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Effect of Long-Term Opioid Therapy on Sexual Dysfunction in Pain Patients

P-014 - (Poster #14) Effect of Long-Term Opioid Therapy on Sexual Dysfunction in Pain Patients

Thursday, September 4, 2025
4:00 PM - 5:30 PM PST
Location:  Exhibit Hall (Level 4)
Background: Patients on chronic opioid therapy are at risk for opioid-induced hypogonadism (OIH) due to inhibition of gonadotropin releasing hormone. Buprenorphine has been theorized to have decreased incidence of OIH due to its unique mechanism of action compared to traditional opioid agonists. Patients treated with buprenorphine have been shown to have increased levels of serum testosterone and lower frequency of sexual dysfunction as compared to methadone maintenance treatment. To date, there has been little research on OIH in a chronic pain population.

Purpose/Objectives: The purpose of this study is to evaluate the incidence of OIH in a chronic pain population treated with long-term opioid therapy and determine if use of buprenorphine decreases OIH incidence as compared to full opioid agonists.

Methods: This was a single-center, retrospective chart review. The primary endpoint was a composite of plasma testosterone < 300 ng/mL, initiation of medications for testosterone replacement therapy or erectile dysfunction (ED), or a new diagnosis for ED or hypogonadism. Adult, male Veterans were included if they received at least 90-days of an opioid prescription for a chronic pain indication during the study period with a preceding 90-day opioid-free interval. Exclusion criteria include meeting components of the primary endpoint within 1 year prior to study medication initiation. Continuous data will be analyzed using Mann-Whitney U test and categorical data using chi square test.

Results: Three hundred and thirty-eight patients were screened; 45 patients were included in the buprenorphine group and 55 in the opioid group. Most common reason for study exclusion was no proceeding 90-day opioid-free interval. There were no significant differences in baseline characteristics, including age, body mass index, and concomitant antidepressant therapy, between study groups. Patients in the opioid group were on a significantly longer duration of therapy than the buprenorphine group during the study period (median 465 days vs 292 days, p=0.006). Fewer patients in the buprenorphine group met the primary composite endpoint as compared to the opioid group (13.3% vs 29.1%, p=0.058), and patients in the buprenorphine group had significantly fewer diagnoses for ED or hypogonadism post-treatment initiation (0% vs 12.7%, p=0.013).

Conclusions/Implications for future research and/or clinical care: No significant difference was found between buprenorphine and full opioid agonists in the primary outcome of interest, but a lower frequency of patients treated with buprenorphine exhibited characteristics consistent with OIH as compared to patients receiving full opioid agonists. A major limitation of the study was the relatively small sample size. These results may support a potential role for buprenorphine to mitigate endocrine-related side effects associated with long-term opioid use. Future studies are needed to validate these results.