A new study of more than 600,000 veterans finds that GLP-1 drugs used for Type 2 diabetes are linked to fewer hospitalizations, emergency visits, and deaths tied to substance use disorders, raising hopes for broader addiction treatment.
The study, published Wednesday in The BMJ, analyzed Department of Veterans Affairs health records to examine whether GLP-1 medications such as semaglutide and tirzepatide affected substance use disorders. Researchers compared patients taking GLP-1 drugs with those using another diabetes medication known as an SGLT2 inhibitor.
All participants had Type 2 diabetes. The average age was about 65, and 90% were men.
VA Study Links GLP-1 Medications to Fewer Addiction-Related Emergencies
Researchers used an “emulated target trial” approach, analyzing existing patient data to simulate seven clinical trials. They assessed whether GLP-1 drugs helped treat existing substance use disorders and whether they reduced the risk of developing new ones.
The findings showed that patients with pre-existing substance use disorders who took GLP-1 drugs experienced fewer addiction-related emergency room visits, hospitalizations, and deaths across multiple substances, including alcohol, opioids, cannabis, cocaine, and nicotine.
Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis who led the study, said the consistency of the results was notable.
“Here is a trial with 600,000 people studying not only opioids or nicotine or alcohol, but all of them,” Al-Aly said. “So it’s unlikely to be a coincidence or chance finding.”
The study also suggested that GLP-1 drugs may reduce the likelihood of substance use disorders resurfacing.
About 50 million people in the United States live with a substance use disorder, according to the National Institute on Drug Abuse, and many do not receive treatment.
Experts Urge Caution, Call for Randomized Clinical Trials
While the findings add to growing research on GLP-1 drugs and addiction, experts caution that observational studies cannot prove cause and effect.
“I think of it as the strongest form of observational evidence, but still something we want to confirm with randomized trials,” said Fares Qeadan, an associate professor of biostatistics at Loyola University Chicago who wrote an editorial accompanying the study.
Christian Hendershot, director of clinical research at the USC Institute for Addiction Science, said accumulating research shows promise for using GLP-1 drugs in addiction treatment. However, he noted that most people develop substance use disorders earlier in life than the study’s average age of 65.
“Most people are talking about this from a treatment standpoint,” Hendershot said. He added that more rigorous trials are already underway and results are expected in the next few years.
Alex DiFeliceantonio, an assistant professor at Virginia Tech’s Fralin Biomedical Research Institute who was not involved in the study, said the need for new treatments is urgent.
“Even with the drugs we have for alcohol use disorder and opioid use disorder, relapse rates are really high,” DiFeliceantonio said.
Researchers Explore How Drugs May Quiet Brain’s Reward Signals
Scientists are still investigating how GLP-1 drugs might influence addiction. The leading theory is that the medications affect the brain’s reward pathways.
“In obesity, when people take GLP-1 agonists, they describe the quieting of food noise,” Al-Aly said. “I think something similar is happening with that preoccupation with needing a substance. It quiets.”
GLP-1 drugs are already widely prescribed for diabetes and weight loss. If confirmed in randomized trials, researchers say the medications could offer a new tool to address multiple substance use disorders.
Still, experts stress that no single drug is likely to work for everyone.
“Substance use disorders are complex conditions,” Hendershot said. “It’s difficult to develop any one medication, especially for substance use disorder, that works for everyone.”
