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Author: Admin | 2025-04-28
INTRODUCTION Opioid substitution therapy (OST) is the treatment of opioid dependence with highest evidence base; it is effective not only to cut down illicit opioid use, but also to reduce HIV risk behavior, decrease the incidence of hepatitis C, overdose-related deaths, criminal behavior, and for overall improvement in functioning and quality of life.[1234] Medications, commonly used for substitution, are methadone and buprenorphine (with or without combined naloxone).[5] In India, a substantial majority of the OST programs use buprenorphine.[6] For the effect of OST on sexual functioning, most of the existing research has focused on methadone.[78] The rate of sexual dysfunction with methadone ranges from 14 to 81;[7] commonly encountered problems are decreased libido and orgasmic dysfunctions. A recently published meta-analysis observed an increased risk of erectile dysfunction (ED) among patients on chronic opioid treatment (including opioid analgesics).[8] Sexual dysfunctions due to opioids are thought to be because of their effect on the gonadal–hypothalamic–pituitary axis.[9] This effect is supposedly mediated through the direct agonist action on the mu receptors.[10] Thus, the existing research suggests a causal link between opioid substitution and the chance of experiencing sexual dysfunction, with variable rates across studies. However, none of the studies had done a comprehensive assessment of sexual dysfunction, covering all the domains. Of the few published studies focusing on sexual dysfunction with buprenorphine-based opioid substitution,[111213] only one is from India.[14] Overall, the rates of sexual dysfunction were lower with buprenorphine, compared to that of methadone.[7] To the best of our knowledge, except the one study from India, no published paper has yet compared the sexual effects of fixed-dose buprenorphine-naloxone combination (BNX) with a control group. This is important to study because, contrary to the usual belief, even sublingually, the bio-availability of naloxone is nearly 25% (as compared to more than 50% buprenorphine), and this systemic exposure to the mu receptor antagonist, naloxone, might influence the sexual function.[1516] Given the scope of expanding the available literature, we intended to explore first, the rate of sexual dysfunction with BNX-based OST, second to compare the rate with a control group, and, finally, to examine the correlates of sexual dysfunction. MATERIALS AND METHODS The study was cross-sectional in design. Study sample The participants were recruited from the OST clinic of the Drug De-addiction and Treatment Centre under the Department of Psychiatry at the Postgraduate Institute of Medical Education and Research, Chandigarh, situated in North India. Our OST clinic runs once a week and prescribes and dispenses BNX as take-home dosages for 1 week. A majority of the patients/visits are with accompanying family member/s who actively participate in the treatment and medication supervision. The study sample included forty consecutive men who were on BNX-based substitution for at least 6 months, who were aged 21–50 years, and who were either married or had stable relationship for at least 6 months. Excluded from the study were those with other substance dependence (except tobacco), with significant symptoms of acute opioid withdrawal, with other comorbid psychiatric disorders, history of trauma or surgery in
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