With the expansion of regulated online gambling in North America, risks associated with problem gambling are getting more attention. Side effects of prescription medications that may result in people experiencing harm from gaming are part of that increased awareness.
Commonly used to treat Parkinson’s Syndrome and Restless Legs Syndrome (RLS), the drug Ropinirole has been linked to issues with gambling, including costly binges. As with any other medication, medical professionals and users must be aware of the risks and weigh those against the potential benefits.
Ropinirole’s connection to problem gambling
According to the US National Institutes of Health, Ropinirole is a dopamine agonist by classification. Practitioners often prescribe the drug to people experiencing symptoms of Parkinson’s and RLS because the theory is that they lack a healthy amount of dopamine, and the drug can bring those levels up to a normal level.
Dopamine is the “reward” chemical in the human brain, associated with elation and excitement. For people with healthy levels, it is associated with enjoyable activities and is the reason why gambling feels fun.
The Cleveland Clinic lists “new or increased gambling urges” among possible side effects of the medication. Other research has confirmed a connection between dopamine agonists and problem gambling.
Scholarship on drug-induced gambling issues
There is significant research on the connection between disordered gambling and dopamine agonist drugs. One of the foremost studies appeared in the Pharmaceutical Medicine journal in January 2023.
In the study, the authors determined that “since reward-related learning is mediated by dopamine, it can be altered by dopaminergic medications, possibly leading to increased gambling behavior and a decreased impulse control.” The authors acknowledged that “a causal relationship between the medications and GD (gambling disorder) seems likely, but the molecular mechanisms behind this association have not been fully described yet.”
The study names Ropinirole as one of the dopamine agonists in question. However, it does not address the scale of the drug-induced gambling disorder issue in North American populations.
Yet more research points to the correlation needing further attention from medical professionals.
Growing prevalence of dopamine agonists
At the same time that authors released the paper on drug-induced gambling disorder, a separate paper that surveyed Parkinson’s Disease diagnoses also surfaced. The January 2023 edition of the NPJ Parkinson’s Disease journal contained a study that posited that diagnoses were actually 50% higher than previous estimates.
While Parkinson’s is a primary use for Ropinirole, RLD may be a more prominent health concern. The Cleveland Clinic estimates that as much as 10% of the US population deals with RLS.
Regardless of the factors behind using the drug, concerns about its potential to induce disordered gambling are more than theoretical.
Settlement shows gravity of drug-induced gambling harm
According to Ben Mitchell of the Independent, a man in the United Kingdom won a 70,000-pound settlement in early December after convincing a court that a gambling binge he went on was due to his use of Ropinirole to treat his RLD. While the man had been a casual gambler prior to beginning to take Ropinirole, he said that his gambling “spiraled out of control” after starting the drug.
Such cases have been rare but showcase potential liability for practitioners who prescribe dopamine agonists. The man’s story also highlights precautions that people who use drugs like Ropinirole should take.
Confronting the risk of drug-induced gambling disorder
The accusation that led to the UK settlement involved the practitioner’s alleged failure to discuss the risk of compromising the patient’s impulse control while taking Ropinirole. Clearly, some primary interventions involve discussions between patients and practitioners about patients’ gambling habits before beginning usage of a dopamine agonist, along with ensuring that patients understand the risks associated with gaming.
For people who proceed in taking drugs like Ropinirole, it could be advisable to take extra precautions if they also choose to gamble while taking such medications. However, issues with gambling alone may not be sufficient reason to discontinue the use of Ropinirole.
Disordered gambling is a layered issue
The 2023 Pharmaceutical Medicine study continues to caution people who take dopamine agonists against a broad prohibition of the drugs.
More research is needed in order to fully outline the clinical picture of GD developing in patient groups with dopaminergic medications, and data are needed on the differentiation of risk in different compounds. In addition, very few interventional studies are available on the management of GD induced by dopaminergic medications. While GD overall can be treated, there is need for treatment studies testing the effectiveness of tapering of the medication or other gambling-specific treatment modalities in these patient groups.
In simpler terms, Ropinirole may trigger problem gambling behavior, but whether it is the sole cause of such behavior is unclear. There are other factors behind disordered gambling, like concurrent mental health issues and attitudes toward gaming.
Treatment for disordered gambling should be comprehensive and address all factors, even for people who use dopamine agonists. While reducing or pausing intake of Ropinirole and similar drugs may be part of those interventions, doing so may not prove sufficient to circumvent the undesirable behavior.
Disordered gambling can be as much of a challenge to some people’s health as Parkinson’s or RLD. That is why gamblers and medical professionals must be aware of the connection and act accordingly.
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