When Erectile Dysfunction Drugs Are Overused and Abused




Where it comes to the business of erectile dysfunction (ED) drugs, it’s hard to argue with success. Pfizer’s best-selling little blue pill, Viagra, is a hallmark blockbuster in pharmaceutical marketing. Since its introduction in 1998, worldwide sales have amounted to about three-quarters of a billion dollars of revenue per year for its maker.

But there is also such a thing as too much success. Viagra, along with its prescriptive ED drug brothers Cialis and Levitra, is reportedly in overuse by men who are a far cry from the original intended patients. The original target consumers were to be men who were ill or who took certain other medications that precluded having a functional erection for sexual activity. In fact, many of the men who are really using it are young, in relatively good health and have no true ED diagnosis.

But there can be consequences to casual and unwarranted use of ED drugs. Initially, certain serious physical consequences of using these drugs included heart attacks and blindness. The former is now understood to be due to a poor interaction with nitrates, and the latter shows no statistically significant correlation. But a worrisome psychological cost is reportedly being paid.

Too young for Viagra

Age itself is not necessarily a factor that causes ED, but being older generally coincides with certain illnesses and medications that can limit or preclude altogether the relative turgidity of an erection.

ED drug marketing has handily picked up on this. Where it once was positioned as something for older men, the product spokesmen have since become decidedly younger.

When it first was introduced following Food and Drug Administration approval in 1998, the product’s advertising spokesperson was retired senator Bob Dole, then age 75. Just a few years later, in 2004, 37-year-old Texas Rangers first baseman Rafael Palmeiro became the spokesperson. Grampa’s ED suddenly became daddy’s.

But Pfizer may have been responding to the market as much as it was leading it. Marketing strategies are usually held close to the vest, so one can only speculate as to what the pharmaceutical giant intended. But it should be noted that according to market-tracking data, users of Viagra have skewed much younger than the septuagenarian set.

According to Express Scripts, Inc., a research firm that looks at pharmaceutical consumption, use among men aged 18-45 rose threefold from 1998 through four years later, in 2002. Looking at medical insurance claims forms of 5 million patients, firm spokesperson Tom Delate noted, “We tried to see if these patients had an underlying medical condition and we couldn’t identify one in the majority.” Delate says this suggests that Viagra is being used extensively for recreational rather than medical purposes.

Others as well have noted the phenomenon. Author Abraham Morgentaler, M.D., a urologist and associate professor at Harvard University, writes about unnecessary ED drug use in his book The Viagra Myth: The Surprising Impact on Love and Relationships. Morgentaler says he sees in his own practice, including among young men studying at Harvard, a desire to be superstuds, to have unfailing and star-quality erections on demand. This isn’t necessarily a good thing, he writes.

Problematic within a relationship and outside it

One such patient of Dr. Morgentaler was a successful, young Hollywood producer whose looks and position enabled him to attract beautiful women, including some A-list actresses. Viagra made it possible for the patient to perform like a champ in every sexual encounter, but things got a little more complicated when he settled down with one girlfriend. Their sex life was enviable and satisfying for both, with his refractory period (time required to achieve an erection following an ejaculation) minimal. But the first time he decided to skip taking Viagra, a disappointment occurred: He was able to have sex once but then couldn’t get it up for a second round a short time later.

A longer refractory period is perfectly normal, even for younger men. But he had set a higher standard — and his girlfriend noticed. Eventually, they talked about his use of the drug, which she hadn’t been aware of, and she took it as a sign that she wasn’t sufficiently attractive. His biggest fear was that without Viagra, he wasn’t the person his girlfriend knew and wanted.

This vignette is seen in doctors’ offices everywhere, but it’s a problem apart from how many men abuse ED drugs. A study presented at the American College of Clinical Pharmacology 35th Annual Meeting, (A. Polles et al., Use and Abuse of Erectile Dysfunction Drugs, University of Florida departments of Psychiatry, Neuroscience, Anesthesiology, Addiction Medicine and Community Health, September 18, 2006) found that among sexually compulsive men, in their twenties on up through their sixties, about half are frequent users of Viagra, Cialis or Levitra. Of those, about half obtain theirs through prescriptions, while others procure one drug or the other through Internet Web sites, friends or “other” means such as drug traffickers.

Although it was not measured, the study noted that sexual compulsivity coincides with illegal drug use (ecstasy, cocaine, ketamine and crystal meth, in particular). This surprises almost no one, as each of those drugs has a dampening effect (along with excess alcohol) on erectile function.

Another study, conducted in 2002 by the San Francisco Department of Health of gay male patients at an STD clinic, found a strong correlation between use of Viagra and higher rates of sexually transmitted diseases, including twice the incidence of HIV among ED drug users than among nonusers.

Neither of these studies proves causation. But the correlation in both suggests adverse outcomes in association with ED drugs.

Alternatives to erectile dysfunction drugs

Among men of all ages who experience erectile dysfunction, organic causes need to be investigated. True erectile dysfunction is looked on by cardiologists as a possible indicator of cardiovascular disease, and with younger patients who have poor lifestyle factors (tobacco use, excess alcohol) and who are obese, a request for an ED drug is reason to test for arterial function overall. Unfortunately, most requests for an ED prescription are made to general practice physicians, who largely comply with those requests without more than a brief conversation.

Not everyone in medicine thinks that’s a good thing. Dr. Andrew Weil (DrWeil.com) joins a chorus of other health professionals in addressing ED problems first with exercise, improved diet, limitation of alcohol and smoking cessation. But he also counsels that anxiety, depression and stress can play a role in ED.

Of course, following through on Dr. Weil’s advice takes work. And none of these behavioral fixes can happen as instantly as when one takes a little blue pill.

In The Viagra Myth, Dr. Morgentaler offers up his own perspective on having the primo hard penis. He cites case upon case of relationships where the predictable erection played a role — usually a positive for the man’s partner, and sometimes not — but that the relationship cannot and should not be fully defined by it. The Hollywood producer ultimately discovered his girlfriend was in love with him because he gave “respect, consideration and tenderness,” he says. “She already thought he was a sweetheart. [She] already loved [him] because of who he was; he just didn’t see it.”

In other words, men really are more than just their erections. But you would be hard pressed (pun intended) to see that in ED drug advertising.