Opioid antagonists in broadly defined behavioral addictions: a narrative review

ABSTRACT

Introduction: Naltrexone (NTX), a mu-opioid receptor antagonist, has been approved for the treatment of alcoholism and opioid dependence. More recently, however, NTX and a related drug, nalmefene (NMF), have also shown positive results for the treatment of gambling disorders.

Areas Covered: In this study, we reviewed the trials testing the effect of opioid antagonists (OA) in gambling disorders and in other broadly defined behavioral addictions, including selected DSM-5 disruptive, impulse-control, and conduct disorders, obsessive-compulsive and related disorders, eating disorders, and other conditions not currently recognized by official classification schemes. We found six randomized controlled trials (RCTs) of OA in gambling disorder, two RCTs of OA in trichotillomania (hair pulling disorder), two RCTs of OA in binge eating disorder, and one RCT of OA for kleptomania. We also reviewed case reports on hypersexual disorder, compulsive buying and skin picking disorders.

Expert Opinion: The reviewed data supported the use of OA, namely NTX and NMF, in gambling disorder (both) and kleptomania (NTX). We did not find enough evidence to support the use of NTX or NMF in trichotillomania (hair pulling disorder), excoriation (skin-picking) disorder, compulsive buying disorder, hypersexual disorder, or binge eating disorder.

KEYWORDS:

• Behavioral addictions
• nalmefene
• naltrexone
• opioid antagonists

Article highlights

• In this study, we evaluated the effect of opioid antagonists in broadly defined (including nonofficial) behavioral addictions.

• We found evidence supporting the use of opioid antagonists in GD and kleptomania.

• However, evidence for the use of opioid antagonists in other ‘behavioral addictions’ is still insufficient.

This box summarizes key points contained in the article.

Declaration of interest

This work was supported by the Department of Psychiatry, Federal University of Rio De Janeiro. LF Fontenelle is supported by the National Council of Scientific and Technological Development (CNPq), Brazil and by the Research Foundation of the Rio de Janeiro State (FAPERJ). LF Fontenelle is a member of the WHO ICD Revision Working Group on the Classification of Obsessive-Compulsive Related Disorders, reporting to the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. The views expressed in this article are those of the authors and, except as specifically noted, do not represent the official policies or positions of the International Advisory Group, the Working Group on Obsessive-Compulsive Related Disorders, or the WHO. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.