sildenafil-citrate and Substance-Related-Disorders

Abuse of sildenafil has been reported since its introduction in 1999 and commonly documented in combination with illicit drugs among men and women of all ages. Increased risks of sexually transmissible diseases including HIV have been associated with sildenafil use in men who have sex with men. Recognizing the abuse potential of phosphodiesterase type 5 inhibitors (PDE5), we aim to summarize the current knowledge of this abuse. An investigation of EMBASE, PubMed, the Food and Drug Administration (FDA) website, MedWatch, and search engines was performed to evaluate information regarding sildenafil, tadalafil, and vardenafil abuse. The EMBASE search provided 46 articles fitting the search criteria and evaluation led to 21 separate publications with specific information regarding PDE5 abuse. A PubMed search found 10 additional publications. MedWatch reported 44 separate warnings since 2000, most of which reported contamination of herbal products with active drug components. Few reports of abuse were among the 14,818 reports in the FDA AERS for sildenafil. A search for "internet drug store" revealed 6.4 million hits and of 7000 internet pharmacies identified by the Verified Internet Pharmacy Practice Sites Program (VIPPS) only 4% were in proper compliance. The role internet pharmacies play in counterfeit PDE5 or abuse is not well documented; however based on easy access, direct patient marketing, and low advertised cost it is likely this role is underreported. Currently the best recommendation for providers is to recognize the possibility of abuse and to educate patients on risks of this behavior.

Topics: Carbolines; Drug Contamination; Humans; Imidazoles; Internet; Marketing; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Tadalafil; Triazines; United States; United States Food and Drug Administration; Vardenafil Dihydrochloride

To determine the rates of sildenafil (Viagra) use among different populations, primarily among men who have sex with men, and to measure the association of sildenafil use with increased sexual risk behavior and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection.. The National Center for Biotechnology Information PubMed was searched using a variety of terms for relevant publications from January 1999 to July 2004. In addition, all scientific abstracts from national and international conferences on STDs from January 1999 to July 2004 were searched. Relevant journal articles and scientific abstracts presenting original data and meeting given criteria were included.. Fourteen studies met the inclusion criteria. Seven of the 11 studies in men who have sex with men showed sildenafil use rates >10% (range 3%-32%). Increased odds of unprotected anal sex with a partner of unknown or serodiscordant HIV status ranged from 2.0 to 5.7 times (mean = 3.9) for sildenafil users versus nonusers. The risk of sildenafil use and STD diagnosis among HIV-positive men who have sex with men was 1.92 (P = 0.05), and the odds of sildenafil use among those newly HIV infected was 2.5 (95% CI 1.1-4.1).. Most studies reported frequent sildenafil use in men who have sex with men, and several showed independent associations between use of the drug and sexual risk behavior, as well as an increased risk for STDs, including incident HIV infection. Although future research among more varied participants is needed, these results warrant a multi-faceted response to reduce the misuse of sildenafil and its consequences, particularly among men who have sex with men.

Topics: Comorbidity; Heterosexuality; HIV Infections; Homosexuality; Humans; Male; Piperazines; Purines; Risk-Taking; Sexually Transmitted Diseases; Sildenafil Citrate; Substance-Related Disorders; Sulfones

To conduct an epidemiologic review of sildenafil in homosexual and bisexual males focusing on concurrent use with club drugs and/or antiretroviral medications.. A search of MEDLINE was conducted (1966-September 2003), and an extensive manual review of journals was performed using the key search terms club drugs, sildenafil, antiretrovirals, and HIV.. All articles identified from the data sources were evaluated and information deemed relevant was included.. Several epidemiologic studies have reported that sildenafil is abused in a recreational fashion, typically with agents commonly known to be "club drugs." In this setting, sildenafil may reverse the impotence-inducing effects of the club drugs and restore sexual capabilities. Many implications of both recreational and nonrecreational use of sildenafil exist in relation to HIV disease. Concern has been raised regarding the potential effects on high-risk sexual practices. Also, several researchers have documented interactions between sildenafil and various club drugs, as well as with antiretrovirals intended for HIV disease.. Serious concerns exist regarding the concurrent use of sildenafil with antiretrovirals and/or club drugs. Clinicians prescribing sildenafil to patients receiving protease inhibitor-containing antiretroviral regimens should be aware of the potential for reduced sildenafil metabolism with resultant adverse effects. Additionally, untoward effects may also occur when sildenafil is used concurrently with various club drugs including amyl and butyl nitrites ("poppers").

