An Ozempic (semaglutide) injection pen is seen on a kitchen table in Riga, Latvia on 06 August, 2023.
Jaap Arriens | Nurphoto | Getty Images
Heather Le Biller shed 9 kilos throughout the first week of taking Novo Nordisk‘s blockbuster diabetes drug Ozempic – after which much more as she continued treatment.
Le Biller, a flight attendant who lives in France, noticed her appetite calm down while taking the weekly injection. But so did her cravings for wine, a drink she called “almost customary to pair with every dinner” in France.
“After I was on Ozempic, it made me not want that as much anymore,” Le Biller told CNBC. “I could have a couple of sips of wine and just be satisfied and move on. I didn’t need multiple glasses an evening, so it definitely seems to assist with that.”
Le Biller is amongst several patients who took diabetes and weight reduction drugs and likewise noticed an effect on their cravings for alcohol, nicotine, opioids and even some compulsive behaviors, equivalent to online shopping and gambling.
Those drugs – including Ozempic and its weight reduction counterpart from Novo Nordisk, Wegovy – are called GLP-1 agonists, which mimic a hormone produced within the gut to suppress an individual’s appetite.
These anecdotal reports add to the growing list of potential advantages of GLP-1s beyond shedding unwanted kilos. Dramatic weight reduction is the first reason why those drugs have skyrocketed in popularity within the U.S., despite the indisputable fact that they’ll cost around $1,000 a month and a few health insurers have stopped covering them altogether.
“We’re prescribing these drugs and seeing this effect as a secondary profit in patients. One in every of my patients even said they don’t seem to be doing as much online shopping, which helps their wallet,” said Dr. Angela Fitch, an obesity medicine physician and president of the Obesity Medicine Association. That group is the biggest organization of physicians, nurse practitioners and other health-care providers dedicated to treating obesity.
A customer drinks a glass of wine on the It’s Italian Cucina restaurant on April 05, 2023 in Austin, Texas. A recent evaluation of greater than 40 years of collected research has found that moderate drinking has no health advantages.
Brandon Bell | Getty Images
This striking effect of GLP-1s is not a recent idea. Several studies have demonstrated that certain GLP-1s curb alcohol intake in rodents and monkeys.
More research must be done, particularly on humans, to prove that the drugs have that effect. Which means it could take years before the Food and Drug Administration and other regulators worldwide approve drugs like Ozempic and Wegovy as addiction treatments.
Novo Nordisk told CNBC in an announcement that they are not pursuing that research.
“Pharma has this general lack of interest in investing within the addiction field” on account of an ideal storm of things, including the high stigma around addiction disorders amongst doctors, physicians and even patients, in response to Dr. Lorenzo Leggio, clinical director of the National Institute on Drug Abuse, or NIDA.
Leggio and other scientists are working to fill the gap – and have already made strides toward confirming the potential of GLP-1s as addiction treatments.
What can we know up to now?
Scientists have published nearly a dozen studies showing how GLP-1s stop binge drinking in rats and mice, reduce their desire for alcohol, prevent relapse in addicted animals and reduce alcohol consumption overall.
Earlier studies have examined older, less potent GLP-1s equivalent to exenatide, a drug approved for diabetes under the names Byetta and Bydureon.
But more moderen studies on semaglutide – the generic name for Ozempic and Wegovy – and one other drug from Eli Lilly called dulaglutide “are essentially the most promising” because they reduced alcohol intake in animals by 60% to 80%, in response to pharmacologist Elisabet Jerlhag.
Studies have also shown that rats that stop taking dulaglutide, which is approved for diabetes under the name Trulicity, “take weeks before they begin drinking again,” she said.
Jerlhag and her colleagues on the University of Gothenburg in Sweden have studied the effect of GLP-1s on addictive behaviors for greater than a decade.
Boxes of the drug trulicity, made by Eli Lilly and Company, sit on a counter at a pharmacy in Provo, Utah, January 9, 2020.
