4.2. Implications for Opioid Use Disorders
Men are more likely to use heroin and other illicit opioids, whereas
women are more likely to use prescription opioids and develop an opioid
use disorder (Section 2.1.1). Moreover, women are much more likely to
experience negative psychosocial consequences from their drug use. These
observations are due to many factors, with psychosocial factors likely
playing the most prominent role. The role of gonadal hormones in
mediating sex differences in opioid use and opioid use disorders has not
been extensively examined, and there is a paucity of both preclinical
and clinical data looking at the role of androgens. It is nonetheless
notable that the abuse of AAS is highly correlated with the abuse of
both licit and illicit opioids, suggesting an underappreciated but still
unknown relationship between the two pharmacological classes of drugs.
Given that the misuse of AAS is a risk factor for opioid abuse, and
similarly, that the misuse of opioids is a risk factor for AAS abuse
(Section 3.1.1), drug-abuse prevention programs should utilize early
interventions appropriately. An obvious target of these interventions
would be adolescent and young adult males, who are mostly likely to
misuse AAS and simultaneously misuse both AAS and opioids. It remains to
be determined whether androgenic activity can be manipulated to aid in
the treatment of opioid use disorders. As mentioned above,
administration of direct or indirect agonists at androgen receptors
would lead to problematic side effects in the majority of individuals.
Androgen receptor antagonists would also be problematic because they
produce feminizing effects in cisgender men. Regardless, if opioid
intake or opioid seeking is sensitive to androgenic manipulations, some
interventions might be feasible. For example, finasteride is a
5α-reductase inhibitor used to treat prostatic hyperplasia (i.e.,
enlarged prostate) and androgenic alopecia (i.e., male-pattern baldness)
that primarily or exclusively impact men with normal levels of
testosterone. Finasteride and other 5α-reductase inhibitors do not
produce feminizing effects and have limited effects on sexual
functioning (Gupta & Charrette, 2014; Hirshburg et al., 2016; Mella et
al., 2010), making them candidates for future clinical trials where
potential masculinizing or feminizing effects must be avoided.