GLP-1 receptor agonists are gaining traction in addiction treatment, though the lack of FDA approval and long-term data continues to limit widespread adoption, Mo Sarhan, MD, medical director of addiction medicine for Wernersville, Pa.-based Caron Treatment Centers, told Becker’s.
Caron’s GLP-1 initiative has enrolled 450 patients with a focus on systematic, monitored clinical use to inform best practices and build internal data. Early signals show when patients are discharged, their refill prescription rates are 20% to 30% higher than those reported for traditional opioid use disorder medications such as naltrexone and suboxone, which may indicate stronger short-term retention at one and three months, he said.
“I certainly hope that with all of the large, randomized controlled trials that are in the pipeline, based on the early anecdotal evidence that we’re seeing, and retrospective cohort studies, that these medications hopefully will be approved for treatment of substance use disorders and/or behavioral addictions,” Dr. Sarhan said. “That would be a huge game changer.”
The drugs target the brain’s reward pathway, including both voluntary and involuntary processes tied to addiction. A study published March 4 in the The BMJ found veterans who were GLP-1 users had a 14% lower risk of developing any substance use disorder compared to patients taking other diabetes medications.
Among participants with preexisting substance use disorders, GLP-1 use was associated with 30% fewer emergency department visits, 25% fewer hospitalizations, 40% fewer overdoses and 50% fewer drug-related deaths over a three-year period.
The medications do not create neural pathways but instead bring “mental quietude” around substance use disorder, giving patients a chance to engage with care, Dr. Sarhan said. During that time, patients may focus on treatment such as therapy, transcranial magnetic stimulation, neurofeedback and medication management.
“If we think about it as a neuro-restorative approach that these medications help modulate part of the brain that’s responding to the reward pathway, it kind of buys the patients time,” he said.
Dr. Sarhan said he has heard reports ranging from cravings being “obliterated” to more modest improvements, with most patients noticing a difference within days to weeks in how often they think about substances and the intensity of cravings.
Patients have also reported a reduction in anxiety, nicotine use, sexual compulsivity and nail biting.
Caron’s protocol includes medical consent and tailored dosing, with patients typically responding well to lower doses with no need to titrate monthly. The organization also works to mitigate adverse effects such as muscle loss by encouraging low-intensity cardiovascular exercise and weight training, while addressing gastrointestinal side effects through nutrition support and increased protein intake.
The next step in integrating these drugs is obtaining FDA approval, which often comes with a stronger operational framework. Phase 3 trials are currently enrolling, with the goal of providing large-scale evidence of efficacy for new indications, though the research and publishing process can take years, Dr. Sarhan said.
Increased media coverage and word of mouth have driven patient awareness, with individuals asking to use GLP-1 drugs to treat substance use disorders.
Questions remain as research continues.
When patients discharge from their provider, an outpatient provider will need to continue prescribing the medications, creating logistical challenges, Dr. Sarhan said. Caron is also unsure whether length of stay and completion rates have been significantly affected by patients on GLP-1s.
“One of the most common questions that people ask that I don’t have guidance on is, ‘How long do we need to be on these medications?’” Dr. Sarhan said.
He views GLP-1s as a tool within a broader, integrative model of care.
“It’s still too early for definitive, long-term outcomes, but our anecdotal evidence is really compelling,” he said. “I feel like our patients are really being the difference and in a specialty where we haven’t had a lot of innovation.”
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