GLP-1 Drugs Tied to Fewer Addictions and Overdoses in Veterans Study

A BMJ analysis of more than 600,000 US veterans with type 2 diabetes found that starting GLP-1 receptor agonists was associated with lower rates of new substance use disorders and with fewer overdoses and substance-related deaths compared with starting SGLT-2 inhibitors; the study was observational and cannot prove causation.

A large analysis of Veterans Affairs health records found that starting a GLP-1 receptor agonist was associated with lower rates of addiction, overdose and related harms. Researchers compared patients who began GLP-1 drugs with those who began SGLT-2 inhibitors across more than 600,000 veterans with type 2 diabetes and followed outcomes for three years. The study, published in BMJ, reported lower risks of new substance use disorders overall and substantially lower overdose and substance-related death among patients with a prior addiction diagnosis. Authors noted the research is observational, cannot establish cause and effect, and that the VA population may limit how broadly the findings apply. Key findings: - The analysis used VA electronic health records for over 600,000 veterans with type 2 diabetes. - Patients who started GLP-1 drugs had a 14% lower risk of developing any substance use disorder versus those who started SGLT-2 inhibitors, about seven fewer new cases per 1,000 patients over three years. - Among patients with an existing addiction diagnosis, GLP-1 use was associated with a 50% lower risk of substance use–related death and a 39% lower risk of overdose, about 12 fewer serious harms per 1,000 patients. - The study also reported fewer addiction-related emergency department visits and hospital admissions, and lower rates of suicidal ideation or attempts among GLP-1 users. - The research was observational, compared two diabetes drug classes rather than a placebo, and relied on a predominantly older, male VA population, which may limit generalizability. Summary: The findings suggest GLP-1 medications may be associated with reduced substance use harms but do not prove causality. The authors and article note that randomized trials focused on hard outcomes such as overdoses and drug-related deaths are needed to test the association further.