Buprenorphine, the medication used to treat addiction to opioids is gaining increasing popularity for both maintenance treatment of opioid dependence and treatment of chronic non- cancer related pain. It is now being offered as an alternative to pure opioids which have a greater abuse potential and can be more dangerous.
By Anjali Varma
The safety of Buprenorphine and the convenience of prescribing it in an office-based setting add to its desirability for healthcare provider. Being a partial agonist – an antagonist at the mu opioid receptor, a site where most pure agonists on the impact of opioid therapy on gonadal hormones act, its side effects are similar to those of pure agonists, and possibly less severe.
In a recent article published in the journal Hormone Molecular Biology and Clinical Investigation, the authors discuss the impact of long term opioid therapy on the hypothalamic-pituitary- gonadal axis (HPG) and examines the few studies that have investigated the impact of buprenorphine treatment on sexual functioning with or without hormonal assays.
Opioid induced hypogonadism is well established. Most studies report that buprenorphine being a partial agonist/ antagonist may not be impacting the pituitary gonadal hormones as much. There are reports of sexual dysfunction in subjects maintained on buprenorphine, some without hormonal correlation.
Thus with the understanding that relevant clinical studies are limited in number, varied in methodology, mostly cross sectional and predominantly in men, the results of such studies should be viewed with caution and considered preliminary and lacking generalizability, at best.
Based on a comprehensive review of the available literature, authors conclude that despite its increasing popularity, buprenorphine has not been adequately studied in respect to its long term effects on the hypothalamic-pituitary- gonadal (HPG) axis. There is much need for longitudinal systematic trials to define the potential buprenorphine-induced endocrine consequences.
Impact statement: Authors encourage an increased awareness among providers and patients of possible impact on the HPG axis and thus emphasize prescription of the lowest possible dose of this medication that helps with cravings and pain symptom alleviation since experts have not adequately investigated the effects.
Read the original article here