Topics: Anti-HIV Agents; Bisexuality; Drug Interactions; Health Knowledge, Attitudes, Practice; HIV Seronegativity; HIV Seropositivity; Homosexuality, Male; Humans; Illicit Drugs; Male; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Vasodilator Agents

Sexualized drug use (SDU) to enhance and extend sexual relations may involve risks of substances abuse (intoxication, interactions and overdose) and higher exposure to HIV and other sexually transmitted infections. There are inconsistencies in the methodology and findings of previous research on SDU in Latin America (LA), and more studies are required. The purpose of this research was to characterize SDU in gay men and other men who have sex with men from 18 LA countries, and describe the aspects by comparing people who practice and do not practice SDU, at the general and country levels.. Cross-sectional study based on the data collected by LAMIS-2018. Dependent variable was SDU (last 12 months), and the independent variables were: drug use (in any context/in sexual context), sociodemographic, socioepidemiological, and psychosocial aspects. A descriptive analysis was carried out, comparing those who practiced and did not practice SDU.. LAMIS-2018 included 64,655 participants, averaging 30 years of age. 13.6% declared having practiced SDU (6.6% with multiple partners). In the last sexual encounter the most commonly used drugs were cannabis (9.3%), poppers (6%), and Viagra (5.4%), and in the last encounter with multiple partners, poppers (19.7%), cannabis (17%), and Viagra (13.2%). HIV diagnosis was reported by 27% of people practicing SDU, vs. 14.3% in the other group. Severe anxiety-depression symptoms were more common among people practicing SDU (9.2% vs. 7%), as were the episodes of homophobic intimidation (52.6% vs. 48.2%), insults (34.4% vs. 28.6%), and aggression (4.1% vs. 3.0%).. SDU was reported by a high percentage of people, with a predominance of the use of drugs related to sexual practice, and others for recreational use. Aspects described as the higher proportion of self-reported HIV diagnosis and severe symptoms of anxiety-depression among those who practiced SDU, show that is necessary to implement preventive strategies to reduce the harmful impacts that can sometimes result from this practice, including harm reduction policies, promote access to mental health services and support in situations of homophobia and stigma.

Topics: Cross-Sectional Studies; HIV Infections; Homosexuality, Male; Humans; Latin America; Male; Sexual and Gender Minorities; Sexual Behavior; Sildenafil Citrate; Substance-Related Disorders

This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.

Topics: Adult; Child, Preschool; HIV Infections; Homosexuality, Male; Humans; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Sexual and Gender Minorities; Sexually Transmitted Diseases; Sildenafil Citrate; Substance-Related Disorders

The routine analysis of driver specimens for gamma-hydroxybutyrate (GHB) is rarely performed by toxicology laboratories as the physical and chemical properties of GHB make it unamenable to the screening methods usually employed. The prevalence of the drug in driver populations has therefore only rarely been reported. This study outlines the results of the routine analysis for GHB in the blood of motor vehicle drivers in Queensland, Australia, over an eight-year period (2011-2018). The methodology for GHB analysis was updated over the course of the study; screening for GHB was conducted using GC/FID or GC/MS between 2011 and 2016 and by LC/MS/MS from 2017 onwards. Due to the endogenous nature of GHB, any specimens containing greater than 5mg/kg GHB were subjected to quantitative analysis by either; GC/MS after liquid-liquid extraction and derivatisation with BSTFA+1%TMCS (2011-2016), or by LC/MS/MS analysis after solvent precipitation from 2017 onwards. Of the 15,061 specimens analysed, 160 were positive for GHB (1.1% of all cases, range 0.4-1.8%). GHB positive drivers were 66.9% male (33.1% female) and had an average age of 32 years. The mean GHB concentration identified was 89mg/kg (range 6-354mg/kg). GHB was found to be closely associated with amphetamine type substances (ATS), particularly methylamphetamine. Though GHB was present in only 2.2% of all ATS positive specimens submitted to the laboratory, 91.2% of all GHB positive cases contained an ATS. Other drugs commonly co-administered with GHB were THC, cocaine, benzodiazepines and erectile dysfunction drugs. GHB was found to be more commonly identified in drivers from city areas and a geographical localisation of the use of the drug was identified in the Gold Coast region of Queensland.

