Popular drugs for diabetes and obesity were linked to sharply lower rates of addiction and overdose in a large study of US veterans, raising the possibility that the medicines could help curb substance abuse.
In an analysis of electronic health records from more than 600,000 veterans with type 2 diabetes, researchers found that patients who started a GLP-1 receptor agonist — a class that includes Novo Nordisk A/S's Ozempic and Eli Lilly & Co.'s Mounjaro — were less likely to develop substance use disorders over the next three years than those who started a different diabetes drug, known as an SGLT-2 inhibitor, including Lilly and Boehringer Ingelheim GmbH's Jardiance.
After more than a decade of steady increases, US overdose deaths linked to synthetic opioids peaked in 2023 and have since fallen dramatically, a shift researchers have partly attributed to disruptions in the illicit fentanyl supply. Still, overdoses remain a leading cause of preventable death, and millions of Americans struggle with alcohol, nicotine and other addictions, underscoring the need for new tools.
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The study, published Wednesday in the journal BMJ, emulated eight clinical trials using Veterans Affairs data. Among patients with no prior history of addiction, those given a GLP-1 medicine had lower risks of being diagnosed with alcohol, cannabis, cocaine, nicotine and opioid use disorders.
Overall, the drugs were associated with a 14% lower risk of developing any substance use disorder compared with SGLT-2 inhibitors. That translated to about seven fewer new cases per 1,000 patients over three years.
Among patients who already had an addiction diagnosis, GLP-1 drugs were linked to a 50% lower risk of substance use–related death and a 39% lower risk of overdose. In absolute terms, that amounted to about 12 fewer cases of serious harm per 1,000 patients. GLP-1 medications were also associated with fewer addiction-related emergency department visits and hospital admissions, as well as lower rates of suicidal ideation or attempts.
‘Drug Noise' Reduction
The findings aren't strong enough to justify prescribing GLP-1 drugs solely to treat addiction, said study co-author Ziyad Al-Aly, director of the Clinical Epidemiology Center at the VA St. Louis Health Care System. But for millions of people already weighing whether to start one for diabetes, obesity or another approved use, the potential impact on alcohol, smoking or other substance use disorders “is one more factor worth considering,” Al-Aly said in an email.
While drugmakers were initially reluctant to study whether GLP-1 medications could be used to treat addiction, it became impossible for them to ignore as anecdotal evidence mounted.
Lilly, for example, is studying an experimental compound called brenipatide in alcohol, tobacco and opioid use disorders. Brenipatide works by mimicking two gut hormones, GLP-1 and GIP, similar to the company's drugs Mounjaro and Zepbound.
“We observed in trials that people drink less, smoke less, gamble less, online shop less,” Chief Executive Officer Dave Ricks said at an event in Chicago last year. “This is what we call the sort of hedonic desires, where you just keep hitting the button because it feels good, and it does seem to tamp that down.”
Novo is also studying whether one of its experimental drugs can change daily alcohol consumption.
Patients often describe a quieting of “food noise” — the persistent thoughts about eating — while on the drugs. A similar dampening may be happening with addictive substances, Al-Aly said, describing it as a reduction in “drug noise.”
The study was observational and can't prove cause and effect. It relied on VA patients, who are predominantly older white men with diabetes, which may limit how broadly the results apply. The comparison was also between two diabetes drug classes, not against a placebo. Still, the authors said the consistency of the findings should spur randomized trials focused on hard outcomes such as overdoses and drug-related deaths.
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