Heroin Use and Sex: Some Patterns in Miami-Dade County, Florida

Much of the literature on heroin and opioid addiction holds that regular, long-term users of heroin and other opioids lose interest in sex as their drug using careers lengthen. Analysis of self-reports collected from IDUs in two crosssectional surveys on patterns of risk behavior in Miami-Dade County, Florida, reveals that large proportions of IDUs report using heroin before or during sex across a wide range of self-injection experience, from as little as twelve months to over 40 years. One half or more of respondents to both surveys reported using heroin in their recent sexual experiences, with similar proportions reported by both males and females. The same IDUs, however, tend not to report using prescription painkillers before or during sex. This finding indicates that co-occurring risk behavior related to both sexual behavior and heroin use may be more prevalent among long-term IDUs than previous literature has suggested. Florida Public Health Review, 2016; 13, 73-81. BACKGROUND Various studies have examined the relationship between drug use and sexual behavior (Benotsch et al., 2011; Johnson et al., 2013; Rawson et al., 2002; Ross & Williams, 2001), and their primary conclusion has been that opioids, both illicit ones such as heroin and prescription ones such as OxyContin, have a dampening effect on sexual desire or appetite. Some reports (e.g., Ross & Williams, 2001) attribute sexual stimulation to use of stimulants, such as methamphetamine or cocaine, but those that report primarily on the use of heroin and prescription opioids in connection with sexual behavior (Rhodes et al., 1998; Rigg & Murphy, 2013; Young et al., 2012) conclude that use of opioids results in loss of libido and impaired sexual performance. The literature on whether or not use of opioids enhances the sexual experience of opioid users is sparse, and much of what has been written focuses on how the drugs affect the sex drive and performance of long-term users. The existing literature also depends heavily on retrospective commentary by heroin users elicited while in treatment for addiction (Bang-Ping 2009; De Leon & Wexler 1973; La Pera et al., 2003; Palha & Esteves, 2002; Palha & Esteves 2008; Rawson et al., 2002). With the exception of their sexual experience during incipient heroin use (Palha & Esteves, 2008), consumers of heroin in most of these studies reported effects on sexual function that were consistently negative. Nevertheless, the notion that opioid drugs have quasiorgasmic effects, and that sexual pleasure can be enhanced by use of opioids in conjunction with sexual activity is actually old (Pfaus & Gorzalka 1987), dating back to the 1560s and the writings of Garcia D’Orta (Guerra, 1974). Physicians and early writers often likened the effects of opioids to sexual orgasm (John Jones quoted in Pfaus & Gorzalka 1987). These accounts make it clear that for a long time physicians and other people who commented on the effects of laudanum, morphine, and eventually heroin made a connection between the experience of sexual orgasm and the acute effects of large doses of opioid preparations. Pfaus and Gorzalka (1987), in their comprehensive review paper on this topic, distinguish between the effects of acute intoxication by opioids and the effects of long-term, regular use of these drugs. The sexual enhancement effects of opioids occurred in the reviewed studies primarily in opioid naïve or novice experimenters with this class of drug