Topics: Adult; Amphetamines; Australia; Benzodiazepines; Driving Under the Influence; Female; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Humans; Male; Narcotics; Phosphodiesterase 5 Inhibitors; Sildenafil Citrate; Sodium Oxybate; Substance Abuse Detection; Substance-Related Disorders; Tadalafil

We present a case of priapism in a homeless patient with a psychiatric history of major depression, PTSD, polysubstance abuse (alcohol and cocaine) and past psychotropic medication use who was admitted to a local hospital for suicidal ideation. Priapism is a serious urological and a medical emergency which has often been associated with psychotropic medications (including the antidepressant trazodone), use of marijuana and alcohol, and other factors. This clinical case highlights the additive risks of medications and comorbid conditions in contributing to onset of priapism, emphasizing the importance of any pre-existing medical illness, diagnoses, and comorbid mental illnesses. Moreover, clinicians should consider potential side effects of all medications used and their drug interactions as they manage patients who develop this condition.

Topics: Adrenergic alpha-1 Receptor Antagonists; Depressive Disorder, Major; Hepatitis C; Humans; Male; Middle Aged; Phenylephrine; Phosphodiesterase 5 Inhibitors; Priapism; Prostatic Hyperplasia; Selective Serotonin Reuptake Inhibitors; Sildenafil Citrate; Sleep Initiation and Maintenance Disorders; Substance-Related Disorders; Sulfonamides; Tamsulosin; Trazodone; Vasoconstrictor Agents

Topics: Adolescent; Humans; Illicit Drugs; Male; Phosphodiesterase 5 Inhibitors; Piperazines; Purines; Seizures; Sildenafil Citrate; Substance-Related Disorders; Sulfonamides

There is anecdotal evidence of misuse of erectile dysfunction medication, particularly to counteract some of the unwanted effects of recreational drugs on erectile function. However, there is little data from the United Kingdom (UK).. To evaluate the prevalence of sildenafil misuse in a UK population that has previously been shown to have high recreational drug use.. Questionnaire survey.. Individuals attending nightclubs catering for the men who have sex with men (MSM) community in South London were asked about lifetime and last year use of recreational drugs and sildenafil.. 313 individuals were surveyed over four nights in 2013: 282 (90.1%) were males and 248 (79.2%) were MSM. Last year use of recreational drugs was high: mephedrone (74.1%), cocaine (61.3%), MDMA/Ecstasy (59.2%), GHB/GBL (52.8%), cannabis (51.8%), and ketamine (50%). 136 (49.1%) MSM versus 6 (18.8%) non-MSM clubbers had misused sildenafil in the last year (p < .001). Amongst the MSM clubbers, 232 (93.5%) had heard of sildenafil, 161 (64.9%) reported misuse of sildenafil in their lifetime and 133 (53.6%) had misused sildenafil in the last year.. This study demonstrates a high prevalence of sildenafil misuse in a population who are heavy users of recreational drugs; it is not likely that this young population have underlying erectile dysfunction as a reason for legitimate sildenafil use. There is the potential for interaction with other recreational drugs used including cocaine and volatile nitrites. Further work is required in to determine the extent and reason for the misuse.

Topics: Adolescent; Adult; Cocaine; Homosexuality, Male; Humans; Illicit Drugs; London; Male; Methamphetamine; Middle Aged; N-Methyl-3,4-methylenedioxyamphetamine; Prescription Drug Misuse; Prevalence; Sildenafil Citrate; Substance-Related Disorders; Young Adult

The role men who have sex with men and women (MSMW) play in heterosexual HIV transmission is not well understood. We analyzed baseline data from Project MIX, a behavioral intervention study of substance-using men who have sex with men (MSM), and identified correlates of unprotected vaginal intercourse, anal intercourse, or both with women (UVAI). Approximately 10 % (n = 194) of the men reported vaginal sex, anal sex, or both with a woman; of these substance-using MSMW, 66 % (129) reported UVAI. Among substance-using MSMW, multivariate analyses found unemployment relative to full/part-time employment (OR = 2.28; 95 % CI 1.01, 5.17), having a primary female partner relative to no primary female partner (OR = 3.44; CI 1.4, 8.46), and higher levels of treatment optimism (OR = 1.73; 95 % CI 1.18, 2.54) increased odds of UVAI. Strong feelings of connection to a same-race gay community (OR = 0.71; 95 % CI 0.56, 0.91) and Viagra use (OR = 0.31; 95 % CI 0.10, 0.95) decreased odds of UVAI. This work suggests that although the proportion of substance-using MSM who also have sex with women is low, these men engage in unprotected sex with women, particularly with primary female partners. This work highlights the need for further research with the substance using MSMW population to inform HIV prevention interventions specifically for MSMW.

