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In late 2016, Steven Klein realized that he’d lost control over his drinking and stimulant use. He became sober that December, with help from 12-step meetings. But he also struggled with overeating, which he views as another addiction. Stress from the pandemic caused him to gain more than 40 pounds during his medical residency. In 2022, he decided to try Mounjaro, part of a new class of medications like Ozempic and Wegovy that are proving effective in treating obesity and diabetes.
Dr. Klein realized that the medication was working while eating a roast beef sandwich from Jimmy John’s. Ordinarily, he would devour his meal. But this time, “I ate half the sandwich and a couple of the chips, and I was done,” he said. “It just felt like my body knew when to stop eating.”
Dr. Klein is now an addiction medicine fellow at the nonprofit Caron Treatment Centers’ residential treatment facility in Pennsylvania. He prescribes these medications to his patients in recovery to treat their obesity or diabetes, and says they report reductions in unhealthy urges for both drugs and food. Early unpublished data from a handful of people taking the drugs at Caron (before Dr. Klein worked there) found that they didn’t experience the rise in craving that would be expected when feeling stressed, which was observed in those given a placebo.
Could these medications — collectively known as GLP-1 receptor agonists — also fight America’s most difficult drug problems?
Striking new data suggests they might. On Thursday, the journal Addiction published a study that examined the medical records of half a million people with opioid use disorder and found that those who were taking GLP-1 drugs, for any reason, had a 40 percent lower overdose risk compared to people not on these drugs. The research also looked at the medical records of over 800,000 people with a history of alcohol use disorder, and found that the number of medical visits that noted current alcohol intoxication was halved in patients who were prescribed GLP-1 drugs, compared with patients who did not take the drugs.
In September, another large study of medical records of people with both opioid use disorder and Type 2 diabetes reported that the risk of hospitalization for overdose was cut by 40 to 70 percent if patients took semaglutide (sold as Ozempic or Wegovy) rather than older diabetes medications, including other, less effective GLP-1 drugs.
By itself, that kind of research cannot prove that Ozempic and similar drugs can treat addiction. But if those findings hold up — and early data from more rigorous clinical trials is promising — those medications could be as big a breakthrough in addiction care as they have been in fighting obesity. Understanding how they work could revolutionize the way we see addiction and how we treat it. However, that means policymakers would need to pressure the pharmaceutical industry to make those medications affordable and accessible.
There’s a new urgency among researchers to figure out how those medications work. Some experts believe that they may make food or addictive substances less pleasant — even repulsive. Others argue that they suppress desire, so that people have fewer cravings urging them to overindulge. Yet others claim that the medications change the body’s so-called set point — the weight or level of drug use that feels sufficient and signals when to stop eating or using.
Dr. Klein describes the change in his life this way: “I can now eat like I’ve seen other people eat with impunity my whole life. I can go places and order a cheesesteak and not eat five of them.”
Nonetheless, he still enjoys his meals. “I’m an Italian Jew, food is near and dear to my heart,” he said, “It has not changed my relationship to food so much as it just changed the quantity.”
That is the ideal outcome for anti-addiction drugs: increasing satisfaction with what one does consume, without creating disgust or limiting a person’s ability to experience pleasure. Significant evidence suggests that GLP-1 drugs may work by lowering the signals in the brain that create craving, with far less impact on the circuits that allow you to enjoy life.
Just how much they mute desire will matter in the long run. Dialing down desire too far could leave people apathetic. Some patients who take these drugs report feeling dull and colorless. But there’s little evidence to suggest that is the norm: Dr. Klein, who just got married, described his life as “zestful and flavorful” and “not any dimmer.”
Until more rigorous trials are published, how well these drugs work for addiction remains uncertain. Dr. Nora Volkow, director of the National Institute on Drug Abuse, is currently building out a plan to enable more government-funded clinical trials to study these drugs for opioid addiction, an important first step.
Unfortunately, despite the drugs’ promise, drug manufacturers seem reluctant to pay for the larger trials that would be needed to seek Food and Drug Administration approval for use for addiction. Historically, pharmaceutical companies have avoided developing anti-addiction medications, in part because of the stigma that frames addiction as a moral problem, not a medical one. Paul Kenny, chair of neuroscience at Mount Sinai Hospital in New York, suggests it’s possible that drug companies may also worry that testing these drugs in people with addiction, who often have multiple medical problems, could reveal or falsely connect the drugs to previously unknown side effects. That might threaten their highly profitable approval for diabetes and obesity.
Doctors are allowed to prescribe medications “off label” for conditions other than what they’re approved for, but insurers often refuse to cover such uses. Most people who would benefit from these expensive medications cannot afford to pay out of pocket.
Given the deadliness of the overdose crisis, it would be shameful not to find out as quickly as possible whether these medications help.
Maia Szalavitz (@maiasz) is a contributing Opinion writer and the author, most recently, of “Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction.”
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