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.