The Drug That Gambles for You
Dopamine agonists calm the tremors of Parkinson’s disease. In roughly one patient in six, they also switch on compulsions the patient cannot recognize as symptoms. Courts on three continents have been deciding who pays.
Didier Jambart, of Nantes, was a defense-ministry official, a local councillor, and a father of two. In 2003, he began taking a Parkinson’s medication from a class of drugs known as dopamine agonists. Within a few years, he had gambled away the family’s savings in online casinos, sold off possessions from the house, fallen into compulsive sexual behavior, and attempted suicide eight times. When the drug was withdrawn, all of it stopped. In November of 2012, an appeals court in Rennes ordered the manufacturer to pay him a hundred and ninety-seven thousand euros, raising the award granted at trial. The reasoning fit into a single sentence: the patient had never been effectively warned of a risk that medicine had known about for years.
Jambart’s story is not a curiosity from the borderland of medicine and law. It is the first widely known European chapter of a dispute that, in the United States and Australia, ran to hundreds of cases and ended in multimillion-dollar verdicts and settlements. Its protagonist is an entire class of drugs: dopamine agonists, prescribed for Parkinson’s disease and restless-legs syndrome, sold in many countries under many trade names, with ropinirole and pramipexole at the head of the family.
Parkinson’s disease kills the neurons that produce dopamine. Dopamine agonists mimic the missing chemical and ease the tremor, but dopamine does not govern movement alone. It is also the currency of the brain’s reward system: the same circuitry on which cocaine and slot machines operate. The drug cannot tell the receptors responsible for a steady hand from the receptors responsible for temptation. It stimulates both.
In a subset of patients, the result is what the literature calls impulse-control disorders: pathological gambling, compulsive shopping, binge eating, hypersexuality. Three features recur. The risk climbs with the dose. The behavior usually subsides when the dose is reduced or the drug withdrawn, which physicians call a positive dechallenge. And, most important for the law, the disorder strips the patient of the capacity to recognize it. The sufferer does not experience his condition as a symptom; he experiences it as a series of his own decisions. A warning that its intended recipient is, by the very nature of the risk, unable to apply to himself has limited protective value. Most of the litigation in this field rests on that paradox.
The first reports linking dopamine agonists to gambling appeared in 2000, and systematic research soon established that these were not stray anecdotes. The largest study, known as DOMINION and published in 2010 in the Archives of Neurology by a team led by Daniel Weintraub, screened three thousand and ninety patients with Parkinson’s disease. Impulse-control disorders turned up in 13.6 per cent of them; among patients taking dopamine agonists, the figure approached seventeen per cent, and pathological or problem gambling alone affected five per cent. The risk was similar for pramipexole and ropinirole, and treatment with an agonist carried two to three and a half times the odds of developing the disorder. One detail rewards attention: the study was financed by one of the manufacturers of this class of drugs.
It is worth sitting with those numbers for a moment. Roughly one patient in six on a dopamine agonist develops compulsive behavior; one in twenty begins to gamble pathologically. In pharmacology, that is not an exotic risk. It is the kind of risk that ought to organize everything a company says about its product.
The history of the warnings, instead, is a history of delay. In the United States, the pramipexole label was not updated to mention compulsive behavior until 2005, five years after the first publications and after years of accumulating reports. That delay became the axis of the first great trial. In 2008, a jury in Minnesota awarded Gary Charbonneau, a pramipexole patient, $8.3 million, $7.8 million of it in punitive damages, for misrepresentation of the risks. Charbonneau’s own casino losses came to roughly two hundred and sixty thousand dollars; the rest of the verdict was the price of delay, since he had started the drug in 2002 and the warning arrived three years later. The manufacturer argued that the regulator had never demanded a label change and that the plaintiff’s gambling predated his treatment; the jury was unpersuaded. Among the plaintiffs who followed was a retired Wall Street trader who lost some three million dollars and learned of the 2005 label change only a year afterward, from a news item about a film director; it is hard to imagine a neater illustration of a warning that never reaches its addressee. A consolidated federal docket of several hundred lawsuits followed, much of it resolved in confidential settlements, and a parallel class action was filed in Canada. The American lesson has a second edge: the cases that failed were lost almost exclusively to the statute of limitations, as in the widely noted ruling against a professor who waited too long to sue. In these disputes, time is an asset, not a decoration.
France added the European precedent in Jambart’s case, which concerned ropinirole directly. Australia supplied the collective dimension: in 2015, a federal court approved a confidential, multimillion-dollar settlement between the maker of cabergoline and a hundred and seventy-two patients who had fed poker machines with hundreds of thousands of dollars between 1996 and 2010; two years earlier, other manufacturers had settled a parallel case over pergolide with thirty-two patients. Parkinson’s UK estimated at the time that just under a fifth of patients on dopamine agonists would develop some form of these compulsions.
