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Heroin Addiction and Related Clinical Problems: 2025, 27, 3

Erectile dysfunction in men treated in opioid addiction treatment programs in Slovenia

Nusa Segrec, and Vanja Erculj

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-3

Summary: Background. Medication-assisted treatment (MAT) with full and partial opioid agonists is one of the options for the treatment of opioid addiction. Sexual dysfunction (SD) is a common side effect of opioid medications. The aim is to compare the incidence of erectile dysfunction (ED) in four groups of men: (I) patients treated with methadone - MTD; (II) buprenorphine - BUP; (III) slow-release morphine – SR M; and (IV) participants with a history of opioid addiction completely abstinent for at least 6 months. Methods All participants were evaluated using a questionnaire that included sociodemographic and substance use data and MAT (1st part), sexual behaviour data (2nd part), and the IIEF 9 (International Index of Erectile Function) questionnaire (3rd part). We used basic descriptive statistics and univariate and multivariate analyses to analyse the data. Results The highest prevalence of ED as a side effect of MAT was in the group receiving SR M, and the lowest in the group receiving BUP. At least 26.7% of abstainers, 35% of BUP recipients, 50% of MTD recipients, and 55% of SR M recipients had mild ED (p = 0.005). The highest rate of severe ED was in the SR M group (40%), followed by the MTD group (21.7%) and BUP (16.7%). Patients with ED received a higher equipotent methadone dose (Me = 60 mg; IQR = 27.5 - 100 mg) compared to those without ED (Me = 40 mg; IQR = 0 - 80 mg) (p = 0.008). Conclusions. The results of the study show how important it is to include sexuality in the comprehensive treatment of addiction. They may help to establish guidelines for the selection of MAT for patients with SD and indirectly contribute to the reduction of substance abuse (with a contribution to the design of clinical recommendations for the treatment of patients enrolled in MAT with SD).

Keywords: Opioid Addiction; Methadone; Buprenorphine; Slow-Release Morphine; Sexual Dysfunction; Erectile Dysfunction