Comparing Sexual Function between Opioid Dependents Consuming Methadone or Opium Tincture
-
Sedigheh Sadat Moeeni
,
Reza Rastgoo Sisakht
,
Nasim Vousooghi
,
Koorosh Kamali
,
Firoozeh Raisi
,
Azarakhsh Mokri
Abstract
Objective: Sexual dysfunction is a side effect of methadone maintenance therapy (MMT). Opium Tincture (OT) has been used as a maintenance treatment. This study aimed to determine and compare the trend of sexual function and its related factors during treatment with both drugs.
Method: An observational study was designed to measure the blood tests including free and total testosterone, prolactin, and sex hormone-binding globulin and a battery of questionnaires, including demographics and drug use history, in 42 and 53 patients entering MMT and OT treatment before and 1 and 3 months after the treatment.
Results: Significant changes in testosterone levels were observed in the MMT but not the OT group. The difference between the two groups was not significant. Neither between nor within changes in the sexual function and premature ejaculation scores were significant (P =0.370& 0.698). Anxiety levels were significantly different (P= 0.001) within and between groups. There was a considerable difference in the trend of depression changes in the OT group, but not different in MMT group and between the two groups.
Conclusion: No difference was found between MMT and OT effects on sexual function variables. The decrease in Testosterone during the three months of MMT, was not associated with diminished sexual function. In the MMT group, anxiety levels diminished during treatment. It seems that decreased testosterone in the MMT group was compensated by improved anxiety. Gonadotropin levels may not be the sole determinant in sexual activity, and complex interaction of mood and anxiety, agonist levels, and gonadotropins are involved.
1. Hurst T. World drug report. The encyclopedia of women and crime. 2019:1-2
2. Mohebbi E, Kamangar F, Rahimi-Movaghar A, Haghdoost AA, Etemadi A, Amirzadeh S, et al. An Exploratory Study of Units of Reporting Opium Usein Iran: Implications for Epidemiologic Studies. Arch Iran Med. 2019;22(10):541-5.
3. Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004(3):Cd002207.
4. Farnia V, Alikhani M, Ebrahimi A, Golshani S, Sadeghi Bahmani D, Brand S. Ginseng treatment improves the sexual side effects of methadone maintenance treatment. Psychiatry Res. 2019;276:142-50.
5. Teoh JB, Yee A, Danaee M, Ng CG, Sulaiman AH. Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life. J Addict Med. 2017;11(1):40-6.
6. Yee A, Loh HS, Ng CG, Sulaiman AH. Sexual Desire in Opiate-Dependent Men Receiving Methadone-Assisted Treatment. Am J Mens Health. 2018;12(4):1016-22.
7. Agha-Mohammadhasani P, Mokhtaree M, Nazari A, Rahnama A. Comparison of Sexual Function and Serum Testosterone Levels in Men Opiate Addicts, under Methadone Maintenance Therapy, and Healthy Men. Addict Health. 2018;10(2):76-85.
8. Yee A, Loh HS, Hisham Hashim HM, Ng CG. The prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments: a meta-analysis study. J Sex Med. 2014;11(1):22-32.
9. Llanes C, Álvarez AI, Pastor MT, Garzón M, González-García N, Montejo Á L. Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment. J Clin Med. 2019;8(3).
10. Bawor M, Bami H, Dennis BB, Plater C, Worster A, Varenbut M, et al. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;149:1-9.
11. Yee A, Danaee M, Loh HS, Sulaiman AH, Ng CG. Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment. PLoS One. 2016;11(1):e0147852.
12. Maremmani AGI, Pacini M, Maremmani I. What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients. Int J Environ Res Public Health. 2019;16(3):447.
13. Yee A, Loh HS, Hisham Hashim HM, Ng CG. Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study. Int J Impot Res. 2014;26(5):161-6.
14. La Pera G, Carderi A, Marianantoni Z, Peris F, Lentini M, Taggi F. Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: preliminary results. J Sex Med. 2008;5(1):164-72.
15. Yee A, Loh HS, Ong TA, Ng CG, Sulaiman AH. Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial of Bupropion as Treatment for Methadone-Emergent Sexual Dysfunction in Men. Am J Mens Health. 2018;12(5):1705-18.
16. Daneshmand R, Alam Mehrjerdi Z, Samiee M. Maintenance Treatment with Opium Tincture: A Preliminary Qualitative Study of the Factors Related to Treatment entry. Iran J Public Health. 2014;43(8):1123-31.
