Hypogonadism may be increased with long-acting opioid use

Daily use of long-acting opioids increases the risk of hypogonadism in men compared with those taking short-acting opioids, according to a recent study.

Although this was a small retrospective study, first author Andrea Rubinstein, MD, of Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, believes this higher rate of hypogonadism shows that there may be some safety considerations that she was not aware of 10 years ago. Data were presented at the 2012 American Academy of Pain Medicine’s annual meeting in Palm Springs, CA.

"There has been a movement over the last 10 to 15 years to convert patients to long-acting opioids from short-acting opioids with the idea that they were more effective and less risky," she said. "This is the first study that calls into question whether or not there is a safety difference between long-acting and short-acting opioids."

A retrospective cohort study of 81 men, between the ages of 18 and 80 years, was conducted with men who were referred by primary care to a tertiary pain clinic. These men were on a stable dose of daily opioids for at least 90 days, and none had a previous diagnosis of hypogonadism. The study excluded patients with any known endocrine disease other than stable, treated hypothyroidism or those with a prior diagnosis of cancer or human immunodeficiency virus.

Morning testosterone levels were taken from each man who was currently on daily opioid therapy for chronic non-cancer pain. The study found that 57% of men were hypogonadal overall, but that 74% of men on long-acting opioids were hypogonadal. Of the men on short-acting opioids, 34% were hypogonadal, which was statistically significant (pThe study defined hypogonadism as a total AM testosterone

Using a multivariate analysis correcting for dose, the study found that patients on a long-acting opioid formulation had a 4.78 greater odds of becoming hypogonadal than did patients on an equivalent dose of a short-acting opioid formulation (95% confidence interval 1.51-15.07, p=.008). The study also found that dose was not significantly associated with hypogonadism in the multivariate model.

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