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 3 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.
Transcript:
JUANA SUMMERS, HOST:
There is new evidence that drugs like Ozempic can reduce a person’s risk of addiction. A large study found that people who started taking GLP-1 drugs for weight loss or diabetes were less likely to misuse substances ranging from alcohol to opioids. NPR’s Jon Hamilton has more.
JON HAMILTON, BYLINE: When millions of Americans began taking GLP-1 drugs a few years ago, Dr. Ziyad Al-Aly began to get some intriguing reports from patients.
ZIYAD AL-ALY: Dr. So-and-so started me on Ozempic for diabetes or for weight loss, and all of a sudden, I don’t care for alcohol anymore, or I stopped smoking.
HAMILTON: Al-Aly is an epidemiologist at WashU Medicine and VA St. Louis Health Care System. He knew that some small studies had suggested that GLP-1 drugs really did help with certain addictions. So he and a team analyzed data on more than 600,000 people in the VA system over a three-year period. All of them had Type 2 diabetes, but Al-Aly says those treated with GLP-1 drugs experienced a welcome side effect.
AL-ALY: They had less risk of developing substance use disorders across several addictive substances, including opioids, cocaine, nicotine, alcohol, cannabis and other substances.
HAMILTON: The risk was about 15- to 20% lower for most of these substances. Al-Aly says the team also looked at a group with a history of addiction. For these people…
AL-ALY: Being on a GLP-1 (ph) reduced the risk of drug-related death, drug overdose, drug-related hospitalization and suicidal attempts.
HAMILTON: Although VA patients are mostly older men, a separate analysis of women and younger men found a similar benefit. Al-Aly says GLP-1 drugs seem to work by reducing the hormone dopamine in what’s known as the brain’s mesolimbic system.
AL-ALY: That is the center of the brain that is responsible for reward-signaling – motivation, stress – and that is a center that is co-opted or hijacked, if you will, by addiction.
HAMILTON: The results appear in The BMJ, a medical journal. But experts say they want to know more before recommending widespread use of GLP-1 drugs to treat addiction. Dr. Klara (ph) Klein is an endocrinologist at the University of North Carolina at Chapel Hill.
KLARA KLEIN: You have to understand that these are not medicines that have been tested in people who don’t have overweight and obesity or don’t have Type 2 diabetes.
HAMILTON: Klein says GLP-1 drugs have revolutionized treatment of those conditions. For addiction, though, she’s waiting to see results from several large controlled trials. Klein says these studies will show how GLP-1 drugs affect people who have a substance use disorder but are otherwise healthy.
KLEIN: People will likely lose weight. We have to do that safely. It can cause bad GI side effects that could cause complications. So what that means is that we also need to do the bigger trials to understand the populations that can benefit the most.
HAMILTON: Klein says the trials should also start to answer questions like how long people with substance use disorder need to take a GLP-1 drug.
KLEIN: My hope is that we’ll figure out ways that a young person that goes on a therapy – that they won’t have to be on a medication for the rest of their lives.
HAMILTON: If GLP-1 drugs do pan out, though, the impact could be huge for nearly 50 million Americans with substance use disorder. Dr. Lorenzo Leggio, an addiction expert at the National Institutes of Health, says now there’s a different treatment for each sort of addiction.
LORENZO LEGGIO: We have a lot of hope that these medications, if proven to be effective via controlled trials, may be helpful for multiple addictions.
HAMILTON: Leggio says that would make it much simpler to treat the majority of people who have substance use disorders.
LEGGIO: It’s rare to see a patient who will only be addicted to one drug as opposed to using multiple drugs at the same time.
HAMILTON: In the future, Leggio says, these people may be treated with a single medication.
Jon Hamilton, NPR News.
(SOUNDBITE OF CLIF SOULO’S “THE WONDERFUL MIND OF A BLACKAMOOR EXPERIENCE”)