GLP-1 receptor agonists — drugs first developed for diabetes and weight-loss — are showing potential to reshape withdrawal management for substance use disorders. At Wernersville, Pa.-based Caron Treatment Centers, Adam Scioli, MD, chief medical officer, said the medications are showing promise by reducing cravings for multiple substances and could expand how leaders conceptualize integrated care.
Caron, a non-profit substance use disorder provider with residential programs in Florida and Pennsylvania, has treated more than 230 patients with GLP-1 receptor agonists since incorporating the drugs into its withdrawal management protocol. The program expands on a collaborative study with the Penn State College of Medicine to explore the efficacy of GLP-1s for the treatment of opioid use disorder.
“What’s most exciting about the GLP-1 receptor agonists is that … they modulate reward pathways and reduce cravings for substances across a pretty wide domain,” Dr. Scioli told Becker’s. “It’s not just alcohol. It’s not just opioids. There’s evidence building that suggests other substances, including nicotine, are impacted by this pathway.”
Unlike medication that targets one receptor, GLP-1s target the brain’s reward system itself, Dr. Scioli said. “Very different from what we’re talking about here with the GLP-1 receptor agonists that actually focus upstream on a system, a network of brain pathways that really, really changes the way [the patient] responds to perceived reward,” he said.
For patients, the impact can be immediate. Dr. Scioli said the drugs have quieted down the craving or “noise” that makes withdrawal difficult, enabling patients to tolerate treatment better and engage more quickly in therapy.
The strongest outcomes have been observed in patients with both metabolic compromise and substance use disorder. “They’re the ones that notice changes in their body, as their mind is changing, as their perspective toward themselves is changing, and as their perspective toward addiction, life and opportunity change,” he said.
Still, Dr. Scioli is cautious. “We have to make sure first that we do no harm. We have to make sure that the patient understands that this is not a magic bullet,” he said. “It’s a very promising tool that can be part of this integrated process toward healing.”
Central to the process, he said, is prioritizing conversations — not only about informed consent but also risks, benefits, side effects and alternatives. This includes communication with the patient and their caregiver about managing expectations and risk throughout the healing journey, he said.
There are still unanswered questions about dosing and duration, he said. “It’s a question a lot of people are asking, and it’s a question many folks don’t have answers to,” Dr. Scioli said. “The questions about dosing, duration, frequency are very important questions to answer, and we really do need to do a lot more research in this area.”
