GLP-1 drugs reduce risk of addiction as well as deaths and overdose
GLP-1 drugs may help reduce the risk of addiction to alcohol, cannabis, cocaine, nicotine, and opioids, a large US study has reported.
Medicines such as semaglutide and tirzepatide may also cut deaths and reduce the risk of overdose and hospital admission for those already diagnosed with a substance use disorder, results suggest.
It adds to a growing body of evidence that glucagon-like peptide-1 (GLP-1) receptor agonists may have a place in tackling addiction to a variety of substances.
The study modelled various scenarios from a database of 606,434 US veterans with type 2 diabetes over a three-year period.
Comparing GLP-1s with sodium-glucose cotransporter-2 (SGLT-2) inhibitors, they found the weight loss injections both reduced the risk of addiction in people with no previous history and reduced adverse outcomes and deaths in those who already had a diagnosed substance use disorder.
Where individuals had no history of addiction, starting a GLP-1 medicine was associated with an overall 14% reduced risk of substance-use disorder.
By substance there was an 18% reduction in addition to alcohol, 14% for cannabis, 20% for cocaine and nicotine and 25% for opioids compared with an SGLT2 inhibitor.
It equated to roughly one to six fewer cases of substance use disorder per 1000 people over three years, the team reported in the BMJ.
For veterans in the study with a pre-existing substance-use disorder, starting a GLP-1 drug was associated with 31% fewer emergency department visits related to their addiction, 26% fewer hospital admissions, a halving of deaths, 39% fewer overdoses and a 25% reduction in suicidal ideation or attempts.
This translated to between one to ten fewer events per 1,000 people over three years, they calculated.
Animal studies have suggested that GLP-1s act on the mesolimbic reward pathways and reduce drug reinforcement in alcohol, nicotine, cocaine, and opioid use disorders.
The evidence base on the impact in humans is growing but has not included a range of substance-use disorders, the researchers noted.
Participants in the study were predominantly older men, though subgroup analyses showed consistent results in women, they added.
And it is possible that factors not accounted for, such as socioeconomic status or lifestyle, may have affected the results.
But the patterns seen were ‘highly consistent’ with what is already known about the pharmacology and neurobiological mechanisms of the drugs, they concluded.
‘These observational data suggest a potential role for GLP-1 receptor agonists in both the prevention and the treatment of various [substance-use disorders] warranting further evaluation.’
A study this year found one in ten British adults take weight loss drugs or intend to do so in the near future.
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