GLP-1-Medikamente können bei der Behandlung und Vorbeugung von Substanzstörungen wirksam sein

Recent research from the Washington University School of Medicine in St. Louis highlights the potential of GLP-1 receptor agonists—commonly used for treating Type 2 diabetes—to also mitigate the effects of substance use disorders across various addictive substances. This finding suggests these medications might target a shared biological pathway that underpins addiction.

Initially developed to manage diabetes, medications like Semaglutide and Tirzepatide have gained popularity for weight loss. Patients taking these drugs have reported a lower desire for alcohol and nicotine, with observational studies indicating a correlation between GLP-1 treatments and a reduced risk of substance use disorders, including alcohol and cannabis misuse, as well as opioid overdoses. However, existing studies primarily explored the effects on individual substances rather than examining whether GLP-1 medications could generally combat multiple substance use disorders and related harms such as overdose and drug-related deaths.

In a comprehensive analysis involving over 600,000 U.S. veterans diagnosed with Type 2 diabetes, researchers found that GLP-1 medications were associated with a decreased risk of developing substance use disorders across all major addictive substances, as well as a reduction in severe outcomes for those already struggling with such disorders.

“In addiction medicine, many treatments focus on a single substance, but no medication has shown broad efficacy across all addictions. The revelation about GLP-1 drugs is that they act effectively against all major substances not necessarily because they specifically target alcohol, opioids, or nicotine, but likely because they address the craving itself,”

Ziyad Al-Aly, MD, lead author and clinical epidemiologist at WashU Medicine

Addressing Complications of Addiction

Dr. Al-Aly pointed out the challenges in treating multiple substance use disorders, particularly for highly addictive substances like methamphetamine, for which no effective pharmacological treatments currently exist. His curiosity stemmed from anecdotal accounts of patients reporting diminished cravings for alcohol and nicotine post-GLP-1 treatment. He and his team connected these observations to the presence of GLP-1 receptors in brain regions that process reward, which may influence cravings across different substances.

The study focused on health records of 606,434 veterans, dividing them into two groups: those without pre-existing substance use disorders and those with such disorders. The researchers tracked these individuals for up to three years after initiating treatment with a GLP-1 receptor agonist—most commonly Semaglutide, Liraglutide, or Dulaglutide—or a different diabetes medication known as an SGLT2 inhibitor.

During the study, the researchers noted which of the 524,817 participants in the first group developed new alcohol, cannabis, cocaine, nicotine, opioid, or other substance use disorders. For those already diagnosed with a substance use disorder, they monitored occurrences of drug-related emergency room visits, hospitalizations, overdose incidents, and suicidal ideation or attempts among the 81,617 participants.

Compared to patients treated with a non-GLP-1 medication, those on GLP-1 therapy exhibited a 14% lower risk of developing a substance use disorder. The likelihood of developing each type of substance use disorder also significantly decreased—by 18% for alcohol, 14% for cannabis, 20% for cocaine and nicotine, and 25% for opioids. This translated to an estimated seven new diagnoses of substance use disorders per 1,000 GLP-1 users.

For patients with existing substance use disorders, GLP-1 treatment correlated with substantial reductions in hospital visits, overdoses, and drug-related deaths. Over three years, emergency room visits decreased by 30%, hospital admissions declined by 25%, while overdose incidents dropped by 40% and drug-related fatalities by 50%, resulting in 12 fewer severe adverse events per 1,000 GLP-1 users.

Dr. Al-Aly remarked, “GLP-1 could offer a dual benefit for patients with chronic conditions such as diabetes or obesity who are also battling substance use disorders, effectively treating both issues concurrently.”

As millions of Americans continue to use GLP-1 medications, their implications for preventing and treating substance use disorders could have significant public health ramifications. Dr. Al-Aly advocates for future clinical studies aimed at testing GLP-1 medications as standalone addiction therapies, especially focusing on their impact on overdose and drug-related mortality.

“Patients on these medications often describe a reduction in the ‘food noise,’ the continuous preoccupation with eating that leads to overeating. What our study suggests, however, is broader: GLP-1 medications may also quell what I refer to as ‘drug noise,’ the relentless craving that drives addiction across different substances. This cross-substance signaling points to a shared biological basis of addiction and opens the door to a fundamentally novel approach: treating the underlying biology of addiction, rather than tackling one substance addiction at a time,” Dr. Al-Aly concluded.