GLP-1s like Ozempic transformed weight loss and diabetes. Is addiction next? : NPR

People taking GLP-1 medications like Ozempic for diabetes were less likely to be diagnosed with a substance use disorder, a new study suggests.

Maria Fabrizio for NPR

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Maria Fabrizio for NPR

There is emerging evidence that GLP-1 drugs like Ozempic may reduce the risk of addiction.

A study of more than 600,000 veterans found that those who started taking a GLP-1 diabetes medication were about 15 to 20 percent less likely to abuse substances ranging from alcohol to opioids.

The study, which appears in The BMJa medical journal, also found that GLP-1 medications helped people with a history of substance use disorders. They were less likely to experience an overdose, drug-related hospitalization, drug-related death or suicide attempt.

“The surprise was that it worked with a variety of substances,” says Dr. Ziyad Al-Aly, study author and clinical epidemiologist at WashU Medicine in St. Louis.

This suggests that a common “biological signal” affected by GLP-1 medications is involved in all addictive disorders, says Al-Aly, who also holds a position at the VA St. Louis Health Care System.

The findings suggest that GLP-1 medications could provide a new option for the 48.4 million Americans suffering from a substance use disorder.

But researchers caution that the study, while large, was not the kind of controlled clinical trial needed to confirm that GLP-1 drugs offer a safe and effective way to treat addiction. Results from several of these studies are expected in the coming year.

“We have a lot of hope that these drugs can 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 excited,” says Dr. Klara Klein, an endocrinologist at UNC School of Medicine in Chapel Hill. “But these are not drugs that have been tested on people who do not suffer from overweight, obesity or type 2 diabetes.”

Unexpected profit

The findings come after smaller studies and animal research suggested that GLP-1 drugs could reduce cravings for specific substances, including alcohol and nicotine.

And since GLP-1 drugs began being administered to millions of Americans seeking to lose weight or control their diabetes, doctors have heard intriguing reports from some patients.

“They would say, ‘I don’t like alcohol anymore’ or ‘I stopped smoking,’” Al-Aly says.

So he and a team decided to see if these anecdotes were supported by data from VA patients. The scientists compared people who received GLP-1 drugs to treat their diabetes with people who received drugs that use a different mechanism to control blood sugar.

The results: GLP-1 users without a history of substance use disorders were less likely to abuse substances such as alcohol, nicotine, cannabis, cocaine and opioids. For most of these substances, the risk reduction was in the order of 15 to 20%.

Among people with a history of substance abuse, those who received a GLP-1 drug had a 25% to 50% lower risk of emergency room 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 the treatment of alcohol use disorder.) But there are currently no other drugs on the market that would do what GLP-1 drugs appear to do: prevent the risk of addiction more generally.

GLP-1 drugs appear to combat 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 like, by addiction,” says Al-Aly.

A few more questions

Over the past decade, GLP-1 drugs have revolutionized weight loss and diabetes treatment. But doctors are still learning how the drugs might affect, say, someone who is already thin and has an alcohol use disorder.

“If they really stop drinking, they lose a lot of the calories they consume through alcohol,” Klein says. “This person could lose a lot of weight and suffer nutritionally.”

It’s also unclear how long people with substance use disorders should take a GLP-1 medication.

“I hope we find ways so that a young person doesn’t have to take medication for the rest of their life,” Klein said.

Ongoing clinical trials will help answer these questions, Leggio says. And if they confirm that GLP-1 drugs are effective in treating addiction, it could change the treatment landscape, he says.

Currently, he says, treatments tend to focus on a single substance, like alcohol or nicotine.

It’s a problem, however, because “it’s rare to see a patient be addicted to a single drug instead of using multiple drugs at the same time,” Leggio says.

With GLP-1 drugs, he says, it might be possible to help these people with just one drug.