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Introduction

Eating disorders affect up to 1%–2% of adolescents, and lead to significant morbidity (e.g., cardiac compromise, malnutrition, osteopenia, substance abuse) and mortality (Franko et al. 2018; Hail and Le Grange 2018). The onset of these disorders occurs during adolescence, making this period of development an important time to recognize and effectively intervene in an attempt to reduce associated poor health outcomes.

Although each eating disorder diagnosis is distinct, they share an element of compulsive behavior (restricting, purging, and/or binge eating). The opioid system is implicated in the reward circuit that drives compulsive behavior. Evidence from both animal and human studies describes the role of the reward circuit in food palatability (e.g., binge eating) and pleasure (e.g., purge behaviors) (Frank 2013; Heal et al. 2017).

Naltrexone, an opioid antagonist, has been used to treat binge eating and purging associated with eating disorders in adults (Jonas and Gold 1988; Raingeard et al. 2004). Few controlled studies have been conducted, and there remains uncertainty regarding effective doses and treatment durations (Mitchell et al. 1989; Alger et al. 1991; Marrazzi et al. 1995). Across all studies, very few adolescents have been included, and no studies looked specifically at this unique population (Raingeard et al. 2004). Consequently, the utility of naltrexone in adolescents with eating disorders is unknown. Few evidence-based pharmacologic treatment options exist for adolescents with eating disorders. This case series is the first to describe naltrexone utilization and response patterns in an adolescent eating disorder center.

Methods

This was a retrospective study of electronic health records for patients meeting inclusion criteria: prescribed naltrexone between 1/1/2010 and 09/30/2018 at a tertiary eating disorder center. There were no exclusion criteria. Data were captured from provider notes (diagnoses, reason for prescription, side effects, response, reason for naltrexone discontinuation), prescription records (naltrexone dose and duration), and laboratory results (liver function tests [LFTs] at baseline and at follow-up to assess for naltrexone safety). Tolerability was determined based on continued use by prescription refill, lack of documented naltrexone side effects, and CGI-I. Naltrexone response was assessed using the Clinical Global Impressions-Improvement (CGI-I) scale and was coded independently by two investigators (S.S. and W.A.). Discrepancies occurred in the rating of two participants and were...

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