Topics: Condoms; Female; Heterosexuality; HIV Infections; Homosexuality, Male; Humans; Male; Piperazines; Purines; Risk Factors; Sexual Behavior; Sexual Partners; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Unemployment; Unsafe Sex

Topics: Central Nervous System Stimulants; Cognition; Doping in Sports; Humans; Illicit Drugs; Nootropic Agents; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones

The frequency of HIV infection is increasing in men who have sex with men (MSM) aged 40 and older yet little is known about factors that influence their risky sexual behavior, such as sexual positioning. The goal of this study was to examine multi-level factors associated with unprotected receptive anal intercourse (URAI) and unprotected insertive anal intercourse (UIAI) in MSM aged 40 and older. A community-based sample of 802 self-identified MSM aged 40-94 years was recruited through targeted outreach from community venues (e.g., bars, social events) in South Florida and completed an anonymous pen-and-paper questionnaire. Logistic regression showed that younger age (i.e., aged 40-59; odds ratio [OR]=0.6; 95% confidence interval [CI]: 0.4, 0.9), HIV-positive status (OR=2.8; 95% CI: 1.9, 4.0), drug use (OR=2.6; 95% CI: 1.7, 3.7), a larger number of male sexual partners (OR=1.7; 95% CI: 1.3, 2.3), and lower scores on internalized homonegativity (OR=0.9; 95% CI: 1.0, 1.0) were associated with higher risk for URAI. Younger age (OR=0.4; 95% CI: 0.3, 0.6), HIV-positive status (OR=1.5; 95% CI: 1.0, 2.1), drug use (OR=1.6; 95% CI: 1.1, 22.3), Viagra use (OR=1.7; 95% CI: 1.2, 2.4), larger number of sexual partners (OR=2.1; 95% CI: 1.6, 2.9), and holding views more characterized by high optimism concerning the future (OR=1.1; 95% CI: 1.0, 1.1) were associated with higher risk for UIAI. These results provide useful information that may guide the development of tailored prevention interventions to reduce the growing rates of HIV among MSM aged 40 and older.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Florida; HIV Infections; HIV Seropositivity; Homosexuality, Male; Humans; Logistic Models; Male; Middle Aged; Piperazines; Purines; Risk Factors; Risk-Taking; Sexual Behavior; Sexual Partners; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Surveys and Questionnaires; Vasodilator Agents

This report deals with a 28-year-old male patient, admitted with a type A aortic dissection, potentially related to the use of sildenafil. In the literature, we found only two other potentially sildenafil-related cases of aortic dissections, one type A and one type B. In our patient, a bicuspid aortic valve and an ascending aortic aneurysm were other underlying anomalies that could have led to the aortic dissection.

Topics: Adult; Aortic Aneurysm; Aortic Dissection; Aortic Valve; Aortography; Heart Defects, Congenital; Humans; Male; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures

A sexual marathon is defined as prolonged sexual activity over hours and even days. This exploratory study examined the phenomenon of sexual marathons in a sample of 341 HIV-positive methamphetamine-using men who have sex with men (MSM). Eighty-four percent of the men reported engaging in marathon sex while high on methamphetamine. MSM who engaged in sexual marathons and those who did not were compared in terms of background characteristics, methamphetamine use variables, alcohol and illicit drug use, sexual risk behaviors, and psychosocial factors. Men who engaged in marathon sex used significantly more illicit drugs, were more likely to use sildenafil (Viagra) and amyl nitrates, and scored higher on a sexual compulsivity scale compared to men who did not engage in marathon sex. In multivariate analyses, use of sildenafil in the past two months was significantly correlated with participation in sexual marathons. Findings are discussed in terms of their implications for HIV/STI prevention and intervention.