George Frey | Reuters
Other studies on animals have also found that GLP-1 drugs reduce the consumption of nicotine, cocaine, heroin and amphetamines.
Few studies have been done on humans, but six clinical trials are actually underway investigating how semaglutide may alter people’s drinking and smoking habits.
The explanation behind this anti-addiction effect of GLP-1s is that those drugs also affect the brain, not only the gut, in response to NIDA’s Leggio.
“The mechanism within the brain that regulates overeating is very important in regulating addictive behaviors as well,” Leggio told CNBC. “There may be a transparent shared overlap. So it’s possible that the medications may help individuals with addiction by acting on that specific mechanism.”
GLP-1s specifically decrease the quantity of dopamine the brain releases after people take pleasure in behaviors like drinking, smoking and even eating a sweet dessert, in response to Dr. Steven Batash, a gastroenterologist who provides nonsurgical weight reduction procedures in Queens, Latest York.
Batash said dopamine is a neurotransmitter that “reinforces the pleasure” of doing those activities. When GLP-1s take away that pleasure, additionally they eliminate the motivation to do those activities.
What needs more research?
Still, NIDA’s Leggio advises against using GLP-1s off-label to scale back addictive behaviors, “just because there’s not enough evidence in humans that they work.”
“The animal studies are very promising and what individuals are reporting could be very, very vital, but as a scientist, I may even let you know that that is not enough,” he told CNBC.
Leggio said scientists have to conduct more double-blind, randomized, placebo-controlled studies on humans – or trials where each participants and researchers do not know who’s getting randomly chosen to receive a placebo or an actual drug. Those forms of studies are “the gold standard” for proving whether a treatment achieves a certain effect or not, he added
But even when those trials confirm that GLP-1s can reduce addictive behaviors in humans, “it’ll almost certainly work for some patients and never others,” in response to Leggio.
“We already know, as a matter of fact, that these medications and any drug overall don’t work for everyone,” he said.
The Good Brigade | Digitalvision | Getty Images
For instance, the only clinical study on this area investigated whether exenatide could treat alcohol use disorder in people, as compared with cognitive behavioral therapy.
But a subgroup evaluation of that 2022 study found that exenatide reduced drinking in a subgroup of participants who had obesity, while the drug actually increased drinking in individuals who didn’t.
The explanation could also be that “leaner patients” treated with exenatide experienced a bigger decrease in blood sugar, which could be related to increased cravings for alcohol, the researchers wrote within the study.
But even that hypothesis must be confirmed with further research.
It is also unclear how long the anti-addiction effect of GLP-1s will last. That is already one criticism patients have with regards to weight reduction: Individuals who shed extra pounds after taking Ozempic or Wegovy are likely to gain most of it – or much more – back inside a couple of years.
“It’s possible that some people will relapse and return to heavy drinking in the event that they stopped taking the medication,” Leggio said. He added that some patients will need constant treatment because addiction is a chronic disease.
Nevertheless, Leggio said there’s “nothing flawed” with a patient in search of GLP-1s to treat diabetes or obesity, along with an addiction disorder.
“If you should see whether Ozempic will assist you to higher control the sugar in your blood but additionally assist you to along with your drinking, that is wonderful. Killing two birds with one stone,” Leggio said. “But when the one reason you should take the drug is due to your alcohol or smoking, then you must wait for more evidence.”
It could take years, but scientists and other health experts hope that a recent class of treatments for alcohol use disorder, smoking and other addictive behaviors is on the horizon.
“It could be that three, 4 or five years from now, you and I are going to say that GLP-1 agonists are wonderful for treating mild diabetes, wonderful for weight reduction, and maybe we may even say that they’re wonderful for curbing addictive behaviors,” Batash told CNBC.
But even when GLP-1s get approved to treat addiction, it’s unclear how many individuals would take them. Uptake of existing medications for addiction is already low.
About 14 million American adults had alcohol use disorder – a disease related to uncontrolled drinking – up to now yr as of 2019. But only one.6% used any of the three FDA-approved drugs for the condition.
