GLP-1 drugs were originally developed to combat diabetes, but are now increasingly being used as weight loss injections. But due to their effect on the reward center in the brain, they may also be able to help against addictions. Data from over 600,000 US veterans show that people treated with GLP-1 agonists for diabetes were less likely to become addicted to drugs or alcohol. For existing addictions, treatment reduced the likelihood of overdoses, hospitalizations and deaths. GLP-1 agonists could therefore open up a new way to combat the causes of addiction.
Active ingredients such as semaglutide and tirzepatide bind to the same receptors as the body’s satiety hormone GLP-1 and thus have an appetite-suppressing effect. That’s why the GLP-1 agonists, originally developed to combat diabetes, are increasingly being used as weight loss injections. But their effect could extend beyond that, because GLP-1 receptors have a far-reaching influence on our reward system. People treated with GLP-1 drugs report reduced interest in alcohol and nicotine, and observational studies have already suggested that treatment is associated with a lower risk of substance abuse.
Reduced risk of addiction
A team led by Miao Cai from the St. Louis Health Care System in the USA has now followed up on this lead. To do this, the researchers evaluated patient information from the US Department of Veterans Affairs databases. These contain information about the health status and medical treatments of US veterans. For their study, Cai and his colleagues used health data from 606,434 US veterans with type 2 diabetes who had been treated with either GLP-1 agonists or another diabetes medication.
The result: Veterans who received GLP-1 agonists had a 14 percent lower risk of developing drug addiction. Their risk of becoming addicted to alcohol was 18 percent lower, to cannabis by 14 percent, to cocaine and nicotine by 20 percent, and to opioids by as much as 25 percent. Patients who already had an addiction also benefited from treatment with GLP-1 agonists. During the three-year observation period, they were admitted to the emergency room 30 percent less often, suffered 40 percent fewer overdoses and 50 percent fewer deaths. “These results suggest that potential benefit is not limited to a single diagnosis or substance, but may also extend to acute and life-threatening consequences of addiction,” writes Fares Qeadan of Loyola University in Chicago, who was not involved in the study, in an accompanying commentary.
Against desire
According to the researchers, such broad effectiveness would be a novelty in addiction treatment. “In addiction medicine, treatments typically target only one problem – for example, a nicotine patch helps against smoking but not alcohol consumption – but there is no drug that works for multiple addictive substances, let alone all of them,” says Cai’s colleague Ziyad Al-Aly. “The results on GLP-1 drugs suggest that they actually work against all major substances, probably by suppressing cravings themselves.”
The class of active ingredients could therefore open up new possibilities to help people who are addicted to several substances at the same time or who are dependent on drugs such as methamphetamines for which there is currently no drug treatment. However, this first requires clinical studies that examine the benefits and possible risks of using GLP-1 agonists against addiction – also in comparison to established therapies.
If semaglutide and the like actually prove to be effective addiction treatments, questions about distributive justice will also arise. “GLP-1 receptor agonists remain costly and access is unequal between and within countries,” points out Qeadan. “Expansion of indication should not result in widening health disparities or shifting care away from established indications.” However, for patients who struggle with addiction and already need treatment for diabetes or obesity, GLP-1 agonists may already be the treatment of choice: “For them, these drugs can offer a dual benefit and treat both diseases at the same time,” says Al-Aly.
Source: Miao Cai (Veterans Affairs St. Louis Health Care System, Missouri, USA) et al., BMJ, doi: 10.1136/bmj.s325