Topics: Adult; Alcohol-Related Disorders; Central Nervous System Stimulants; HIV Infections; Homosexuality, Male; Humans; Logistic Models; Male; Methamphetamine; Multivariate Analysis; Neuropsychological Tests; Nitrates; Pentanols; Piperazines; Purines; Risk-Taking; Sexual Behavior; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Vasodilator Agents

We examined how drugs, high-risk sexual behaviors, and socio-demographic variables are associated with recent HIV infection among men who have sex with men (MSM) in a case-control study. Interviewers collected risk factor data among 111 cases with recent HIV infection, and 333 HIV-negative controls from Chicago and Los Angeles. Compared with controls, cases had more unprotected anal intercourse (UAI) with both HIV-positive and HIV-negative partners. MSM with lower income or prior sexually transmitted infections (STI) were more likely to be recently HIV infected. Substances associated with UAI included amyl nitrate ("poppers"), methamphetamine, Viagra (or similar PDE-5 inhibitors), ketamine, and gamma hydroxybutyrate (GHB). Cases more frequently used Viagra, poppers, and methamphetamine during UAI compared with controls. In multivariate analysis, income, UAI with HIV-positive partners, Viagra, and poppers remained associated with recent HIV seroconversion. Better methods are needed to prevent HIV among MSM who engage in high-risk sex with concurrent drug use.

Topics: Adult; Case-Control Studies; Central Nervous System Stimulants; Chicago; HIV Infections; Homosexuality, Male; Humans; Los Angeles; Male; Methamphetamine; Middle Aged; Piperazines; Purines; Risk Factors; Risk-Taking; Sildenafil Citrate; Socioeconomic Factors; Substance-Related Disorders; Sulfones; Surveys and Questionnaires; Vasodilator Agents

Sildenafil (Viagra) has been developed as a drug to treat male impotence. It has also been used to reduce symptoms (e.g. improved exercise capacity) in patients with pulmonary arterial hypertension. A case of subarachnoid haemorrhage (SAH) following the illicit use of sildenafil is reported.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Calcium Channel Blockers; Humans; Male; Middle Aged; Naproxen; Nimodipine; Piperazines; Purines; Radiography; Sildenafil Citrate; Subarachnoid Hemorrhage; Substance-Related Disorders; Sulfones; Vasodilator Agents

Data ascertained in a study of club drug use among 450 gay and bisexual men indicate that at least one class of PDE-5 (phosphodiesterase type 5 inhibitor, sildenafil [Viagra]) is used frequently in combination with club drugs such as methamphetamine, MDMA (3,4 methylenedioxymethamphetamine [ecstasy]), ketamine, cocaine, and GHB (gamma hydroxy butyrate). Patterns of sildenafil use in combination with each of the club drugs differ among key demographics including race and age. Multivariate models, controlling for demographic factors, suggest that contextual factors are key to understanding why men mix sildenafil with club drugs, although age may still be an important issue to consider. Of particular importance is the fact that use of club drugs in combination with sildenafil is strongly associated with circuit and sex parties, where a centerpiece of these environments focuses on sexual exchange. These models imply interplay between person-level and contextual factors in explaining drug use patterns and further indicate that interventions aimed at addressing illicit substance use must carefully consider the role of environmental factors in explaining behavior.

Topics: Bisexuality; Cocaine; Drug Combinations; Homosexuality, Male; Humans; Illicit Drugs; Ketamine; Leisure Activities; Male; Methamphetamine; N-Methyl-3,4-methylenedioxyamphetamine; Piperazines; Purines; Sildenafil Citrate; Sodium Oxybate; Substance-Related Disorders; Sulfones

In the current study, a qualitative approach was used to investigate relevant beliefs and norms associated with sildenafil citrate (Viagra) consumption, initiation, and perceived consequences. Focus groups were conducted with 43 young men aged 18 and 19 years who identified themselves as lifetime sildenafil citrate users. The majority of focus group participants believed that "curiosity" and "peer pressure" contributed to their initial use. Most revealed that they first heard about sildenafil citrate from television advertisements, family members, friends, or sporting events, and they were able to obtain the drug from their friends and family members or they stole it from their father or grandfather. These findings may highlight the relative importance of exposure to prescription drug messages among those to whom the message is not specifically targeted, that is, young men. It is possible that the sildenafil citrate television messages are recalled by not only older male audiences but also by teenagers and younger men, producing similar cognitive processing and curiosity in both age cohorts.

