Opiate-Related Testicular Stem Cell Niche Toxic Pathology

The recent paper on the methadone- and buprenor- phine- related testicular toxicity (1) adds a detailed study to the gonadal toxicity of opiates given over the brief period of 15 days. The study mentions the divergent pub- lished views relating to opiate-induced hypogonadism, and rightly cites the importance of hypothalamic hypo- gonadism as the major background endocrine factor. The real importance of this study however lies in the place it occupies in our biological understanding of the testis as an important and well described stem cell niche environ- ment, and the place of the gonads in the panorama of opiate related organ-specific toxico pathological mecha- nisms. This latter effect was described by Web Appendix 6 of a report on the largest Australian opiate maintenance program with over 21 years of follow-up, documenting greatly elevated standardized mortality rates amongst decadents in the psycho neurological, pulmonary, he- patic, gastrointestinal and cardiovascular systems, and cancer- related disease (2), which strongly suggests accel- eration by opiates of age-related degenerative processes.