17. Alam Mehrjerdi Z, Zarghami M. Maintenance therapy with opium tincture for injecting drug users; implications for prevention from viral infections. Hepat Mon. 2013;13(4):e8334.
18. Seiri L, Mokri A, Dezhakam H, Noroozi A. Using tincture of opium for treatment of opiate abusers in Iran. Drug and Alcohol Dependence. 2014(140):e200.
19. Nikoo M, Moazen-Zadeh E, Nikoo N, Javidanbardan S, Kazemi A, Choi F, et al. Comparing opium tincture and methadone for medication-assisted treatment of patients with opioid use disorder: Protocol for a multicenter parallel group noninferiority double-blind randomized controlled trial. Int J Methods Psychiatr Res. 2019;28(1):e1768.
20. Battle DE. Diagnostic and Statistical Manual of Mental Disorders (DSM). Codas. 2013;25(2):191-2.
21. Babakhanian M, Alam Mehrjerdi Z, Shenaiy Y. Sexual dysfunction in male crystalline heroin dependents before and after MMT: a pilot study. Arch Iran Med. 2012;15(12):751-5.
22. https://darman.tums.ac.ir/Content/media/filepool3/2015/9/1137.pdf
23. Mokri A, Ekhtiari H, Norouzi A, Farnam R, Ehterami M, Meshkini B. An introduction to INCAS Substance to Abuse Profile (ISAP); Instrumental Framework for Iranian Informatics Network for Addiction Clinics (INAC) Quartery Journal of Addiction. 2008;2:16–24.
24. Pakpour AH, Zeidi IM, Yekaninejad MS, Burri A. Validation of a translated and culturally adapted Iranian version of the International Index of Erectile Function. Journal of sex & marital therapy. 2014;40(6):541-51.
25. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-30.
26. Yuan YM, Xin ZC, Jiang H, Guo YJ, Liu WJ, Tian L, et al. Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation. Asian J Androl. 2004;6(2):121-6.
27. Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. Japanese Psychological Research. 2013;55(4):350-7.
28. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
29. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92.
30. Beck A, Steer R. Manual of the Beck Anxiety Inventory. San Antonio, TX: The Psychology Corporation. Harcourt, Brace; 1990.
31. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal. 2008.
32. Kheradmand A, Fazeli A, Mazaheri Meybodi A. Comparing the Effects of Methadone, Buprenorphine, and Opium Tincture Maintenance Therapy on Sexual Function. Addict Health. 2019;11(2):120-8.
33. Mooney LJ, Saxon A. State-of-The-Art Treatment of Opioid Use Disorder. The Assessment and Treatment of Addiction: Elsevier; 2019. p. 91-104.
34. Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, Attia J. Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment. J Sex Med. 2008;5(3):684-92.
35. Brown R, Balousek S, Mundt M, Fleming M. Methadone maintenance and male sexual dysfunction. J Addict Dis. 2005;24(2):91-106.
36. Zhang M, Zhang H, Shi CX, McGoogan JM, Zhang B, Zhao L, et al. Sexual dysfunction improved in heroin-dependent men after methadone maintenance treatment in Tianjin, China. PLoS One. 2014;9(2):e88289.
37. Zafarghandi MBS, Nik MM, Birashk B, Assari A, Khanehkeshi A. Sexual dysfunction among males with opiate dependence undergoing methadone maintenance therapy (MMT). International Journal of High Risk Behaviors and Addiction. 2016;5(4).
38. Babakhanian M, Haghdoost AA, Afshari M, Taghizadeh F, Moosazadeh M. Methadone Replacement Therapy and Sexual Disorders among Opium Dependent Iranian Men: A Meta-Analysis Study. Addict Health. 2017;9(1):1-10.
39. Hosseini SH, Isapour A, Tavakoli M, Taghipour M, Rasuli M. Erectile dysfunction in methadone maintenance patients: a cross sectional study in northern Iran. Iranian journal of psychiatry. 2013;8(4):172.
40. Gerra G, Manfredini M, Somaini L, Maremmani I, Leonardi C, Donnini C. Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates. Eur Addict Res. 2016;22(3):163-75.
41. Kirana P-S, Tripodi F, Reisman Y, Porst H. The EFS and ESSM syllabus of clinical sexology: Medix; 2013.
42. Baharudin A, Mislan N, Ibrahim N, Sidi H, Nik Jaafar NR. Depression in male patients on methadone maintenance therapy. Asia Pac Psychiatry. 2013;5 Suppl 1:67-73.
