Drugs for obesity and diabetes reveal great potential against addictions

Some studies have suggested that GLP-1 acts on the brain’s reward circuits and could therefore be effective in treating and preventing substance use disorders, but so far no large-scale analysis has confirmed its feasibility in preventing or treating substance use disorders.

To find out, a team of researchers at Washington University School of Medicine in St. Louis (United States) used data from more than 600,000 American veterans to verify whether taking GLP-1 is associated with a lower risk of substance use disorders in people without a history of such disorders.

Over three years, the team analyzed the medical records of 606,343 veterans with type 2 diabetes and divided them into two groups: those without a prior substance use disorder and those who already had one. At the beginning of the study, some started taking GLP-1 and others a diabetes medication called an SGLT2 inhibitor.

The study, whose results were published this Thursday in The BMJ, showed that in patients without a history of addiction, GLP-1 use was associated with a 14% reduction in the occurrence of new substance use disorders.

The risk decreased by 18% for alcohol, 20% for cocaine and nicotine, and 25% for opioid addiction.

In people already suffering from addictions, the drug GLP-1 proved to be a lifesaver: drug-related deaths were reduced by 50% and overdoses by 39%.

Additionally, the drug was associated with fewer emergency room visits (31%), fewer hospital admissions (26%), and fewer suicide attempts or suicidal thoughts (25%).

“In addiction medicine, many treatments target one thing, such as a nicotine patch that helps with smoking but not alcohol, but there is no medication that works for all addictive substances,” explains lead author Ziyad Al Aly, an epidemiologist at Washington University School of Medicine in St. Louis.

However, GLP-1 seems to address the common biology of addiction and this finding, Al-Aly emphasizes, opens the door to an unprecedented therapeutic strategy, being able to silence the “drug noise” in the brain (craving), understood as the relentless desire that drives addiction, regardless of the substance.

Furthermore, “GLP-1 may offer a dual benefit for patients with chronic conditions such as diabetes or obesity who also struggle with a substance use disorder: A single medication can treat both conditions at once,” concludes Al Aly.

Given that millions of people already take GLP-1 medications and their use is increasing, these effects on the prevention and treatment of substance use disorders could have a significant impact at the population level.

In that sense, in a related editorial, Fares Qeadan, from Loyola University in Chicago (United States), points out that although traditional treatments remain the priority, the results of this study should be taken into account by doctors when prescribing GLP-1 for metabolic reasons.

In his opinion, the next step should be to validate these data in specific clinical trials to convert this “accidental finding” into an official treatment against addiction and transform public health globally.