Topics: Adolescent; Advertising; Erectile Dysfunction; Exploratory Behavior; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Male; Peer Group; Piperazines; Purines; Qualitative Research; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Texas; Young Adult

This study examined the ways by which patients obtain nonprescription sildenafil and the patient predictors associated with nonprescribed use.. We conducted this descriptive study by distributing an anonymous questionnaire to 231 male sildenafil users (ages 18 to 80) between December 1, 2002 and April 30, 2003 at outpatient Family Medicine and Urology Clinics at The Brooklyn Hospital Center, Brooklyn, NY. Patients were divided into 2 groups: those with erectile dysfunction (as defined by their physician) and those without.. The prevalence of erectile dysfunction in our total study population of sildenafil users (n=231) was 40.3% (n=93); 59.7% (n=138) did not have erectile dysfunction. Of those without erectile dysfunction, 76% (n=105) admitted to cannabis use, compared with 7.5% (n=7) of the subjects with erectile dysfunction. Patients without erectile dysfunction and history of cannabis abuse reported obtaining sildenafil from friends and street vendors significantly more often than non-cannabis users with erectile dysfunction (54.3%, n=57 vs 9.3%, n=8; P<.0001).. Illicit use of cannabis is a strong predictor of recreational sildenafil use among patients without erectile dysfunction.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adolescent; Adult; Aged; Aged, 80 and over; Drug Synergism; Erectile Dysfunction; Humans; Libido; Male; Marijuana Abuse; Middle Aged; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones

Few studies of erectile dysfunction (ED) medications use among heterosexual drug using or abusing men have been conducted. The aims of this study were to provide information on ED medication use prevalence, method of acquisition, and sexual effects among men seeking substance abuse treatment. A single time point cross-sectional anonymous survey was completed by 297 men over the age of 18 seeking substance abuse treatment at an outpatient clinic at a Veterans Affairs Medical Center in the Pacific Northwest. Mean age of participants was 49.7 years and 59.4% self-identified as Caucasian. Alcohol (56.7%) and cocaine (26.1%) were the primary drugs of abuse. Lifetime use of ED medications was reported by 24% (95%CI = 8.6%, 39.4%) of men. Almost 69% of ED medication users reported obtaining ED medications from a physician. Fifty-nine percent of ED medication users reported taking the medications to enhance their sexual experience rather than to treat ED, which was marginally associated with stimulant use (OR = 3.86, 95%CI = 0.96, 15.54, p = .057). These results add to an emerging recognition of the need to address the health implications of ED medication use among heterosexual drug using populations.

Topics: Adolescent; Adult; Cross-Sectional Studies; Drug Therapy; Erectile Dysfunction; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Surveys and Questionnaires

Topics: Female; Humans; Male; Patient Education as Topic; Phosphodiesterase Inhibitors; Piperazines; Purines; Sexual Behavior; Sexually Transmitted Diseases; Sildenafil Citrate; Substance-Related Disorders; Sulfones

There is evidence that methamphetamine and sildenafil (Viagra) use are associated with sexual risk behaviour among men who have sex with men (MSM). We investigated the association of methamphetamine, sildenafil, and other substance use with unprotected receptive and insertive anal sex among MSM by conducting an encounter specific analysis.. Data were from a cross sectional, community based survey of MSM in San Francisco regarding behaviour during their most recent anal sex encounter. Mulitvariate regression analysed independent associations of specific substance use and demographic variables with unprotected anal sex behaviours.. The sample (n = 388) was diverse in race/ethnicity, age, income, education, HIV status, and homosexual/bisexual identification. More than half (53%) reported unprotected anal sex, including insertive (29%) and receptive (37%) during their most recent anal sex encounter; 12% reported unprotected insertive and 17% reported unprotected receptive anal sex with an HIV discordant or unknown partner. Methamphetamine was used by 15% and sildenafil was used by 6% of the men before or during the encounter; 2% used both drugs. In multivariate analysis controlling for demographic factors and other substance use, methamphetamine use was associated with unprotected receptive (odds ratio (OR), 2.03; 95% confidence interval (CI), 1.09 to 3.76) and sildenafil use was associated with unprotected insertive (OR, 6.51; CI, 2.46 to 17.24) anal sex. Effects were stronger with HIV discordant or unknown sex partners specifically.. Encounter specific associations of methamphetamine and sildenafil use with unprotected receptive and insertive anal sex, respectively, indicate the importance of assessment specificity and tailoring risk reduction efforts to address certain drugs and sexual behavioural roles among MSM.

