ 123456usal.es
                Author notes
                [* ]Correspondence: cllanes@ 123456saludcastillayleon.es ; Tel.: +34-980-548-820 (ext. 48200)
                Author information
                https://orcid.org/0000-0002-7094-0511
                https://orcid.org/0000-0002-2814-2807
                https://orcid.org/0000-0003-4383-1333
                Article
                Publisher ID: jcm-08-00321
                DOI: 10.3390/jcm8030321
                PMC ID: 6463066
                PubMed ID: 30866482
                SO-VID: 77bb5138-7940-46b5-8bf2-9d1929ac18d8
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 31 January 2019
                Date accepted : 01 March 2019
                Categories
                Subject: Article

                Keywords: opioid-related disorders,methadone,adverse effects,erectile dysfunction,medication adherence
                Data availability:
                Keywords: opioid-related disorders, methadone, adverse effects, erectile dysfunction, medication adherence

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