Sexual Dysfunction in Opiate Use Disorder in Male Egyptian Patients

Abstract

Summary S ubstance use and dependence cause a significant burden to individuals and societies throughout the world.Opioid dependency has increased in prevalence over the last few decades, particularly in the Middle East, including Egypt. A 2007 National Survey report stated that 8.5% of Egyptians - or six million people - are addicted to drugs and that the majority of them are between 15 and 25 years old. While 2014 National Survey report stated that 0.2% the Egyptian population above the age of 15. A proportion of 19.3% were experimental users, 6.7% were regular on substance use, while 6.4% were fulfilling the criteria of dependence. Among a range of potential side effects of opiates misuse, SD is common and clinically significant. Psychoactive substances are believed in many cultures to be of aphrodisiac function; but in reality they have deleterious effects on all the aspects of sexual and hormonal functions. Whether withdrawal from the substances could restore erectile function remains unknown. Compared with the general population, studies with regular heroin users, revealed decreased libido reported in the majority of addicts, erectile dysfunction in 39∼48% and delayed ejaculation in over 50% of the addicts. Current knowledge is briefly reviewed about the role of the opioid system in the regulation of reproductive physiology, at multiple levels; at the levels of the central nervous system, at the testes level and at sperm level. Evidence suggests that opioids – both endogenous and exogenous – can bind to opioid receptors primarily in the hypothalamus, but potentially also in the pituitary and the testes, to modulate gonadal function. Decreased release, or interference with the normal pulsatility of release of GNRH at the level of the hypothalamus, has been documented, with consequent decreased release of LH and FSH from the pituitary. Direct effects of opioids on the testes, including decreased secretion of testosterone and testicular interstitial fluid, have been documented as well. The relationship between psychoactive substances and sexual behavior are complex. Caution should be taken when interpreting research on the effects of drugs on sexual function, as psychological, physiological, environmental, or cultural factors may be associated with use of a particular substance, and may have independent or intervening effects. Moreover, although tramadol was thought to have low abuse potentials worldwide, its abuse has become a serious problem in many countries, particularly in the Middle East. Tramadol HCl dependency is at the top of all substances abused after cannabis in Egypt, at frequency of 49%, followed by polysubstances at 43%. Despite the high prevalence of SD in addicted opiate users, only a few studies on SD with these patients have been undertaken in Egypt. As a result, the importance of SD in this vulnerable group has been underestimated. And to the best of our knowledge, none of previous studies was conducted on atypical opioids such as tramadol. Therefore, we attempted to investigate the sexual functioning of males using tramadol and its relationship to levels of free testosterone, LH, and FSH sex hormones and to compare them with heroin addicts and healthy controls. This is one of the rare studies discussing this important problem in Egypt. We hyposethized, that there is a significant prevalence of sexual dysfunction and decrease in testosterone level, LH & FSH in opiate abusers (tramadol HCL and heroin). Aim of the work: To verify the hypothesis, and to evaluate the following points if the hypothesis is verified: 1- To evaluate the risk of sexual dysfunction in patients with opiates abuse disorder. 2- To evaluate the correlation of opiates abuse disorders and decrease in testosterone, LH & FSH levels. 3- To compare and detect if there a difference in sexual dysfunction, free testosterone level, LH & FSH between tramadol HCL dependence and heroin dependence 4- To assess the characteristics of opiate abuse in patients with sexual dysfunction The study comprises 60 male patients with opioid dependency (30 heroin and 30 tramadol HCL use disorders patients) and 30 healthy controls, presenting to the both OPCs and inpatient addiction unit of Ain Shams University psychiatry department, Cairo, Egypt, from January 2015 until January 2016.