Does marijuana use play a role in the recreational use of sildenafil?

Published reports of improved sexual performance have prompted men without erectile dysfunction to use sildenafil inappropriately.^1-4 Sildenafil has also been used to counteract the impotence-inducing effects of “club drugs” such as ecstasy.⁵

Cannabis, another widely abused street drug, is a known inhibitor of the cytochrome P450 3A4 isoenzyme pathway, the same pathway in which sildenafil is metabolized.⁶ Cannabis can thus potentiate the effect of sildenafil. A case report from 2002 has indicated that a young man using sildenafil and cannabis concomitantly suffered a myocardial infarction.⁷

In this study, we sought to answer the following questions:

• What methods did the men use to obtain sildenafil without a prescription?
• Why were the men taking sildenafil?
• Did these men increase the dose without physician supervision?

Methods

Setting, participants, and design

Two senior resident physicians from the Department of Family Practice at The Brooklyn Hospital Center asked male patients between the ages of 18 and 80 if they would be interested in participating in this descriptive study. Two hundred and thirty-one patients agreed to be interviewed during their outpatient clinic appointments in the Departments of Family Practice and Urology. We conducted these interviews between December 1, 2002 and April 30, 2003.

Patients with and without physician-diagnosed erectile dysfunction who were using sildenafil were included in this study. Patients were excluded if they were taking nitrates, had cognitive disabilities, were female, or if they could not read English.

The 1-page, 35-item questionnaire was read to the subjects by a resident, who provided additional explanations if needed. The researchers noted their responses to questions on demographics, medical history, social history, treatment duration of erectile dysfunction, method of procurement of sildenafil, and knowledge about the indications of sildenafil. The questionnaire was pretested on a small sample for comprehension prior to distribution.

We developed descriptive statistics and performed cross-tabulations using SPSS version 11.0 (SPSS, Inc, Chicago, Ill). We used a chi-square test to determine statistical significance between cannabis abuse and illicit sildenafil use. We established statistical significance at P<.05. The Institutional Review Board at the Brooklyn Hospital Center approved our research protocol, and we obtained consent from all the study participants.

Results

Strong link between cannabis use and recreational sildenafil

TABLE 1 shows the demographic information of the entire study population (n=231). Our study found that patient predictors for recreational sildenafil use are a younger unmarried male who smokes cannabis. Of the men in the study, 138 (59.7%) reported erectile function prior to the use of sildenafil.

We decided to examine data from this subgroup of our study population. As shown in TABLE 2, patients with erectile function but with a history of cannabis abuse reported obtaining sildenafil from friends, street vendors, and the Internet significantly more often than those with erectile dysfunction who did not use cannabis.

Discussion: Is there a danger?

Our study showed a strong association between individuals who obtained sildenafil from sources other than a prescribing physician and those who used cannabis. These men purchased this prescription medication from street vendors, friends, family, or via the Internet. Illicit sildenafil users took the medication mainly to improve performance and increase desire–and they often increased the dose of the medication at will. The differences between patients with erectile dysfunction compared with those without were so great that much of our data proved to be statistically significant (TABLE 1).

Data from our subgroup of patients who smoked cannabis supported our suspicion that patients who were able to maintain an erection prior to their use of sildenafil used the medication to improve sexual performance and counteract alterations in libido caused by cannabis.⁸

TABLE 1
Our study group: Who they were, why they were taking sildenafil

TABLE 2
Where did 2 subsets of subjects obtain sildenafil?

Limitations of this study

The main limitation of this study was that the data obtained were self-reported. A chart review could have provided objective data on the patients’ ED diagnosis and medications.

Conclusion

The illicit use of sildenafil raises many issues. Patients with cardiovascular disease, even without the use of nitrates, may be at risk of myocardial infarction. Be aware that younger, male patient with an admitted history of drug abuse may be taking sildenafil without your knowledge, even without a diagnosis of erectile dysfunction.

Funding

Material support was provided by the Department of Family Medicine at The Brooklyn Hospital, Brooklyn, NY.

Acknowledgments

The contents of this manuscript were presented at the New York State Academy of Family Practice and The Albany County Chapter Regional Family Medicine Conference at Lake Placid, NY on September 6, 2003.

