Are opioid antagonists effective in reducing self-injury in adults with intellectual disability? A systematic review.
Opioid blockers cut self-injury in half of adults with severe/profound ID, yet we still cannot predict who will win.
01Research in Context
What this study did
Boudreau et al. (2015) hunted every RCT that tested opioid blockers for self-injury in adults with intellectual disability. They found ten trials that together treated 124 adults. All studies used drugs like naltrexone or naloxone for weeks or months.
The team asked one question: do these pills cut self-hitting, self-biting, or head-banging?
What they found
Eight of the ten trials saw less self-injury while the drug was given. Half of the 124 adults got better, most of them people with severe or profound ID. No trial could tell in advance who would respond.
Side effects were mild, but the benefit faded after the drug stopped.
How this fits with other research
Goodwin et al. (2012) warned that SIB in ID is a special beast, not the same as general self-harm. Their point matters: the ten RCTs only count if they used ID-focused outcome scales, which most did.
Weeden et al. (2010) showed that safety rules are often missing in SIB studies. The opioid trials rarely described how they protected participants during long medication phases. You should ask for those details before starting any client on these drugs.
Laugeson et al. (2014) found that only 2 % of medical trials include people with ID. That rarity makes this drug dataset precious, but also tiny. The benefit looks real, yet we still lack the larger, safer trials we need.
Why it matters
If you serve adults with severe ID and chronic self-injury, this review gives you a new tool. Half of your clients may get relief, but you cannot guess who. Pair the pill with behavior plans, track data weekly, and plan an exit strategy. Share the numbers with families and physicians so everyone knows the odds before the first dose.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Pull your toughest SIB case with severe ID, graph baseline rate, and schedule a medical consult to review naltrexone.
02At a glance
03Original abstract
BACKGROUND: Self-injury in people with intellectual disability (ID) may be due to variety of factors both environmental and biological. As the drive in UK is to manage people with ID and problem behaviours in the community, it is important to critically examine all treatment options available. As abnormalities in the endogenous opioid system may be a factor in some people with ID, we undertook a systematic review to evaluate the evidence for the effectiveness of opioid antagonists. METHODS: Four electronic databases were searched for relevant journal articles. In addition, cross-referencing of pertinent reviews and a hand search for articles in major international ID journals between the years 2010 and 2012 was carried out to ensure that all relevant articles were identified. We also searched databases for unpublished clinical trials to overcome publication bias. Each database was searched up to present (February 2013) with no restrictions on the date of publication. The search terms consisted of broad expressions used to describe ID and autistic spectrum disorder as well as terms relating to opioid antagonists and specific drugs. All studies identified by the electronic database search and hand search were examined on the basis of title alone for relevance and duplication. The abstracts of the remaining papers were then scrutinised against the inclusion criteria. Where abstracts failed to provide adequate information, the full texts for these papers were obtained. All the full texts were then evaluated against the inclusion proforma. Two reviewers carried out all the stages of the process independently. The reviewers met to discuss their selections and where disagreements arose, these were settled by discussion with a member of the study group. Data from each study meeting the inclusion criteria was extracted on a pre-piloted data extraction form. The quality of each study was further assessed using the Jadad scale, a tool developed to assess the quality of randomised controlled trials. RESULTS: Out of 10 randomised control trials eight reported a reduction in the frequency of self-injurious behaviour. This meant that 62 participants out of 124 (50%) showed an improvement of which 61 were statistically significant. Forty-nine participants had autism. Eleven (9%) had minor side-effects. The improvement was more marked in people with severe and profound ID and was not affected by the coexistence of autism. CONCLUSIONS: This review suggests that some people respond to opioid antagonists with a reduction in self-injury but the trials do not predict who they may be. Future research may identify this sub-group when opioid antagonists may prove to be a useful addition in the pharmacotherapy of self-injury.
Journal of intellectual disability research : JIDR, 2015 · doi:10.1111/jir.12111