People who took GLP-1 drugs had lower risk of all types of drug and alcohol addiction
A large epidemiological study of more than 600,000 veterans with diabetes suggests that GLP-1 weight loss drugs may reduce drug and alcohol-related overdoses and deaths.
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From online forums to clinics, people have reported that diabetes and weight-loss drugs like Ozempic and Vegovy can dramatically reduce their compulsive behaviors — including alcohol and nicotine cravings. The flood of anecdotes has led to a wave of preliminary trials and one-off studies that have examined specific substance use disorders individually. But researchers don’t understand how widespread the effects could be.
Now a large epidemiological study is published today bmj Suggest that glucagonlike peptide 1 (GLP-1) drugs – as these drugs are called –Reduce the risk of all types of substance use disordersWhich include alcohol, nicotine, cannabis, opioids and cocaine. GLP-1 drugs not only appeared to prevent people from developing these addictions, but they also reduced the rate of life-threatening events, including drug-related overdoses and deaths.
Seeing the reduction in each disorder, “I was like, ‘Is this real?’ Because there is nothing like that,” says clinical epidemiologist Ziad Al-Ali, lead author of the study and chief of research and development at the U.S. Department of Veterans Affairs St. Louis Health Care System. “It’s an obesity and diabetes drug; It is not an addictive drug. So the big surprise was: It worked consistently on all substances.”
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The analysis followed more than 600,000 people with type 2 diabetes in the US VA health care system for three years. Participants who took GLP-1 drugs for diabetes were compared with participants taking other diabetes treatments that were not associated with reduced addiction. Among veterans with no history of a substance use disorder, GLP-1 drugs were associated with a 14 percent reduced risk across all substance use conditions, with the largest drop — 25 percent — seen in opioid use disorders.
The broad preventive effects “didn’t surprise me, but it’s really nice 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 had an existing substance use disorder. Those results were surprising: Starting GLP-1 treatment led to a 31 percent reduction in substance-use-disorder-related emergency department visits, a 26 percent reduction in related hospital admissions, a 39 percent reduction in overdoses, and a 25 percent reduction in suicidal thoughts or attempts. Drug-related deaths decreased by 50 percent.
The link between GLP-1 and reductions in drug-related deaths is “really powerful,” says Alex DiFelicantonio, a neuroscientist who studies appetite at Virginia Tech and was not involved in the new research. She says this finding is especially fascinating for treatments.
Exactly how GLP-1 drugs can reduce drug craving and curb addiction is still unclear. Al-Aly suggests it may be related to overlapping reward pathways in the brain.
“People taking GLP-1 medications often describe the silencing of ‘food noise,’ the constant mental chatter about food and eating,” he says. “I think something similar is happening with addiction: the silencing of what I think of as ‘drug noise,’ that constant craving that draws people back to a substance.”
New weight loss drugs mimic the gut hormone GLP-1, which increases insulin production and satiety. Receptors for the hormone are also found in the brain’s mesolimbic system — circuits that regulate reward, motivation, impulse control, and stress, says Al-Aly. These circuits are active in animal studies of addiction. He says that if GLP-1 drugs work similarly on this brain circuit in humans, they could “really reduce or put the brakes on all types of cravings”. Further investigation of GLP-1 may reveal “a common biological pathway at the root of all addictions”—which may ultimately lead to drug addiction, he added.
DiFelicantonio says another important part of the mechanism probably lies in the gut: Recent research from his team suggests that the ability of GLP-1 drugs to slow digestion may also play a role in reducing alcohol consumption in people.
The population of the new study was largely older white male veterans. However, a subgroup of women in the dataset showed similar trends in reductions. The research did not examine different doses or fully compare all types of GLP-1 drugs.
When it comes to GLP-1 drugs for potential addiction treatment, “we really need to start figuring out what are the most effective drugs and what is the most effective dosage,” DiFelicantonio says. Previous studies provide some clues: Research has shown that various GLP-1 drugs have efficacy against alcohol use disorder, smoking And opioid cravings, even at low doses. Grigson is now leading a multisite clinical trial testing Ozempic as an opioid use disorder treatment.
“Some (GLP-1) medications are going to work better for some people than others,” says Grigson. “We still have a lot to learn about proper diet.”
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