An Ozempic (semaglutide) injector pen is seen on a kitchen table in Riga, Latvia, August 6, 2023.
Jaap Arriens | Nuphoto | Getty Images
Heather Le Biller lost 9 pounds in the first week of taking it Novo NordiskOzempic, ‘s blockbuster diabetes drug, and even more so as she continued her treatment.
Le Biller, a flight attendant who lives in France, noticed that her appetite had calmed while she took the weekly injection. But also her desire for wine, a drink that she describes as “almost usual to accompany every dinner” in France.
“When I was on Ozempic, I didn’t want it as much anymore,” Le Biller told CNBC. “I could have a few sips of wine, just be satisfied and move on. I didn’t need multiple glasses a night, so that really seems to help.”
Biller is among several patients who took diabetes and weight loss medications and also noticed an effect on their cravings for alcohol, nicotine, opioids or even certain compulsive behaviors, such as shopping online and gambling.
These drugs — including Ozempic and its weight-loss counterpart from Novo Nordisk, Wegovy — are called GLP-1 agonists, which mimic a hormone produced in the gut to suppress a person’s appetite.
These anecdotal reports add to the growing list of potential benefits of GLP-1 beyond shedding excess pounds. Dramatic weight loss is the main reason these drugs have gained popularity in the United States, despite the fact that they can cost around $1,000 a month and some health insurers have stopped covering them altogether.
“We prescribe these medications and view this effect as a secondary benefit in patients. One of my patients even said he wasn’t shopping online as much, which was helping his wallet,” said Dr. Angela Fitch , specialist in obesity medicine. physician and president of the Obesity Medicine Association. This group is the largest organization of doctors, nurse practitioners and other health care providers dedicated to the treatment of obesity.
A customer drinks a glass of wine at It’s Italian Cucina restaurant on April 5, 2023 in Austin, Texas. A new analysis of more than 40 years of accumulated research has found that moderate alcohol consumption has no health benefits.
Brandon Bell | Getty Images
This striking effect of GLP-1 is not a new idea. Several studies have demonstrated that certain GLP-1s slow down alcohol consumption in rodents and monkeys. More research needs to be done, especially on humans, to prove that the drugs have this effect. That means it could be years before the Food and Drug Administration and other regulators around the world approve drugs like Ozempic and Wegovy as addiction treatments.
Manufacturers like Novo Nordisk have stated that they are not continuing this research.
“The pharmaceutical industry has this general lack of interest in investing in the addiction space” due to a perfect combination of factors, including the heavy stigma surrounding addictive disorders among doctors, physicians and even patients , according to Dr. Lorenzo Leggio, clinical director of the National Institute on Drug Abuse, or NIDA.
Leggio and other scientists are working to fill this gap – and have already made great strides in confirming GLP-1’s potential as an addiction treatment.
What do we know so far?
Scientists have published nearly a dozen studies showing how GLP-1 stops excessive alcohol consumption in rats and mice, reduces their desire for alcohol, prevents relapses in addicted animals, and overall decreases the alcohol consumption.
Previous studies have looked at older, less potent GLP-1s, such as exenatide, a drug approved for diabetes under the names Byetta and Bydureon.
But more recent studies of semaglutide – the generic name for Ozempic and Wegovy – and another drug Elie Lilly called dulaglutide “are the most promising” because they reduce alcohol consumption in animals by 60 to 80%, according to pharmacologist Elisabet Jerlhag.
Studies have also shown that rats who stop taking dulaglutide, approved for diabetes under the name Trulicity, “take weeks before they start drinking again,” she said.
Jerlhag and colleagues at the University of Gothenburg in Sweden have been studying the effect of GLP-1 on addictive behaviors for more than a decade.
Boxes of the drug Trulicity, manufactured by Eli Lilly and Company, sit on the counter of a pharmacy in Provo, Utah, January 9, 2020.
Georges Frey | Reuters
Other animal studies have also shown that GLP-1 drugs reduce the use of nicotine, cocaine, heroin, and amphetamines.
Few studies have been done in humans, but six clinical trials are currently underway to study how semaglutide may change drinking and smoking habits.
The reason behind this anti-addiction effect of GLP-1 is that these drugs also affect the brain, not just the gut, according to NIDA’s Leggio.
“The brain mechanism that regulates overeating is also important in regulating addictive behaviors,” Leggio told CNBC. “There is a clear overlap, so it is possible that drugs could help addicted people by acting on this specific mechanism.”
GLP-1s specifically decrease the amount of dopamine released by the brain after people engage in behaviors such as drinking, smoking or even eating a sugary dessert, according to Dr. Steven Batash, a gastroenterologist who offers nonsurgical procedures. weight loss center in Queens, New York.
Batash said dopamine is a neurotransmitter that “enhances the pleasure” of doing these activities. When GLP-1 suppresses this pleasure, it also eliminates the motivation to do these activities.
What needs more research?
Still, NIDA’s Leggio advises against using GLP-1 off-label to reduce addictive behaviors, “simply because there is insufficient evidence in humans of their effectiveness.”
“The animal studies are very promising and what people are reporting is very, very important, but as a scientist I will also tell you that it’s not enough,” he told CNBC.
Leggio said scientists need to conduct more double-blind, randomized, placebo-controlled studies in humans – or trials in which participants and researchers do not know who is randomly selected to receive a placebo or drug real. These types of studies are “the gold standard” for proving whether or not a treatment produces a certain effect, he added.
But even if these trials confirm that GLP-1 can reduce addictive behaviors in humans, “it will most likely work for some patients and not others,” according to Leggio.
“We already know, in fact, that these drugs and all drugs in general do not work for everyone,” he said.
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For example, the only clinical study in this area examined whether exenatide could treat alcohol use disorder in humans, compared to cognitive behavioral therapy.
But this 2022 study found that exenatide reduced alcohol consumption in a subgroup of obese participants, while the drug actually increased alcohol consumption in people who did not have the condition.
The reason could be that “thinner patients” treated with exenatide experienced a greater decrease in blood sugar, which could be associated with increased alcohol cravings, the researchers wrote in the study.
But even this conclusion needs to be confirmed by further research.
It is also unclear how long the anti-addiction effect of GLP-1 will last. It’s already a patient complaint when it comes to weight loss: People who lose weight after taking Ozempic or Wegovy tend to gain most of it back — or more — within a few years.
“It’s possible that some people will relapse and start drinking heavily again if they stop taking their medications,” Leggio said. He added that some patients will need constant treatment because addiction is a chronic disease.
However, Leggio said there is “nothing wrong” with a patient seeking GLP-1 to treat diabetes or obesity, in addition to an addiction disorder.
“If you want to see if Ozempic will help you control your blood sugar better but also your drinking, that’s wonderful. Killing two birds with one stone,” Leggio said. “But if the only reason you want to take this medication is because you drink or smoke, then you should wait for more evidence.”
It may take years, but scientists and other health experts are hopeful that a new class of treatments for disorders related to alcohol use, smoking and other addictive behaviors is on the horizon. horizon.
“It may be that in three, four, five years, you and I will say that GLP-1 agonists are wonderful for treating mild diabetes, wonderful for weight loss, and perhaps we will also say that they are wonderful for curbing diabetes.” addictive behaviors,” Batash told CNBC.
But even if GLP-1s were approved to treat addiction, it’s unclear how many people would take them. Use of existing addiction medications is already low. About 14 million American adults suffered from alcohol use disorder — a condition associated with uncontrolled drinking — in 2019. But only 1.6% used one of three medications approved by the FDA to treat the condition .