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Efficacy of Opioid Antagonist in the Treatment of Pathological Gambling

9 August 2014


Background: Gambling is a legal form of entertainment in 48 states and is enjoyed by many. In Approximately 1% of the population, casual gaming can turn into pathological gambling (PG) resulting in devastating consequences. There are currently no guidelines or regulations for clinical providers regarding the most effective treatments of PG. Previous research has shown opioid antagonist to be effective in treating similar addictions such as alcoholism and heroin. How effective are opioid antagonist in the treatment of pathological gambling?

Methods: An exhaustive search of Medline-OVID, CINAHL, PSYCHINFO, Evidence Based Medicine Reviews Multifile, and Web of science using keywords: gambling, drug therapy, and narcotic antagonist. Limitations included studies in the English language and on humans. Articles pertaining to the area of interest were evaluated using GRADE.

Results: Three studies met inclusion criteria which are discussed in this systematic review. A randomized double-blind, placebo-controlled trial with 112 participants showed statistically significant reduction in gambling behaviors and urges with 18 weeks of treatment with naltrexone. Another randomized double-blind, placebo-controlled trial with 233 participants failed to show significant decrease in gambling behaviors and urges with 18 weeks of treatment with nalmefene compared. Finally, a case study showed complete cessation of gambling behavior and urges with intramuscular monthly injections of naltrexone.

Conclusion: Opioid antagonist drug naltrexone may be an effective option for treating pathological gambling whereas a similar drug nalmefene seems to be ineffective. Due to the low quality of evidence, effective injectable naltrexone effective dosing is undetermined.


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