When one in six Americans over age 12 experiences substance use disorders, it’s understandable to look to GLP-1s, a medication that quells desire, as a possible treatment. That’s especially true in light of study results making headlines, the fact that there only are few effective, FDA-approved medications that treat addiction; and that innovation in developing new classes of medication for this condition has been slow.
GLP-1s already are FDA-approved for weight management, diabetes and cardiovascular disease. They’re being studied for lowering the risk of cancer and show neuroprotective benefits against Alzheimer’s and Parkinson’s disease. These medications are transforming everything from clothing and portion sizes, to the worlds of travel and hospitality. But how much promise do GLP-1s really hold for SUDs? We don’t know … yet.
It’s compelling to read anecdotes about patients taking the drugs for weight management and experiencing lower desire to use alcohol or opioids — but that doesn’t make them sufficient for widespread use. Today’s research is preliminary and must take its course. There also are the undeniable basics of addiction: it’s a complex condition with multiple underlying factors that medication may not be able to address universally. Even if GLP-1s become an additional tool in addiction specialists’ treatment toolkit, addiction is a bio-psycho-social condition frequently requiring multifaceted treatment.
So far, GLP-1s may be associated with a potential reduction in severe adverse outcomes in addiction, with some data suggesting the drugs are associated with a 50% reduction in SUD-related mortality, a 39% reduction in overdose risk and a 31% reduction in SUD-related emergency room visits. There are findings across multiple substances, with some studies having shown reductions and variations in risk in use of alcohol, nicotine and opioids, along with some data on cocaine and cannabis.
GLP-1s also have potential to align with current harm reduction practices, as the drugs seem to lessen cravings and consumption, but wouldn’t require abstinence. All of this, however, warrants further study.
Researchers and addiction specialists need to have a clear understanding of the fundamental mechanisms behind GLP-1s. We know this medication works in both the body and the brain. The “body” effect is what people might feel in the stomach, slowing digestion and creating a feeling of fullness. The “brain” effect is thought to modulate the brain’s reward pathways, directly influencing cravings. We don’t know yet which of these is doing more to reduce the desire to use drugs.
The concept that GLP-1s could help treat addiction is at such an early stage, that there aren’t yet data-driven recommendations for how long patients with SUDs would need to be on them. Researchers don’t yet know what the optimal dosage should be for potential SUD benefits as it may differ from currently established dosing recommendations. Addiction is a chronic condition that requires continuous management, yet we don’t have answers about the long-term safety or side effects of using GLP-1s for this purpose. Are there patient-specific factors — the severity of the addiction, co-occurring medical and/or psychological illnesses — that might influence how effective this medication might be? Addiction specialists need these answers.
There’s also the difficult truth that patients’ receptivity towards medication for SUDs is too often low to mixed, with its use often underutilized and stigmatized. For some, it’s because they’ve been influenced by abstinence-only approaches that tell people they aren’t “truly” sober if they’re taking medication for addiction; they’re seen as substituting one drug for another. Others insist medications are a shortcut, that facing the condition independently or “toughing it out” is paramount. This purity test approach could make it difficult to get patients with addiction to participate in future clinical trials.
One would hope the pervasive use of GLP-1s could serve as a reminder that addiction is a condition requiring a combination of approaches to treatment, one of which is medication. It’s a helpful perspective because it makes room for addiction’s biological, psychological and social underpinnings. So perhaps the future of GLP-1s in treating SUDs may be that medication facilitates each component.
If GLP-1s are found to reduce cravings for substances like drugs and alcohol by stabilizing the reward pathways that drive addiction, it may improve patients’ ability to engage in psychological therapies such as cognitive behavioral therapy or motivational interviewing. If the impact of GLP-1s is significant enough, maybe it would enable patients to participate in support and recovery communities, employment and meaningful relationships.
Today, however, we don’t know whether these medications are, in fact, the next frontier in managing addiction. We face unanswered questions about everything from how the drug works in patients with SUDs and its long-term efficacy and dosage, to whether patients experiencing addiction will be open to using them. For now, it’s important to recognize the limits of the current information alongside the complex nature of SUDs so hope doesn’t outpace reality.
Manassa Hany, MD, is chief of the division of addiction psychiatry at Northwell Health. Soteri Polydorou, MD is the medical director of addiction services for Northwell Health.
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