Correspondence
Marie L. Eloi-Stiven, MD, Director of Research, The Brooklyn Hospital Center, Department of Family Medicine, 121 Dekalb Ave, Brooklyn, NY 11201; dad9022@nyp.org

Published reports of improved sexual performance have prompted men without erectile dysfunction to use sildenafil inappropriately.^1-4 Sildenafil has also been used to counteract the impotence-inducing effects of “club drugs” such as ecstasy.⁵

Cannabis, another widely abused street drug, is a known inhibitor of the cytochrome P450 3A4 isoenzyme pathway, the same pathway in which sildenafil is metabolized.⁶ Cannabis can thus potentiate the effect of sildenafil. A case report from 2002 has indicated that a young man using sildenafil and cannabis concomitantly suffered a myocardial infarction.⁷

In this study, we sought to answer the following questions:

• What methods did the men use to obtain sildenafil without a prescription?
• Why were the men taking sildenafil?
• Did these men increase the dose without physician supervision?

Methods

Setting, participants, and design

Two senior resident physicians from the Department of Family Practice at The Brooklyn Hospital Center asked male patients between the ages of 18 and 80 if they would be interested in participating in this descriptive study. Two hundred and thirty-one patients agreed to be interviewed during their outpatient clinic appointments in the Departments of Family Practice and Urology. We conducted these interviews between December 1, 2002 and April 30, 2003.

Patients with and without physician-diagnosed erectile dysfunction who were using sildenafil were included in this study. Patients were excluded if they were taking nitrates, had cognitive disabilities, were female, or if they could not read English.

The 1-page, 35-item questionnaire was read to the subjects by a resident, who provided additional explanations if needed. The researchers noted their responses to questions on demographics, medical history, social history, treatment duration of erectile dysfunction, method of procurement of sildenafil, and knowledge about the indications of sildenafil. The questionnaire was pretested on a small sample for comprehension prior to distribution.

We developed descriptive statistics and performed cross-tabulations using SPSS version 11.0 (SPSS, Inc, Chicago, Ill). We used a chi-square test to determine statistical significance between cannabis abuse and illicit sildenafil use. We established statistical significance at P<.05. The Institutional Review Board at the Brooklyn Hospital Center approved our research protocol, and we obtained consent from all the study participants.

Results

Strong link between cannabis use and recreational sildenafil

TABLE 1 shows the demographic information of the entire study population (n=231). Our study found that patient predictors for recreational sildenafil use are a younger unmarried male who smokes cannabis. Of the men in the study, 138 (59.7%) reported erectile function prior to the use of sildenafil.

We decided to examine data from this subgroup of our study population. As shown in TABLE 2, patients with erectile function but with a history of cannabis abuse reported obtaining sildenafil from friends, street vendors, and the Internet significantly more often than those with erectile dysfunction who did not use cannabis.

Discussion: Is there a danger?

Our study showed a strong association between individuals who obtained sildenafil from sources other than a prescribing physician and those who used cannabis. These men purchased this prescription medication from street vendors, friends, family, or via the Internet. Illicit sildenafil users took the medication mainly to improve performance and increase desire–and they often increased the dose of the medication at will. The differences between patients with erectile dysfunction compared with those without were so great that much of our data proved to be statistically significant (TABLE 1).

Data from our subgroup of patients who smoked cannabis supported our suspicion that patients who were able to maintain an erection prior to their use of sildenafil used the medication to improve sexual performance and counteract alterations in libido caused by cannabis.⁸

TABLE 1
Our study group: Who they were, why they were taking sildenafil

TABLE 2
Where did 2 subsets of subjects obtain sildenafil?

Limitations of this study

The main limitation of this study was that the data obtained were self-reported. A chart review could have provided objective data on the patients’ ED diagnosis and medications.

Conclusion

The illicit use of sildenafil raises many issues. Patients with cardiovascular disease, even without the use of nitrates, may be at risk of myocardial infarction. Be aware that younger, male patient with an admitted history of drug abuse may be taking sildenafil without your knowledge, even without a diagnosis of erectile dysfunction.

Funding

Material support was provided by the Department of Family Medicine at The Brooklyn Hospital, Brooklyn, NY.

Acknowledgments

The contents of this manuscript were presented at the New York State Academy of Family Practice and The Albany County Chapter Regional Family Medicine Conference at Lake Placid, NY on September 6, 2003.