Italy is the most instructive jurisdiction, because it has ruled both ways. In 2021, the Milan court of appeals upheld a judgment ordering the maker of pergolide to pay a patient roughly four hundred and eighty-four thousand euros in damages after compulsive gambling consumed his estate. In the same period, suits concerning ropinirole were dismissed, and the dismissals held on appeal: not because the courts denied the drug’s risks but because the plaintiffs could not prove causation in their individual cases. The Italian lesson is simple and universal. In these cases, neither the label nor the statistics wins. What wins is proof of causation in one particular human being.
Polish courts have yet to publish a judgment on impulse-control disorders caused by dopamine agonists, which means that the first well-prepared cases will mark the trail. The legal architecture is ready. Poland’s strict-liability regime for dangerous products, codified in Article 449(1) of the Civil Code, requires no proof of the manufacturer’s fault, and a product’s safety is judged in part by the way it was presented and the information given to the consumer. Alongside it stand liability on general tort principles and compensation for injury to health. Claims generally expire three years after the injured person learns of the harm and of who must answer for it, so the moment a physician first connects a patient’s behavior to the drug starts the clock. On the horizon is the European Union’s new product-liability directive of 2024, which, once transposed, will ease access to manufacturers’ files and soften the burden of proof in scientifically complex cases. Meanwhile, the official product information filed with Poland’s drug regulator still lists gambling addiction as an adverse reaction of unknown frequency, though the literature has for years put it at several per cent, with the whole family of impulse-control disorders in the double digits.
An injured patient in Poland also has two parallel fronts, because the manufacturer’s liability does not exclude claims against the casinos themselves. In a judgment of April 16, 2026, in Case C-440/23, the Court of Justice of the European Union confirmed that a consumer may demand restitution of lost stakes from an operator established in another member state where the games in question were prohibited in his country of residence; in Poland, where online casinos are a state monopoly, that covers nearly the entire foreign market. The same timeline that proves causation against the manufacturer prices the claim against the operator.
The greatest change, though, has come not in the statutes but in the evidence. Plaintiffs a decade ago reconstructed their compulsions from family testimony and bank statements. Today’s victim leaves behind a digital record of a resolution that experts could once only dream of: a casino account history with every spin logged to the second; a credit-registry file showing loan applications time-stamped at three and four in the morning; an electronic prescription history documenting the escalation of doses; even the logs of the protective locks the patient himself set up and then, in the grip of the compulsion, kept lifting for half an hour at a time. Laid on a single timeline against the medical file, such data can show precisely what the Italian plaintiffs could not: behavior that begins with the drug, intensifies with the dose, and stops when the dose comes down, in a person with no gambling history at all. Causation ceases to be a matter of belief and becomes a matter of reading.
For a patient on a dopamine agonist who suddenly discovers gambling, or shopping sprees, or any behavior previously foreign to him, the order of operations is fixed. First, a conversation with the treating physician about adjusting the therapy, because health precedes every claim, and a doctor’s contemporaneous note linking behavior to drug is also the most valuable evidence there is. Then, preservation of the record before it disappears: the full medical file and prescription history, the account histories at gaming operators, the credit-registry report, the bank statements. Reporting the adverse reaction to the national drug agency creates an official trace and feeds the safety system. And no waiting: the American cases lost to the calendar are a cheaper cautionary tale than one’s own.
Robert Nogacki – licensed legal counsel (radca prawny, WA-9026), Founder of Kancelaria Prawna Skarbiec.
There are lawyers who practice law. And there are those who deal with problems for which the law has no ready answer. For over twenty years, Kancelaria Skarbiec has worked at the intersection of tax law, corporate structures, and the deeply human reluctance to give the state more than the state is owed. We advise entrepreneurs from over a dozen countries – from those on the Forbes list to those whose bank account was just seized by the tax authority and who do not know what to do tomorrow morning.
One of the most frequently cited experts on tax law in Polish media – he writes for Rzeczpospolita, Dziennik Gazeta Prawna, and Parkiet not because it looks good on a résumé, but because certain things cannot be explained in a court filing and someone needs to say them out loud. Author of AI Decoding Satoshi Nakamoto: Artificial Intelligence on the Trail of Bitcoin’s Creator. Co-author of the award-winning book Bezpieczeństwo współczesnej firmy (Security of a Modern Company).
Kancelaria Skarbiec holds top positions in the tax law firm rankings of Dziennik Gazeta Prawna. Four-time winner of the European Medal, recipient of the title International Tax Planning Law Firm of the Year in Poland.
He specializes in tax disputes with fiscal authorities, international tax planning, crypto-asset regulation, and asset protection. Since 2006, he has led the WGI case – one of the longest-running criminal proceedings in the history of the Polish financial market – because there are things you do not leave half-done, even if they take two decades. He believes the law is too serious to be treated only seriously – and that the best legal advice is the kind that ensures the client never has to stand before a court.