2. Mohebbi E, Kamangar F, Rahimi-Movaghar A, Haghdoost AA, Etemadi A, Amirzadeh S, et al. An Exploratory Study of Units of Reporting Opium Usein Iran: Implications for Epidemiologic Studies. Arch Iran Med. 2019;22(10):541-5.
3. Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004(3):Cd002207.
4. Farnia V, Alikhani M, Ebrahimi A, Golshani S, Sadeghi Bahmani D, Brand S. Ginseng treatment improves the sexual side effects of methadone maintenance treatment. Psychiatry Res. 2019;276:142-50.
5. Teoh JB, Yee A, Danaee M, Ng CG, Sulaiman AH. Erectile Dysfunction Among Patients on Methadone Maintenance Therapy and Its Association With Quality of Life. J Addict Med. 2017;11(1):40-6.
6. Yee A, Loh HS, Ng CG, Sulaiman AH. Sexual Desire in Opiate-Dependent Men Receiving Methadone-Assisted Treatment. Am J Mens Health. 2018;12(4):1016-22.
7. Agha-Mohammadhasani P, Mokhtaree M, Nazari A, Rahnama A. Comparison of Sexual Function and Serum Testosterone Levels in Men Opiate Addicts, under Methadone Maintenance Therapy, and Healthy Men. Addict Health. 2018;10(2):76-85.
8. Yee A, Loh HS, Hisham Hashim HM, Ng CG. The prevalence of sexual dysfunction among male patients on methadone and buprenorphine treatments: a meta-analysis study. J Sex Med. 2014;11(1):22-32.
9. Llanes C, Álvarez AI, Pastor MT, Garzón M, González-García N, Montejo Á L. Sexual Dysfunction and Quality of Life in Chronic Heroin-Dependent Individuals on Methadone Maintenance Treatment. J Clin Med. 2019;8(3).
10. Bawor M, Bami H, Dennis BB, Plater C, Worster A, Varenbut M, et al. Testosterone suppression in opioid users: a systematic review and meta-analysis. Drug Alcohol Depend. 2015;149:1-9.
11. Yee A, Danaee M, Loh HS, Sulaiman AH, Ng CG. Sexual Dysfunction in Heroin Dependents: A Comparison between Methadone and Buprenorphine Maintenance Treatment. PLoS One. 2016;11(1):e0147852.
12. Maremmani AGI, Pacini M, Maremmani I. What we have learned from the Methadone Maintenance Treatment of Dual Disorder Heroin Use Disorder patients. Int J Environ Res Public Health. 2019;16(3):447.
13. Yee A, Loh HS, Hisham Hashim HM, Ng CG. Clinical factors associated with sexual dysfunction among men in methadone maintenance treatment and buprenorphine maintenance treatment: a meta-analysis study. Int J Impot Res. 2014;26(5):161-6.
14. La Pera G, Carderi A, Marianantoni Z, Peris F, Lentini M, Taggi F. Sexual dysfunction prior to first drug use among former drug addicts and its possible causal meaning on drug addiction: preliminary results. J Sex Med. 2008;5(1):164-72.
15. Yee A, Loh HS, Ong TA, Ng CG, Sulaiman AH. Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Trial of Bupropion as Treatment for Methadone-Emergent Sexual Dysfunction in Men. Am J Mens Health. 2018;12(5):1705-18.
16. Daneshmand R, Alam Mehrjerdi Z, Samiee M. Maintenance Treatment with Opium Tincture: A Preliminary Qualitative Study of the Factors Related to Treatment entry. Iran J Public Health. 2014;43(8):1123-31.
17. Alam Mehrjerdi Z, Zarghami M. Maintenance therapy with opium tincture for injecting drug users; implications for prevention from viral infections. Hepat Mon. 2013;13(4):e8334.
18. Seiri L, Mokri A, Dezhakam H, Noroozi A. Using tincture of opium for treatment of opiate abusers in Iran. Drug and Alcohol Dependence. 2014(140):e200.
19. Nikoo M, Moazen-Zadeh E, Nikoo N, Javidanbardan S, Kazemi A, Choi F, et al. Comparing opium tincture and methadone for medication-assisted treatment of patients with opioid use disorder: Protocol for a multicenter parallel group noninferiority double-blind randomized controlled trial. Int J Methods Psychiatr Res. 2019;28(1):e1768.
20. Battle DE. Diagnostic and Statistical Manual of Mental Disorders (DSM). Codas. 2013;25(2):191-2.
21. Babakhanian M, Alam Mehrjerdi Z, Shenaiy Y. Sexual dysfunction in male crystalline heroin dependents before and after MMT: a pilot study. Arch Iran Med. 2012;15(12):751-5.
