A large new study using Veterans Affairs medical records found that GLP-1 drugs like Ozempic were associated with significantly lower rates of substance-use disorders and a 50% reduction in drug
GLP-1, the blockbuster weight-loss drugs that have reshaped conversations about obesity and diabetes may be on the verge of transforming another area of medicine entirely. A growing body of evidence suggests that GLP-1 medications, sold under brand names including Ozempic, Wegovy, Mounjaro could hold meaningful potential for treating addiction, and the scientific community is now racing to find out just how far that potential extends.
The drugs, which work by mimicking the GLP-1 hormone to regulate digestion, insulin and appetite, are already used by millions of Americans for weight management and diabetes. They are known to quiet cravings and reduce what many users describe as constant mental preoccupation with food. Researchers believe those same mechanisms, particularly the drugs’ effects on reward and craving pathways in the brain, may be what makes them relevant to addiction as well.
What the new VA study found
The latest and most significant piece of evidence comes from a large analysis of medical records from the U.S. Department of Veterans Affairs, conducted by researchers at Washington University School of Medicine in St. Louis and published Wednesday in the BMJ. The study examined substance use disorder outcomes among more than 600,000 people with type 2 diabetes who were treated with either GLP-1 medications or a separate drug class called SGLT2 inhibitors.
The findings were notable across several dimensions. People using GLP-1 drugs were less likely to develop substance-use disorders related to alcohol, cannabis, cocaine, nicotine and opioids, among others. Specifically, GLP-1 use was associated with approximately 7 fewer people per 1,000 developing any substance use disorder over the three year study period.
For those who already had a substance use disorder diagnosis, the results were even more striking. The study found a 50% reduction in drug-related deaths among GLP-1 users compared to those on other diabetes medications. The study also found a 25% reduction in suicidal ideation among GLP-1 users, adding to prior research that had found no increased risk of suicide associated with the drugs following an earlier European regulatory investigation into the matter.
Why experts are encouraged but urging caution
The breadth of the findings across so many different substances caught the attention of researchers inside and outside the study. One of the most notable aspects was the suggestion of protective effects against cocaine and cannabis-use disorders specifically, two areas where currently no approved medications exist for treatment.
However, several experts not involved in the research raised important caveats. The VA database used for the study is overwhelmingly male and older than the general population, raising questions about whether the results would apply more broadly. There is also the concern that people who choose to start GLP-1 medications may differ in meaningful ways from those who start other diabetes drugs, including being more health conscious, more engaged with their medical care or receiving more intensive clinical follow up. Those differences, rather than the medication itself, could be influencing the outcomes.
At least one expert described the magnitude of the reduction in overdose deaths as appearing too large to be entirely believable on its face, while still acknowledging the study’s considerable strengths in terms of scale and design.
Clinical trials are the next critical step
What the field urgently needs now, researchers agree, are large, well designed randomized controlled trials that can isolate the effect of the drugs on addiction independent of other factors. That work is already underway or being planned across several fronts.
One trial is evaluating semaglutide, the active ingredient in Ozempic, specifically for alcohol reduction, with a parallel trial underway at the National Institute on Drug Abuse in Baltimore. Novo Nordisk, the maker of Ozempic, has said it will study its drugs’ effects on alcohol consumption in a trial focused on people with alcohol related liver disease. Eli Lilly, which makes the competing drug Mounjaro, is testing an experimental compound called brenipatide on alcohol, tobacco and opioid-use disorders. Additional trials targeting cocaine use disorder and opioid addiction are also in development.
Experts in the field say results from several well-powered trials focused on alcohol-use disorder in particular are expected within the next six months, which could significantly sharpen the picture.
Questions that remain unanswered
Even those most encouraged by the emerging data are quick to note how much is still unknown. Researchers are still working to understand what happens to patients who stop taking GLP-1 drugs after extended use, whether the brain adapts to the medications over time in ways that could reduce their effectiveness, and whether influencing the brain’s reward circuitry could have unintended consequences on everyday motivation and enjoyment of life.
If the drugs do ultimately prove safe and effective for addiction treatment, the implications would be far-reaching. Because Glucagon-like peptide-1 medications are already in widespread use for obesity and diabetes, they could rapidly become the most commonly prescribed pharmacological treatment for substance use disorders almost by default, filling a gap in addiction medicine that has persisted for decades.ozempic