There's new evidence that GLP-1 drugs like Ozempic can reduce the risk of addiction.
A study of more than 600,000 veterans followed for up to three years found that those who started taking a GLP-1 drug for diabetes were about 15% to 20% less likely to misuse substances ranging from alcohol to opioids.
The study, which appears in The BMJ, a medical journal, also found that GLP-1 drugs helped people with a history of substance use disorder. They were less likely to experience an overdose, drug-related hospitalization, drug-related death or suicide attempt.
"The surprise was that it was working across various substances," says Dr. Ziyad Al-Aly, an author of the study and a clinical epidemiologist at WashU Medicine in St. Louis.
That suggests a common "biologic signal" affected by GLP-1 drugs is involved in all addictive disorders, says Al-Aly, who also holds a position at VA St. Louis Health Care System.
The results suggest that GLP-1 drugs could offer a new option for the 48.4 million Americans with a substance use disorder.
But researchers caution that the study, though large, was not the sort of controlled clinical trial needed to confirm that GLP-1 drugs offer a safe and effective way to treat addiction. Results from several of those studies are expected in the coming year.
"We have a lot of hope that these medications may be helpful," says Dr. Lorenzo Leggio, an addiction researcher at the National Institutes of Health, who was not involved in the study.
"There's every reason to be incredibly enthusiastic," says Dr. Klara Klein, an endocrinologist at the UNC School of Medicine in Chapel Hill. "But these are not medicines that have been tested in people who don't have overweight and obesity, or Type 2 diabetes."
Unexpected benefit
The results come after smaller studies and research on animals suggested that GLP-1 drugs could reduce the cravings for specific substances, including alcohol and nicotine.
And ever since GLP-1 drugs began to reach millions of Americans seeking to lose weight or control diabetes, doctors have been hearing intriguing reports from certain patients.
"They would say, 'I don't care for alcohol anymore' or 'I stopped smoking,'" Al-Aly says.
So he and a team decided to see whether those anecdotes were supported by data from VA patients. The scientists compared people who got GLP-1 drugs for their diabetes with people who got drugs that use a different mechanism to control blood sugar levels.
The results: GLP-1 users without a history of substance abuse disorder were less likely to misuse substances including alcohol, nicotine, cannabis, cocaine and opioids. For most of these substances, the reduction in risk was in the 15% to 20% range.
Among people who did have a history of substance abuse, those who got a GLP-1 drug had a 25% to 50% lower risk for emergency departments visits, hospitalization, drug overdose, suicidal thoughts or attempts, and death.
Some medications, like naltrexone and buprenorphine, are used specifically to prevent relapse in people trying to recover from opioid use disorder. (Naltrexone is also used in alcohol use disorder.) But there's currently no other drug on the market that would do what GLP-1 drugs appear to do — prevent risk of addiction more generally.
GLP-1 drugs seem to fight addiction by reducing the hormone dopamine in a brain system involved in reward, motivation and stress — a system "that is co-opted or hijacked, if you will, by addiction," Al-Aly says.
Still some questions
In the past decade, GLP-1 drugs have revolutionized weight loss and diabetes treatment. But doctors are still learning how the drugs might affect, say, a person who is already thin and has alcohol use disorder.
"If they really stop drinking, they lose a lot of the calories that they intake from alcohol," Klein says. "That person might lose really a lot of weight and suffer nutritionally."
It's also unclear how long people with substance use disorder would need to take a GLP-1 drug.
"My hope is that we'll figure out ways that a young person won't have to be on a medication for the rest of their lives," Klein says.
Ongoing clinical trials will help answer those questions, Leggio says. And if they confirm that GLP-1 drugs are effective for treating addiction, he says, it could change the treatment landscape.
At the moment, he says, treatments tend to focus on a single substance, like alcohol or nicotine.
That's a problem, though, because "it's rare to see a patient only be addicted to one drug as opposed to using multiple drugs at the same time," Leggio says.
With GLP-1 drugs, he says, it may be possible to help these people with a single medication.
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