For the past two years, there has been a buzz around the “wonderdrug” Ozempic — a medication in the class known as GLP-1 receptor agonists — from clickbait celebrity gossip websites to the front pages of leading medical journals. The ability of these medications to reduce weight, fight diabetes, even decrease the incidence of death from cardiovascular disease, has been well-studied.
But Ozempic’s effectiveness seems to be stretching beyond the realm of cardiometabolic disease and into the field of addiction medicine. Volkow’s study adds to a growing body of scientific and anecdotal evidence that GLP-1 medications can reduce cravings among people with substance use disorders, including alcohol, tobacco, opioids, cannabis and stimulants. In addition to increasing the release of insulin and slowing stomach emptying, GLP-1 analogs are thought to impact the brain’s reward circuits, leading to fewer cravings and decreased use.
As a resident physician in internal medicine and medical historian focused on addiction, I believe this data represents a tremendous breakthrough in the field of addiction treatment. It could also be the medication that brings the treatment of addiction — historically siloed from general medical practice — into mainstream medicine.
A handful of my primary care patients have made comments like what J. Paul Grayson, a patient taking Ozempic for obesity, reported to NPR last year: “Before Ozempic, I could consume a whole bottle of wine in an evening without trying real hard … But with Ozempic, even one beer didn’t feel good to me somehow.” Many patients simply don’t crave substances like they used to.
Fatal overdose, especially from fentanyl, continues to be the leading cause of death among people aged 18 to 45 in the U.S., surpassing deaths from suicide and car accidents. While much of the data on the link between Ozempic and decreased substance use warrants further investigation, health care providers should not wait for the Food and Drug Administration (FDA) to approve these medications before prescribing them. If a patient has obesity or Type 2 diabetes and a substance use disorder, providers can and should start prescribing GLP-1 agonists “off-label” as a form of addiction treatment.
If a patient has a substance use disorder and another indication for a GLP-1 analog, providers — and patients themselves — should advocate for their use. As Dr. Kenneth Morford, an addiction medicine physician and assistant professor at Yale School of Medicine, told me, “If a patient qualifies for a medication like semaglutide and happens to have a substance use disorder with no contraindication to the medication, we have nothing to lose. Why don’t we try it?”
Attaining FDA approval for GLP-1 analogs with the specific indication of treating alcohol use disorder, for example, will take years. The ongoing extreme shortages of medications like Ozempic may compound the delay even further. While a few randomized clinical trials have been completed, dozens more are only just starting to recruit participants with substance use disorders ranging from cocaine to opioids. Leaders at NIDA like Volkow — who has called this data “very, very exciting” — and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) are allocating more funding to addiction researchers on this topic.
But in the meantime, young people are dying. Patients and health care providers are running out of time looking for potential answers.
Health care providers have been prescribing GLP-1 analogs for the treatment of Type 2 diabetes for the past decade. Due to increased demand for medications like Ozempic, providers in general practice settings have become increasingly familiar with how to prescribe these medications. Largely due to stigma and the failure to educate physicians, many primary care physicians view the treatment of addiction as outside their scope of practice.
Many medications used to treat addiction are extremely difficult to access. Methadone, one of the most effective medications for opioid addiction, can only be accessed through special clinics due to federal regulations borne out of President Richard Nixon’s War on Drugs. Buprenorphine (colloquially known by the brand name Suboxone) is more accessible than methadone and available in primary care settings. In 2023, buprenorphine became even easier to prescribe, yet primary care providers are still hesitant to begin prescribing it, likely due to fear and stigma.
That’s just opioids. Even though 29 million people in the U.S. have an alcohol use disorder, less than nine percent of patients with alcohol use disorder are prescribed any medication. Stimulants like cocaine and methamphetamine pose an even larger problem. Experts are now characterizing stimulant-related overdose deaths as a “fourth wave” of our overdose crisis. There are few if any medications that have been shown to decrease stimulant use. Ozempic could be the first medication that meaningfully treats addiction to stimulants.
Ozempic presents a tremendous opportunity to get providers on board who might not otherwise be comfortable with prescribing medications for addiction. Unlike some of the other medications used to treat addiction, GLP-1 analogs are not controlled substances, which have potential for misuse and partially explain providers’ discomfort behind prescribing.
Our overdose crisis and lack of access to addiction treatment are urgent issues that endanger thousands of young, healthy individuals. The medical community’s discrimination against people who use drugs has crippled humane access to care in general medical settings. GLP-1 analogs have the potential to bridge this historic divide and treat multiple addictions at once. Health care providers must not wait for FDA-approval to prescribe GLP-1 analogs to patients who are currently eligible due to comorbid conditions. We must respond to our overdose epidemic in innovative ways, using all the tools at our disposal. This now includes GLP-1 analogs.
