Could GLP1 medication reduce cocaine or cannabis use disorders?

As blogged previously, there is emerging evidence suggesting that GLP1 medications may help to curb drinking and even smoking. GLP1 medications are used for diabetes, weight management, and other weight-related health issues; examples include semaglutide (Ozempic/Wegovy), tirzepatide (Mounjaro/Zepbound), liraglutide (Victoza/Saxenda), and dulaglutide (Trulicity).

Could GLP1 medications reduce other substance use disorders, such as cocaine, cannabis, or opioid (narcotic)?

A recent study looked at people with type 2 diabetes in the US Veterans Affairs database. Compared with people who started SGLT2 inhibitors (another diabetes medication), people who started a GLP1 had:

18% lower risk of developing alcohol use disorders
14% lower risk of developing cannabis use disorders
20% lower risk of developing cocaine use disorders
20% lower risk of developing nicotine use disorders
25% lower risk of developing opioid use disorders

They also found that, amongst people with pre-existing substance use disorders, compared to starting an SGLT2 inhibitor, starting a GLP1 was associated with

31% lower risk of emergency room visits related to substance use
26% lower risk of hospitalization related to substance use
50% lower risk of death from substance use
39% lower risk of drug overdose
25% lower risk of suicidal ideation or attempt (more on this topic blogged here and here)

That GLP1 medications could decrease substance use fits with our knowledge that GLP1s reduce the reward response in our brain to food. I also wonder if some of the reduced tendency to use substances could be related to people often feeling better about themselves, building self confidence, having less pain, and improved quality of life with improvement in weight and health afforded by GLP1s.

As this study is a retrospective database analysis, we have to take the results with a big grain of salt. Also, being a Veterans Affairs database, the population studies was mostly older white men (93% were over 50 years old, and 94% were men). So we don’t know if we can extrapolate these data to younger people or women.

BOTTOM LINE: There is a growing body of evidence that GLP1 medications may have a side bonus of reducing tendency to use substances. Dedicated clinical trials are needed to explore these potential benefits further.

If you need help for substance use, reach out to your health care team or government services for support. Here is a link to help with substance use in Canada.

Disclaimer: I am/have been an investigator in clinical trials of semaglutide, tirzepatide, dulaglutide, liraglutide. I receive honoraria as a continuing medical education speaker and consultant from the makers of tirzepatide and dulaglutide (Eli Lilly), and liraglutide and semaglutide (Novo Nordisk).

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