A category of medication popular for treating diabetes and obesity may additionally reduce the danger of addiction — and help individuals who have already got one, A new study shows.
Semaglutide (also generally known as Ozempic), liraglutide and tirzepatide (Wegovy) belong to a category of medication called GLP-1 (glucagon-like peptide-1) receptor agonists. They mimic hormones involved in regulating blood sugar and appetite.
Interest in GLP-1s for addiction has grown previously decade, as some have prescribed them for diabetes or weight reduction in the event that they were drinking less alcohol or smoking less.
Animal studies suggested that these drugs may reduce cravings and reduce the danger of relapse. Larger studies using health records or Administrative data pointed to an analogous pattern.
This A new studypublished today within the BMJ, found that starting a GLP-1 drug reduced the danger of developing a brand new substance use disorder, including alcohol, cannabis, cocaine, nicotine and opioids, by 14 percent. Among individuals with a current substance use disorder, taking GLP-1 reduced substance-related hospital admissions by 26 percent.
What did the researchers do?
Researchers examined electronic health records from greater than 600,000 veterans with diabetes who were treated by the United States Department of Veterans Affairs.
The researchers compared the newly prescribed GLP-1 to a unique class of diabetes drugs called SGLT2 inhibitors (including empagliflozin and dapagliflozin) – a well-established treatment used as a comparator.
The study followed participants for 3 years, asking two questions:
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Among those with out a prior diagnosis of addiction, were those taking GLP-1 drugs less more likely to develop addiction?
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Among those that already had a substance use disorder, were those taking GLP-1 drugs less more likely to experience serious harms, corresponding to hospitalizations, overdoses, emergency department visits, or death?
The researchers used a technique called “target trial emulation,” which designs an observational study to mimic a randomized controlled trial as closely as possible.
In a randomized controlled trial, participants are randomly assigned to receive either the drug being tested or a comparison treatment. The two groups should be equivalent in all respects aside from their treatment. If one group does higher, we will be confident that the drug is the cause.
Observational studies work otherwise. No matter how fastidiously researchers attempt to account for differences corresponding to weight, age, and other health conditions, there may be at all times the likelihood that an unexplained factor explains the outcomes.
The goal trial emulation design used here is amongst one of the best methods available for observational data, nevertheless it cannot eliminate this problem. It can tell us that something is with higher results; It can’t prove that the drug these results.
What did they find?
With that caveat in mind, the outcomes were remarkable. Among those with out a pre-existing substance use disorder, those taking GLP-1 drugs were less more likely to develop one in each substance category tested:
- Alcohol, 18 percent lower risk
- Hemp, down 14%
- Cocaine, 20% less
- Nicotine, 20% less
- Opioids, 25% less.
This equates to about 1-6 fewer cases per 1,000 people over three years.
For those that already had a substance use disorder, the prescribed GLP-1 medication had higher outcomes in every measure:
- 31% fewer emergency department visits are related to their substance use disorder.
- 26% fewer hospital admissions
- 39% reduction in overdose
- 25% reduction in suicidal thoughts or attempts
- 50% less deaths.
This equates to about 1-10 fewer cases per 1,000 people over three years.
That these patterns hold in multiple substances and multiple outcomes makes them difficult to rule out.
But those associations remain, not evidence. Ongoing randomized trials will likely be vital to find out whether GLP-1 drugs truly cause these advantages, or whether something else is at work.
But these results may not apply to everyone.
The group was 90% male with a mean age of 65 years, so the outcomes may not generalize to women, younger people, or individuals with type 2 diabetes.
This group also had significant health complications. More than half (57%) were current or former smokers, greater than 40% had high cholesterol, and plenty of had additional conditions including hypertension, heart disease and heart failure.
Mental health conditions were also common – greater than 18% had post-traumatic stress disorder (PTSD), greater than 10% had depression and greater than 10% had anxiety.
We also have no idea whether participants were receiving any treatment for his or her substance use disorder, which itself can have affected the outcomes.
The big picture
Perhaps an important pathway isn’t about GLP-1 drugs. Substance use disorders are highly treatable.
Effective, evidence-based medications exist already – naltrexone and acamprosate for alcohol, methadone and buprenorphine for opioids – together with a big selection of psychiatric treatments.
These are remedies. safe And effectiveyet only a small fraction of those that may gain advantage from them ever receive them. An estimate 3% of people with alcohol use disorder Sometimes effective medications are prescribed.
The biggest barrier is not availability: it’s stigma, shame, fear of judgment and discrimination. Society still sees addiction as an ethical failing reasonably than a health condition.
For people living with substance use disorders, this research on GLP-1s is encouraging however the more immediate message is that effective treatments are already available.