Chapter: Basic & Clinical Pharmacology : Drugs of Abuse

Drugs of Abuse

Drugs are abused (used in ways that are not medically approved) because they cause strong feelings of euphoria or alter perception.

Drugs of Abuse

Drugs are abused (used in ways that are not medically approved) because they cause strong feelings of euphoria or alter perception. However, repetitive exposure induces widespread adaptive changes in the brain. As a consequence, drug use may become compulsive— the hallmark of addiction.

CASE STUDY

A retired accountant developed a tremor and slowing of movements and was diagnosed with Parkinson’s disease at age 67. At that time, his neurologist prescribed levodopa to restore dopamine levels. Two years later, motor symptoms start to fluctuate and the dopamine receptor agonist ropini-role is added to his treatment.∗ A few months later, he devel-oped a strong interest in gambling, first buying lottery tickets and then visiting a casino almost every day. He concealed his gambling activity until he had lost more than $100,000. When he came for a consultation 5 weeks ago, ropinirole was replaced with monoamine oxidase inhibitor therapy. He now reports that his interest in gambling has disappeared. Is there a link between the dopamine agonist treatment and gambling addiction?

CASE STUDY ANSWER

The patient was diagnosed with pathologic gambling sec-ondary to the dopamine agonist prescription. Compulsive behavior including gambling, binge eating, or hypersexu-ality is observed in about 15% of patients who receive dopamine agonist treatment. The condition is not related to Parkinson’s disease, as compulsive behaviors also occur in patients with restless legs syndrome who are treated with the same medication. The incidence with levodopa is lower, and compulsive behavior is sometimes preceded by dose escalation.

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Basic & Clinical Pharmacology : Drugs of Abuse : Drugs of Abuse |