Does marijuana use play a role in the recreational use of sildenafil?
It may, according to this study, which suggests that marijuana smokers use it to counteract cannabis’ effect on their libido.
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
| ALL SUBJECTS (N=231) | WITH ED (N=93) | WITHOUTED (N=138) | P-VALUE | |
|---|---|---|---|---|
| DEMOGRAPHICS | ||||
| Age (years) | ||||
| 18–30 | 17 (7.4%) | 2 (2.2%) | 15 (10.9%) | .03 |
| 31–40 | 56 (24.2%) | 1 (1.1%) | 55 (39.9%) | <.0001 |
| 41–50 | 68 (29.4%) | 19 (20.4%) | 49 (35.5%) | .02 |
| 51–60 | 38 (16.5%) | 25 (26.9%) | 13 (9.4%) | .001 |
| 61–70 | 35 (15.2%) | 29 (31.2%) | 6 (4.3%) | <.0001 |
| 71–80 | 17 (7.4%) | 17 (18.3%) | 0 (0.0%) | <.0001 |
| Health insurance | ||||
| Self-pay | 23 (10%) | 4 (4.3%) | 19 (13.8%) | .03 |
| Medicaid | 73 (31.6%) | 30 (32.3%) | 43 (31.2%) | .97 |
| Medicare | 17 (7.4%) | 15 (16.1%) | 2 (1.4%) | <.0001 |
| Private carriers | 118 (51.1%) | 44 (47.3%) | 74 (53.6%) | <.42 |
| Marital status | ||||
| Married | 107 (46.3%) | 56 (60.2%) | 51 (37.0%) | .001 |
| Unmarried | 92 (39.8%) | 14 (15.1%) | 78 (56.5%) | <.0001 |
| Divorced | 32 (13.9%) | 23 (24.7%) | 9 (6.5%) | <.0001 |
| Drug use | ||||
| Yes | 121 (52.4%) | 9 (9.7%) | 112 (81.2%) | <.0001 |
| No | 110 (47.6%) | 84 (90.3%) | 26 (18.8%) | |
| Marijuana use | ||||
| Yes | 112 (48.5%) | 7 (7.5%) | 105 (76.1%) | <.0001 |
| No | 119 (51.5%) | 86 (92.5%) | 33 (23.9%) | <.0001 |
| USE OF SILDENAFIL | ||||
| Purchased from a friend/street vendor | ||||
| Yes | 149 (64.5%) | 26 (28.0%) | 123 (89.1%) | <.0001 |
| No | 82 (35.5%) | 67 (72.0%) | 15 (10.9%) | |
| Sold to a friend | ||||
| Yes | 72 (31.2%) | 7 (7.5%) | 65 (47.1%) | <.0001 |
| No | 159 (68.8%) | 86 (92.5%) | 73 (52.9%) | |
| Increased dose without physician authorization? | ||||
| Yes | 150 (64.9%) | 40 (43.0%) | 110 (79.7%) | <.0001 |
| No | 81 (35.1%) | 53 (57.0%) | 28 (20.3%) | |
| SEXUAL PROBLEM | ||||
| Lack of desire/interest | 14 (6.1%) | 2 (2.2%) | 12 (8.7%) | .08 |
| Lack of erection/difficulty in achieving erection | 82 (35.5%) | 69 (74.2%) | 13 (9.4%) | <.0001 |
| Difficulty in performance/endurance | 59 (25.5%) | 4 (4.3%) | 55 (39.9%) | <.0001 |
| Difficulty in orgasm/ejaculation | 14 (6.1%) | 3 (3.2%) | 11 (8.0%) | .22 |
| Lack of desire/lack of erection | 29 (12.6%) | 13 (14.0%) | 16 (11.6%) | .74 |
| Lack of desire+difficulty with performance | 33 (14.3%) | 2 (2.2%) | 31 (22.5%) | <.0001 |
| ED, erectile dysfunction | ||||
TABLE 2
Where did 2 subsets of subjects obtain sildenafil?
| SOURCE | NO ED/CANNABIS USERS (N=105) | ED/NON-CANNABIS USERS (N=86) | P-VALUE |
|---|---|---|---|
| PCP/specialist | 12 (11.4%) | 75 (87.2%) | <.0001 |
| Over-the-counter* | 8 (7.6%) | 2 (2.3%) | .19 |
| Friends/street vendors | 57 (54.3%) | 8 (9.3%) | <.0001 |
| Internet | 28 (26.7%) | 1 (1.2%) | <.0001 |
| * Purchased without a prescription from a privately owned business (such as a convenience store). | |||
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
