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 providers. 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 examine 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 as a partial agonist/antagonist, buprenorphine may not impact the pituitary gonadal hormones as much. There have been reports of sexual dysfunction among people taking on buprenorphine, some without hormonal correlation.
Therefore, with the understanding that relevant clinical studies are limited in number, varied in methodology, mostly cross sectional and have predominantly been carried out on men, the results of such studies should be at best viewed with caution and considered preliminary and lacking generalizability.
Based on a comprehensive review of the available literature, the 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 a great need for longitudinal systematic trials to define the potential buprenorphine-induced endocrine consequences.
In conclusion, the authors encourage an increased awareness among healthcare providers and patients of the possible impact on the HPG axis. Furthermore, since the effects of the drug have not yet been adequately investigated, the authors stress that the medication should only be prescribed to alleviate cravings and pain in the lowest possible dosage.
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