Correspondence
Marie L. Eloi-Stiven, MD, Director of Research, The Brooklyn Hospital Center, Department of Family Medicine, 121 Dekalb Ave, Brooklyn, NY 11201; dad9022@nyp.org

Published reports of improved sexual performance have prompted men without erectile dysfunction to use sildenafil inappropriately.^1-4 Sildenafil has also been used to counteract the impotence-inducing effects of “club drugs” such as ecstasy.⁵

Cannabis, another widely abused street drug, is a known inhibitor of the cytochrome P450 3A4 isoenzyme pathway, the same pathway in which sildenafil is metabolized.⁶ Cannabis can thus potentiate the effect of sildenafil. A case report from 2002 has indicated that a young man using sildenafil and cannabis concomitantly suffered a myocardial infarction.⁷

In this study, we sought to answer the following questions:

• What methods did the men use to obtain sildenafil without a prescription?
• Why were the men taking sildenafil?
• Did these men increase the dose without physician supervision?

Methods

Setting, participants, and design

Two senior resident physicians from the Department of Family Practice at The Brooklyn Hospital Center asked male patients between the ages of 18 and 80 if they would be interested in participating in this descriptive study. Two hundred and thirty-one patients agreed to be interviewed during their outpatient clinic appointments in the Departments of Family Practice and Urology. We conducted these interviews between December 1, 2002 and April 30, 2003.

Patients with and without physician-diagnosed erectile dysfunction who were using sildenafil were included in this study. Patients were excluded if they were taking nitrates, had cognitive disabilities, were female, or if they could not read English.

The 1-page, 35-item questionnaire was read to the subjects by a resident, who provided additional explanations if needed. The researchers noted their responses to questions on demographics, medical history, social history, treatment duration of erectile dysfunction, method of procurement of sildenafil, and knowledge about the indications of sildenafil. The questionnaire was pretested on a small sample for comprehension prior to distribution.

We developed descriptive statistics and performed cross-tabulations using SPSS version 11.0 (SPSS, Inc, Chicago, Ill). We used a chi-square test to determine statistical significance between cannabis abuse and illicit sildenafil use. We established statistical significance at P<.05. The Institutional Review Board at the Brooklyn Hospital Center approved our research protocol, and we obtained consent from all the study participants.

Results

Strong link between cannabis use and recreational sildenafil

TABLE 1 shows the demographic information of the entire study population (n=231). Our study found that patient predictors for recreational sildenafil use are a younger unmarried male who smokes cannabis. Of the men in the study, 138 (59.7%) reported erectile function prior to the use of sildenafil.

We decided to examine data from this subgroup of our study population. As shown in TABLE 2, patients with erectile function but with a history of cannabis abuse reported obtaining sildenafil from friends, street vendors, and the Internet significantly more often than those with erectile dysfunction who did not use cannabis.

Discussion: Is there a danger?

Our study showed a strong association between individuals who obtained sildenafil from sources other than a prescribing physician and those who used cannabis. These men purchased this prescription medication from street vendors, friends, family, or via the Internet. Illicit sildenafil users took the medication mainly to improve performance and increase desire–and they often increased the dose of the medication at will. The differences between patients with erectile dysfunction compared with those without were so great that much of our data proved to be statistically significant (TABLE 1).

Data from our subgroup of patients who smoked cannabis supported our suspicion that patients who were able to maintain an erection prior to their use of sildenafil used the medication to improve sexual performance and counteract alterations in libido caused by cannabis.⁸

TABLE 1
Our study group: Who they were, why they were taking sildenafil

TABLE 2
Where did 2 subsets of subjects obtain sildenafil?

Limitations of this study

The main limitation of this study was that the data obtained were self-reported. A chart review could have provided objective data on the patients’ ED diagnosis and medications.

Conclusion

The illicit use of sildenafil raises many issues. Patients with cardiovascular disease, even without the use of nitrates, may be at risk of myocardial infarction. Be aware that younger, male patient with an admitted history of drug abuse may be taking sildenafil without your knowledge, even without a diagnosis of erectile dysfunction.

Funding

Material support was provided by the Department of Family Medicine at The Brooklyn Hospital, Brooklyn, NY.

Acknowledgments

The contents of this manuscript were presented at the New York State Academy of Family Practice and The Albany County Chapter Regional Family Medicine Conference at Lake Placid, NY on September 6, 2003.

Correspondence
Marie L. Eloi-Stiven, MD, Director of Research, The Brooklyn Hospital Center, Department of Family Medicine, 121 Dekalb Ave, Brooklyn, NY 11201; dad9022@nyp.org