‘GREAT PROMISE BUT NOT PROVEN YET’: Could Ozempic treat addiction?

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In 2018, Matt Christensen kicked heroin by replacing drugs with drinking. When he stopped drinking in 2022, he turned to food. He put on 95 pounds.

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His doctor recommended he try Wegovy, part of a class of drugs known as GLP-1 receptor agonists, to help him lose weight. Eventually he switched to a different drug called Zepbound, which targets both GLP-1 and GIP agonists. The drugs worked.

But a funny thing happened on his weight-loss journey: His cravings for food had diminished but so had his cravings for drugs and alcohol.

Christensen, 42, started drinking at age 9 and using heroin at 17. For decades, catching a cold meant reaching for a hot toddy. Work stress meant numbing out with Xanax. Even passing through certain neighborhoods in Chicago where he used to buy drugs would lead to cravings.

But after he started taking GLP-1 agonists, those triggers became, well, less triggering.

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“It was the weirdest thing,” he said. “It was just quiet. I just found it really easy all of a sudden.”

More than that, Christensen noticed that an unease he had always felt in his body – a discomfort he perpetually tried to quell with fidgeting, food or drugs – was diminishing. “That’s a feeling that I’ve had my entire life,” he said. “Taking these drugs has toned that down.

“There’s no silver bullet for addiction or mental illness, but for me, in concert with the other treatments, it has been an absolute game changer,” he said.

GLP-1 receptor agonists like Ozempic and Wegovy have received lots of attention for their efficacy at promoting weight loss, reducing “food noise” and treating diabetes. But a new crop of evidence – both anecdotal and research based – is pointing to these drugs as a potential option for people facing addiction issues.

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The operative word here is “potential.”

“We have something there that holds great promise but that is not proven yet,” said Luba Yammine, an associate professor in the department of psychology at UTHealth Houston who researches treatments for substance use disorders.

Yammine conducted a study on the efficacy of a GLP-1 drug called exenatide as a tool to help quit smoking. The results were promising, so her team is currently conducting larger clinical trials using GLP-1 agonists in the context of smoking cessation.

But she’s saving her celebrations until these studies are completed, which will take another two to three years.

“As excited as we are, it is too early to make conclusions,” Yammine said.

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In November, Silvia Martinelli, a medical doctor specializing in psychiatry in the department of life sciences and public health at Catholic University of the Sacred Heart in Rome, published a systematic review of randomized trials related to GLP-1 drugs that suggested they could treat substance use disorders.

Martinelli also collaborated with Niccolò Petrucciani, a medical doctor and associate professor of general surgery at Sapienza University in Rome, on a meta-study published in March that found 4.28 percent of people who received bariatric surgery developed new-onset substance use disorder. That is, a “non-negligible” number of people who got weight loss surgery ended up developing addictions to substances like opioids or alcohol.

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Her research might point to a neurological connection between overeating and substance abuse.

“Certainly our understanding of neurohormonal mechanisms to date is still limited,” Martinelli wrote in an email to The Washington Post. “Medical physiology has only recently deepened the close connection that exists between our brain and the gastro-intestinal system.”

Markku Lähteenvuo, a clinical scientist in Kuopio, Finland, recently published a study of 227,000 Swedish patients with alcohol use disorder that found GLP-1 drugs were associated with a 30 to 40 percent reduction in hospitalizations and other problems related to alcohol use.

Why would these drugs help with addictions to alcohol and drugs? “I really don’t think we know yet,” Lähteenvuo said, though he noted that some primate studies have pointed to GLP-1 drugs affecting dopamine in the brain.

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Dopamine is a hormone and neurotransmitter linked to generating pleasure in the brain, and its effects have been connected to cocaine, alcohol and even social media use (although some researchers have warned that the effects of scrolling on dopamine are often misunderstood).

Many researchers agree that if GLP-1 drugs do prove effective in treating addiction, it is probably because of dopamine, although absent further research, this is still hypothetical.

“Chances are there is more than one mechanism and these mechanisms may not be mutually exclusive,” Yammine said.

Lähteenvuo agrees. “But I have to say, I am quite enthusiastic,” he said. Lähteenvuo is hopeful that GLP-1 drugs could help treat both obesity and addiction, two of the most common medical conditions in the Western world.

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“I think it might be a nice way to get two birds with one stone, treating multiple problems with a single medication, which is always good if we can manage it,” he said.

Brandi Moore, an accountant from Pittsburgh, said that for her, taking GLP-1 drugs has killed more than two proverbial birds. “Like all addicts, we have a voice and that voice wants to kill us,” Moore said. She described that internal “voice” as driving her to cocaine addiction, food addiction and negative self talk.

“That voice is gone,” said Moore, 49. “It’s the first time I’ve felt peace from that. And it’s incredible.”

Sitting in her work cubicle, Moore pulled out a photo from her wedding day to illustrate how much weight she had lost. “My thigh is smaller than my arm was there,” she said.

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In 2017, Moore underwent weight-loss surgery. She went from 287 pounds to 179 pounds, but then found herself unable to lose more weight.

Moore started taking semaglutide in March after her doctor recommended a Groupon for a telehealth site. In her words, her weight “plummeted” to 135 pounds. She also experienced “terrible” constipation and had to adjust her ADHD medications, which she has taken since 1999, after a dip in their efficacy. She also found herself feeling numb and listless when she first started taking semaglutide.

But after adjusting her dosages, Moore hit her stride and has no plans to stop using GLP-1 drugs or prescription ADHD medication. Now, she said, she’s never felt calmer or more centered.

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“That part of my personality that’s being chemically controlled, I want to control it,” she said. “So it kind of put power back in my hands” – a power she wished she had access to years ago when her cocaine addiction led to problems with the law.

Taking GLP-1 agonists also inspired Moore to pursue other ways to take care of her mental health. “I’ve gotten into therapy because I’m afraid of the voice coming back,” she said. She’s also taken up meditation.

Stories like these are compelling. Maybe too compelling?

Yammine cautioned that no drug – from GLP-1 agonists to aspirin – works for everyone. Every individual experiences the effects and side effects of a drug differently. Regarding off-label use of GLP-1 agonists to treat addiction, Yammine thinks that it’s too early. “We should wait for the results of rigorous clinical trials to establish that these medications are efficacious, safe and acceptable to people with alcohol and substance use disorders,” she wrote via email.

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But Christensen doesn’t plan on stopping his GLP-1 prescription, even though the long-term effects are unknown and the drugs are pricey.

“I’m a little privileged in that I can afford it, even though it’s a lot cheaper than it used to be,” he said. “I work on the South Side of Chicago and a lot of people down there are struggling with much more basic things. A $300 a month prescription is just not on the agenda.”

But Christensen has done a cost-benefit analysis, and it’s worth it to keep taking the drug, maybe for the rest of his life.

“It doesn’t just make me feel good,” he said. “My finances are better, my marriage is stable, my house is clean.” Doing dishes or cooking a meal used to be arduous, sometimes impossible. Now, Christensen has enough clarity and peace of mind to keep fresh flowers in his apartment.

“There’s these little details of life that I would not give up for the world,” he said. “It’s not directly because of these drugs, but they play a major part in me being able to live a life that I find productive and satisfying.”

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