Evidence is mounting that the wildly popular weight-loss medicines known as GLP-1s may also hold potential for treating addiction, and the field may be on the verge of obtaining desperately needed answers through more study.
The drugs, approved to treat diabetes and obesity as Ozempic, Wegovy, Mounjaro and Zepbound, are used by millions of Americans. They help people lose weight by working in both the gut and the brain, acting on digestion, insulin and appetite, helping quiet cravings and what users describe as “food noise.”
So named for the GLP-1 hormone they mimic, the medicines have also shown success in cardiovascular disease, heart failure, sleep apnea and kidney disease. Addiction may be one of their next frontiers, an area where only small fractions of patients currently receive medications as treatment.
“If these drugs turn out to be safe and efficacious for treatment of substance-use disorder, because they are so broadly used for other reasons in our society, they would just automatically, de facto, become the most widely prescribed pharmacotherapy for addiction,” said Dr. W. Kyle Simmons, a professor of pharmacology and physiology at Oklahoma State University who studies GLP-1s in addiction. “We don’t have all the data yet, but it’s sure trending in the right direction, and that is a hopeful sign.”
Much of the research on the medicines in addiction so far has been in animals, work that’s helped elucidate how they might act on reward systems in the brain. There have also been a number of studies examining impacts on addiction in real-world use of the drugs prescribed for other diseases, as well as countless anecdotes of people’s personal experiences.
And although some smaller clinical trials have added to the drugs’ promise in areas such as alcohol-use disorder, larger ones are needed to confirm their effect, said Dr. Daniel Drucker, a pioneer of GLP-1 research at the University of Toronto.
Those answers may finally be close, after a slower start for interest and investment in trials of GLP-1 drugs in addiction. Now, Simmons said, “it’s exploding, frankly. There are a handful of well-designed, well-powered [trials] that are going to be reading out in the next six months, specifically with alcohol-use disorder and GLP-1.”
A glimpse into the VA
Until then, studies such as a newly published analysis of medical records continue to add to the hope.
Using databases from the US Department of Veterans Affairs, researchers at the Washington University School of Medicine in St. Louis analyzed substance-use disorder outcomes among more than 600,000 people with type 2 diabetes. They were treated with either GLP-1 medicines or those in another class called SGLT2 inhibitors.
The study found that people using GLP-1 drugs were less likely to develop an array of substance-use disorders or to have bad outcomes – such as hospitalization or drug overdose – if they’d already been diagnosed with one. The study was published Wednesday in the BMJ.
“We’re talking about a diabetes and obesity drug; we’re not talking about an addiction drug here,” said Dr. Ziyad Al-Aly, a clinical epidemiologist and chief of the Research and Development Service at the VA St. Louis Health Care System, who led the study. “What’s surprising is the breadth and consistency of effect across all of these different substances.”
Al-Aly and his team compared the risk that people would be diagnosed with substance-use disorders related to alcohol, cannabis, cocaine, nicotine, opioids and others. They found that GLP-1 use was associated with about 7 fewer people per 1,000 developing any substance-use disorder over the study period of three years.
(CNN Health)
“One of the most promising aspects of these findings is the evidence for potential protective effects across several types of [substance-use disorder] in the same dataset,” said Dr. Christian Hendershot, director of clinical research at the USC Institute for Addiction Science, who wasn’t involved in the new research but has run trials of GLP-1s in addiction. He pointed specifically to the study’s findings on cocaine and cannabis-use disorder, “for which we don’t have medications currently.”
