GLP-1 diabetes medications lower risk of all kinds of substance use disorders, study finds

People who took GLP-1 medications had a lower risk of developing all kinds of drug and alcohol addictions.

By Lauren J. Young edited by Tanya Lewis

From online forums to clinics, people have reported that diabetes medications and weight loss medications such as Ozempic and Wegovy can significantly quell their compulsive behaviors, including cravings for alcohol and nicotine. The flurry of anecdotes has sparked a wave of preliminary trials and one-off studies that have mostly studied specific substance use disorders individually. But researchers have not yet grasped the magnitude of these effects.

Today, a large epidemiological study published in the BMJ suggests that glucagonlike peptide 1 (GLP-1) medications, as these drugs are called, reduce the risk of all kinds of substance use disorders, including those involving alcohol, nicotine, cannabis, opioids, and cocaine. Not only do GLP-1 drugs appear to prevent people from developing these addictions, but they also decrease rates of life-threatening events, including overdoses and drug-related deaths.

Seeing reductions for each disorder, “I thought, ‘Is this real? because there’s nothing like it,” says clinical epidemiologist Ziyad Al-Aly, lead author of the study and chief of research and development at the U.S. Department of Veterans Affairs St. Louis Health System. “It’s a drug for obesity and diabetes; it’s not a drug for addiction. So the big surprise was: It worked consistently with all the substances.”

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The analysis followed more than 600,000 people with type 2 diabetes in the U.S. VA healthcare system for three years. Participants who took GLP-1 medications for diabetes were compared to those who took another diabetes treatment that had not been associated with reduced dependence. Among veterans without a history of substance use disorders, GLP-1 medications were associated with a 14% reduction in risk across all substance use conditions, with the largest decline (25%) seen in opioid use disorders.

The widespread preventive effects “didn’t surprise me, but it’s really good to see,” says Patricia “Sue” Grigson, a neuroscientist and addiction researcher at the Pennsylvania State University College of Medicine, who was not involved in the study. She also notes that the protective benefits took effect in the first year and persisted through the third year of observation.

The study also looked at people who already had a substance use disorder. These results were striking: Starting GLP-1 treatment was linked to a 31% reduction in emergency room visits related to substance use disorders, a 26% reduction in associated hospitalizations, a 39% reduction in overdoses, and a 25% reduction in suicidal ideation or attempts. Drug-related deaths have been reduced by 50 percent.

The link between GLP-1 and reduced drug-related deaths “is really powerful,” says Alex DiFeliceantonio, a neuroscientist who studies appetite at Virginia Tech and was not involved in the new research. This discovery is particularly interesting for treatments, she says.

It remains unclear exactly how GLP-1 drugs might reduce drug cravings and curb addiction. Al-Aly suggests this could be due to overlapping reward pathways in the brain.

“People who take GLP-1 medications often describe the quieting of ‘food noise,’ the constant mental chatter about food and eating,” he says. “I think something similar can happen with addiction: a quieting of what I think of as the ‘drug noise,’ the incessant craving that draws people back to a substance.”

New weight loss drugs mimic the gut hormone GLP-1, which increases insulin production and satiety. The hormone’s receptors are also found in the brain’s mesolimbic system, circuits that control reward, motivation, impulse control and stress, Al-Aly explains. These circuits are active in animal studies of addictions. If GLP-1 drugs act the same way on this brain circuit in humans, they “might actually blunt or curb cravings” of all kinds, he says. Further investigation of GLP-1 could reveal a “common biological pathway that underlies all addictions” – one that could potentially be drugged, he adds.

DiFeliceantonio notes that another important part of the mechanism likely lies in the gut: His team’s recent research suggests that the ability of GLP-1 drugs to slow digestion may also play a role in reducing alcohol consumption.

The new study’s population was largely made up of older, white veterans. A subset of women in the dataset, however, showed similar trends in reductions. The research also has not looked at different dosages or fully compared all types of GLP-1 drugs.

When it comes to GLP-1 drugs, “we really need to start figuring out which ones are the most effective and what the most effective dose is” for possible addiction treatments, DiFeliceantonio says. Previous studies provide some clues: Research has shown that different GLP-1 drugs are effective for alcohol use disorders, smoking, and opioid craving, even at low doses. Grigson is currently leading a multisite clinical trial testing Ozempic as a treatment for opioid use disorder.

“A few [GLP-1] “Medication will work better for some people than others,” Grigson says. “We still have a lot to learn about the proper diet.”

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