Topics: Adolescent; Adult; Aged; Condoms; Cross-Sectional Studies; Homosexuality, Male; Humans; Male; Methamphetamine; Middle Aged; Multivariate Analysis; Phosphodiesterase Inhibitors; Piperazines; Prevalence; Purines; San Francisco; Sexual Partners; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Unsafe Sex

Viagra use among British nightclubbers, a sentinel population of illicit drug users, was first reported in 1999. There has since been little attention paid to the evolution of patterns of non-prescribed use, apart from among men who have sex with men. Beginning in 1999 an annual survey has been conducted with a specialist dance music magazine, permitting cross-sectional comparisons over time. Rising levels of lifetime and current use prevalence and data on patterns of both male and female use are reported, along with elevated prevalence levels among both gay men and women. Experimentation with Viagra appears increasingly to have become established among British nightclubbers who use recreational drugs. Ethnographic and epidemiological study and monitoring of adverse consequences is now needed to fully appreciate reasons for use and the extent of possible harms.

Topics: Adult; Cross-Sectional Studies; Female; Health Surveys; Humans; Male; Piperazines; Prevalence; Purines; Sexual Behavior; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Time Factors; United Kingdom; Vasodilator Agents

The objective of the study was to examine correlates of sexual risk behavior among men who have sex with men (MSM) traveling for leisure.. MSM (N = 304) visiting popular tourist areas completed a brief survey assessing sexual behavior and substances used while on vacation, including the use of erectile dysfunction medications (e.g., Viagra).. Forty-seven percent of the respondents were sexually active during their vacation, with a mean of 1.33 unprotected anal sex acts during their brief stay (mean = 3.6 days). More than half of the sexually active men reported sex with a partner of unknown HIV status. Individuals reporting substance use or taking erectile dysfunction medications reported higher rates of sexual risk behaviors.. Many MSM travelers report behaviors that may put their health at risk, including substance use and unprotected sexual activity. Interventions designed to reduce risk behaviors among MSM tourists are needed.

Topics: Adult; Delaware; Florida; HIV Infections; Homosexuality, Male; Humans; Male; Piperazines; Purines; Risk-Taking; Sexual Behavior; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Surveys and Questionnaires; Travel

We surveyed 234 sexually active males aged 18-25 years about erectile dysfunction (ED). Thirteen percent reported ED, but rarely discussed this with medical providers; 25% reported ED occurring with condom use, which was associated with risky sex. Six percent used ED medications, rarely under medical supervision, and often mixed with recreational drugs.

Topics: Adolescent; Adult; Comorbidity; Erectile Dysfunction; Humans; Male; Odds Ratio; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Vasodilator Agents

To examine the use and correlates of the use of prescription drugs that may affect sexual behavior among HIV-positive gay and bisexual men.. In a cross-sectional assessment of baseline data from a behavioral intervention, we recruited 1168 HIV-positive gay and bisexual men in 2000-2001 from community venues in New York City and San Francisco, and determined the point prevalence of the use of viagra, testosterone, and antidepressants. We examined bivariate and multivariate associations between the use of each drug and demographics, health status, substance use, psychological symptoms, and sexual risk.. The current use of antidepressants was 21%, testosterone 19%, and viagra 12%. Some viagra users reported using drugs that could interact dangerously with viagra. The use of viagra, testosterone, or antidepressants was related to unprotected receptive anal intercourse and unprotected insertive oral intercourse (UIOI) with both HIV-positive and HIV-negative/unknown-status casual partners. The use of viagra was also associated with unprotected insertive anal intercourse. In multivariate models, viagra use was associated with being older, more educated, using ketamine, and engaging in UIOI with HIV-negative/unknown-status casual partners. Testosterone use was associated with being more educated and using nitrites (poppers). Antidepressant use was associated with race, using poppers, and being more depressed.. Prescription medications used by HIV-positive men can have unintended negative effects such as drug interactions or associations with risky sexual behavior, particularly a drug such as viagra that is fast acting, short lasting, and provides a desirable effect. Physicians should discuss these issues with patients when prescribing, and interventions should address these challenges.

