GLP-1s may reduce substance use disorders from alcohol to opioids

A Veterans Affairs data analysis of more than 600,000 patients with type 2 diabetes found that treatment with GLP-1 drugs was associated with fewer emergency visits, hospitalizations and deaths related to substance use across alcohol, opioids, stimulants and nicotine. The study’s authors and an accompanying editorial note that randomized trials are needed and several clinical trials are already underway.

Researchers reported that GLP-1 drugs, a class that includes semaglutide and tirzepatide, were linked with lower substance-related health events in a large retrospective study. The study, published in The BMJ, analyzed electronic health records from a Department of Veterans Affairs database of more than 600,000 people with type 2 diabetes. The average age was about 65 and roughly 90% of the sample were men. Investigators compared patients prescribed GLP-1 drugs with those using SGLT2 inhibitors and emulated several target trials to examine both treatment and prevention effects. Key findings: - Study sample included over 600,000 VA patients with type 2 diabetes; average age ~65 and about 90% male. - Comparison group consisted of patients receiving sodium-glucose cotransporter-2 (SGLT2) inhibitors rather than GLP-1 drugs. - Among people with pre-existing substance use disorders, GLP-1 use was associated with fewer emergency room visits, hospitalizations and deaths related to substance use. - Reported associations were consistent across multiple substance types, including alcohol, opioids, stimulants and nicotine. - Researchers also observed a possible reduced risk of developing a substance use disorder with GLP-1s, though authors described this preventive finding as weaker. Summary: The study adds to accumulating observational evidence that GLP-1 drugs may affect reward-related brain pathways and reduce substance-related harms. Authors and an accompanying editorial emphasize that randomized clinical trials are needed to confirm these findings, and several such trials are underway. The applicability of results beyond the VA population is undetermined at this time.