What topics does this cannabis study cover?

This study covers research on: Addiction, Mental Health.

Where was this research published?

Published in Sexual medicine on August 28, 2026.

Older men with ED may face higher risks of substance misuse

Q: What did this research study find?

Among men aged **65 and older**, *erectile dysfunction* was associated with a higher risk of subsequent *cannabis* abuse or dependence diagnoses (HR **1.45**, 95% CI 1.10–1.92).

Erectile dysfunction and subsequent substance abuse: a retrospective cohort study of US non-academic hospitals.

Sexual medicine • August 28, 2026 • Moderately Relevant

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AI Summary

This large retrospective cohort study examined whether men diagnosed with erectile dysfunction (ED) were more likely to later receive diagnoses related to substance abuse or dependence. Researchers analyzed 323,838 adult men from US hospitals, matching men with ED to similar controls and following them for 3 years. Because this was an observational study based on medical records, the findings show associations rather than proof that ED causes substance use disorders.

The relationship varied by age. Among men aged 65 and older, ED was associated with higher risks of several substance-related diagnoses, including cannabis use disorders (HR 1.45), opioids, cocaine, and—most strongly—sedatives (HR 2.28). Men aged 40–64 also showed a modestly higher risk for cannabis and other psychoactive-substance diagnoses, while younger men showed protective associations for opioid and stimulant diagnoses. Clinicians may therefore consider age-specific screening and counseling, particularly for sedative and cannabis misuse in older men with ED.

💡 Key Findings

Among men aged 65 and older, erectile dysfunction was associated with a higher risk of subsequent cannabis abuse or dependence diagnoses (HR 1.45, 95% CI 1.10–1.92).

Good

75%

In the oldest age group, sedative abuse or dependence showed the strongest association with ED (HR 2.28), followed by risks involving other psychoactive substances, opioids, cocaine, and cannabis.

Good

75%

Men aged 40–64 with ED had increased risks of cannabis (HR 1.32) and other psychoactive-substance diagnoses, while younger men showed protective associations for opioid and stimulant diagnoses.

Good

70%

The authors recommend age-specific substance-use screening and counseling, especially when evaluating older men with ED; the study does not establish that ED directly causes substance misuse.

High

80%

📄 Original Abstract

Erectile dysfunction (ED) affects millions and is associated with cardiovascular disease, diabetes, and depression-conditions that share risk factors with substance use disorders. This study investigates the temporal relationship between ED diagnosis and subsequent substance abuse/dependence diagnoses across different age groups. This retrospective cohort study used the TriNetX database to identify adult males from US hospitals with ED diagnoses (ICD-10: N52) with at least 3 years of follow-up. Controls were propensity-matched 1:1 on age and race. Patients were stratified into three age groups (20-39, 40-64, and ≥ 65 years). Cox proportional hazards models assessed risk over a 3-year follow-up period. Primary outcome was any substance abuse/dependence diagnosis (ICD-10: F10-F19 categories); secondary outcomes examined individual substance categories. The study included 323 838 patients (161 919 with ED, 161919 controls) across three age strata. In men ≥65 years (n = 176 960), ED was associated with elevated risk for multiple substances. Sedative abuse/dependence showed the strongest association (HR 2.28, 95% CI 1.52-3.42, P < .001), followed by other psychoactive substances (HR 1.79, 95% CI 1.43-2.24), opioids (HR 1.58, 95% CI 1.27-1.95), cocaine (HR 1.60, 95% CI 1.26-2.04), and cannabis (HR 1.45, 95% CI 1.10-1.92) (all P < .05). The elderly cohort showed reduced overall risk (HR 0.86, 95% CI 0.82-0.89, P < .001), driven by protection against nicotine dependence (HR 0.71, 95% CI 0.68-0.75, P < .001). In men 40-64 years (n = 133 292), ED was associated with increased risk for cannabis (HR 1.32, P = .013) and other psychoactive substances (HR 1.21, P = .031), with protective effects for nicotine (HR 0.90, P < .001). Men 20-39 years (n = 13 586) showed protective associations for opioid (HR 0.53, P = .020) and stimulant abuse (HR 0.35, P = .003). Clinicians should maintain heightened awareness for substance abuse risk, particularly sedative misuse, when evaluating and treating elderly men with ED. Age-specific screening and counseling may be warranted. Strengths include large sample size and propensity matching. Limitations include potential selection bias, inability to assess treatment adherence, and database-specific coding variations. Elderly men with ED demonstrate significantly elevated risk for sedative, opioid, and cocaine abuse in the 3 years following ED diagnosis, while younger men show protective associations. These findings suggest a bidirectional relationship that warrants further investigation.

Paper Type

📄 Research

Publication

Journal: Sexual medicine
Published: August 28, 2026
PMID: 42666794
DOI: 10.1093/sexmed/qfag059

Authors (8)

Hossein A Zolfaghari Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
Juan Miguel Riestra Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
Aleksandar Popovic Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
Melissa Nanotkar Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
Diba Atar Department of Medical Education, Penn State University College of Medicine, Hershey, PA 17033, United States.
+3 more authors