Topics: Adult; Antidepressive Agents; Bisexuality; Cross-Sectional Studies; Depressive Disorder; Drug Interactions; Drug Prescriptions; Erectile Dysfunction; Health Status; HIV Seropositivity; Homosexuality, Male; Humans; Male; Multivariate Analysis; New York City; Phosphodiesterase Inhibitors; Piperazines; Purines; Regression Analysis; Risk Factors; San Francisco; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Testosterone

Topics: Comorbidity; Humans; Male; Piperazines; Purines; Risk-Taking; Sexual Behavior; Sexually Transmitted Diseases; Sildenafil Citrate; Substance-Related Disorders; Sulfones

The objective of this study was to examine sildenafil (Viagra) use and its relationship to sexual risk behavior for HIV and sexually transmitted diseases among men who have sex with men (MSM).. A population-based telephone sample of MSM in San Francisco was interviewed about sexual behavior, substance use, HIV and health status, and demographic characteristics.. Recent Viagra use was reported by 29% of the sample and was associated with HIV serostatus, greater numbers of male sexual partners, higher levels of unprotected anal sex, and higher levels of illicit recreational drug use. Viagra use was not associated with age, race, or socioeconomic status.. Viagra use appears to have become a stable fixture of the sexual culture of MSM, crossing age, race, and socioeconomic subgroups. Its use is associated with a general behavioral risk pattern for HIV/STD transmission.

Topics: Health Status; HIV Infections; Homosexuality, Male; Humans; Interviews as Topic; Male; Piperazines; Population Surveillance; Purines; Risk-Taking; Sildenafil Citrate; Substance-Related Disorders; Sulfones; United States; Unsafe Sex; Urban Population

Given the potential for Viagra (sildenafil) use to foster greater friction during sex (owing to enlarged erection size) and prolonged sex, the recreational use of this substance warrants investigation in the context of STI risk. Thus, an exploratory study was conducted to identify bivariate correlates of recreational (non-prescription) Viagra use among men who have sex with men (MSM) attending a popular sex resort for men located in the southern United States.. A cross sectional study was conducted. Behavioural measures, including Viagra use, were assessed using a 3 month recall period.. Of 164 men asked to participate, 91% completed a self administered questionnaire. Men resided in 14 states, most of which were located in the southern United States. Their average age was 40 years. Most (93%) men self identified as white. The median annual income interval was $25,000 to $50,000. One sixth (16.7%) reported being HIV positive. 16% reported using non-prescription Viagra. Age (p=0.41), income (p=0.32), and HIV serostatus (p=0.85) were not associated with Viagra use. Of men recently using ecstasy during sex, 35% reported Viagra use compared to 13% among those not using ecstasy (p=0.01). Of men recently using cocaine during sex, 37% reported Viagra use compared to 13% among those not using cocaine (p=0.009). Use of "poppers" approached, but did not achieve, statistical significance as a correlate of Viagra use (p=0.06). Recent frequency of unprotected anal sex (p=0.79), fisting (p=0.10), rimming (p=0.64), and having five or more sex partners (p=0.09) were not associated with Viagra use.. Recreational Viagra use was relatively common among men, regardless of age or HIV serostatus. Viagra use was associated with men's substance abuse behaviours rather than their sexual risk behaviours.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Adult; Cross-Sectional Studies; Georgia; Homosexuality, Male; Humans; Male; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Unsafe Sex

Topics: Drug Interactions; Humans; Male; Patient Education as Topic; Piperazines; Purines; Sexual Behavior; Sildenafil Citrate; Substance-Related Disorders; Sulfones

This case report describes four cases of substance abusers with sexual dysfunction, three of them with erectile dysfunction, and the fourth with erectile dysfunction and ejaculatia praecox. They were treated with sildenafil and their condition improved. There is a need to examine more fully the problem of sexual dysfunction in patients reporting for the treatment of addictions, given that it appears that their problem can be treated.

Topics: Erectile Dysfunction; Humans; Male; Piperazines; Purines; Sildenafil Citrate; Substance-Related Disorders; Sulfones; Treatment Outcome; Vasodilator Agents