22. https://darman.tums.ac.ir/Content/media/filepool3/2015/9/1137.pdf
23. Mokri A, Ekhtiari H, Norouzi A, Farnam R, Ehterami M, Meshkini B. An introduction to INCAS Substance to Abuse Profile (ISAP); Instrumental Framework for Iranian Informatics Network for Addiction Clinics (INAC) Quartery Journal of Addiction. 2008;2:16–24.
24. Pakpour AH, Zeidi IM, Yekaninejad MS, Burri A. Validation of a translated and culturally adapted Iranian version of the International Index of Erectile Function. Journal of sex & marital therapy. 2014;40(6):541-51.
25. Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-30.
26. Yuan YM, Xin ZC, Jiang H, Guo YJ, Liu WJ, Tian L, et al. Sexual function of premature ejaculation patients assayed with Chinese Index of Premature Ejaculation. Asian J Androl. 2004;6(2):121-6.
27. Mohammadi SD, Mohammadkhani P, Dolatshahi B, Dadkhah A. Effectiveness of cognitive behavioral therapy on the signs, symptoms and clinical consequences of premature ejaculation. Japanese Psychological Research. 2013;55(4):350-7.
28. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
29. Ghassemzadeh H, Mojtabai R, Karamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory--Second edition: BDI-II-PERSIAN. Depress Anxiety. 2005;21(4):185-92.
30. Beck A, Steer R. Manual of the Beck Anxiety Inventory. San Antonio, TX: The Psychology Corporation. Harcourt, Brace; 1990.
31. Kaviani H, Mousavi AS. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal. 2008.
32. Kheradmand A, Fazeli A, Mazaheri Meybodi A. Comparing the Effects of Methadone, Buprenorphine, and Opium Tincture Maintenance Therapy on Sexual Function. Addict Health. 2019;11(2):120-8.
33. Mooney LJ, Saxon A. State-of-The-Art Treatment of Opioid Use Disorder. The Assessment and Treatment of Addiction: Elsevier; 2019. p. 91-104.
34. Hallinan R, Byrne A, Agho K, McMahon C, Tynan P, Attia J. Erectile dysfunction in men receiving methadone and buprenorphine maintenance treatment. J Sex Med. 2008;5(3):684-92.
35. Brown R, Balousek S, Mundt M, Fleming M. Methadone maintenance and male sexual dysfunction. J Addict Dis. 2005;24(2):91-106.
36. Zhang M, Zhang H, Shi CX, McGoogan JM, Zhang B, Zhao L, et al. Sexual dysfunction improved in heroin-dependent men after methadone maintenance treatment in Tianjin, China. PLoS One. 2014;9(2):e88289.
37. Zafarghandi MBS, Nik MM, Birashk B, Assari A, Khanehkeshi A. Sexual dysfunction among males with opiate dependence undergoing methadone maintenance therapy (MMT). International Journal of High Risk Behaviors and Addiction. 2016;5(4).
38. Babakhanian M, Haghdoost AA, Afshari M, Taghizadeh F, Moosazadeh M. Methadone Replacement Therapy and Sexual Disorders among Opium Dependent Iranian Men: A Meta-Analysis Study. Addict Health. 2017;9(1):1-10.
39. Hosseini SH, Isapour A, Tavakoli M, Taghipour M, Rasuli M. Erectile dysfunction in methadone maintenance patients: a cross sectional study in northern Iran. Iranian journal of psychiatry. 2013;8(4):172.
40. Gerra G, Manfredini M, Somaini L, Maremmani I, Leonardi C, Donnini C. Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates. Eur Addict Res. 2016;22(3):163-75.
41. Kirana P-S, Tripodi F, Reisman Y, Porst H. The EFS and ESSM syllabus of clinical sexology: Medix; 2013.
42. Baharudin A, Mislan N, Ibrahim N, Sidi H, Nik Jaafar NR. Depression in male patients on methadone maintenance therapy. Asia Pac Psychiatry. 2013;5 Suppl 1:67-73.
| Files | ||
| Issue | Vol 16 No 3 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v16i3.6257 | |
| Keywords | ||
| Anxiety Opioid Substitution Therapy Opium Sexual Dysfunction Testosterone | ||
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How to Cite
1.
Moeeni SS, Rastgoo Sisakht R, Vousooghi N, Kamali K, Raisi F, Mokri A. Comparing Sexual Function between Opioid Dependents Consuming Methadone or Opium Tincture. Iran J Psychiatry. 2021;16(3):312-319.
