Hundreds of hundreds of individuals worldwide are popping up like Ozempic to drop extra pounds. But what can we actually find out about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
Semaglutide (sold as Ozempic, Wegovy and Rybelsus) was initially developed to treat diabetes. It works by stimulating the production of insulin to maintain blood sugar levels in check.
This form of drug is increasingly being prescribed for weight reduction, despite the actual fact it was initially approved for an additional purpose. Recently, there was growing interest in one other possible use: to treat addiction.
Anecdotal reports from patients taking semaglutide for weight reduction suggest it reduces their appetite and craving for food, but surprisingly, it also may reduce their desire to drink alcohol, smoke cigarettes or take other drugs.
But does the research evidence back this up?
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Animal studies show positive results
Semaglutide works on glucagon-like peptide-1 receptors and is referred to as a “GLP-1 agonist”.
Animal studies in rodents and monkeys have been overwhelmingly positive. Studies suggest GLP-1 agonists can reduce drug consumption and the rewarding value of medicine, including alcohol, nicotine, cocaine and opioids.
Out team has reviewed the evidence and located greater than 30 different pre-clinical studies have been conducted. The majority show positive leads to reducing drug and alcohol consumption or cravings. More than half of those studies focus specifically on alcohol use.
However, translating research evidence from animal models to people living with addiction is difficult. Although these results are promising, it’s still too early to inform if it’ll be protected and effective in humans with alcohol use disorder, nicotine addiction or one other drug dependence.
What about research in humans?
Research findings are mixed in human studies.
Only one large randomised controlled trial has been conducted thus far on alcohol. This study of 127 people found no difference between exenatide (a GLP-1 agonist) and placebo (a sham treatment) in reducing alcohol use or heavy drinking over 26 weeks.
In fact, everyone within the study reduced their drinking, each people on energetic medication and within the placebo group.
However, the authors conducted further analyses to look at changes in drinking in relation to weight. They found there was a discount in drinking for individuals who had each alcohol use problems and obesity.
For individuals who began at a standard weight (BMI lower than 30), despite initial reductions in drinking, they observed a rebound increase in levels of heavy drinking after 4 weeks of medication, with an overall increase in heavy drinking days relative to those that took the placebo.
There were no differences between groups for other measures of drinking, resembling cravings.
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In one other 12-week trialresearchers found the GLP-1 agonist dulaglutide didn’t help to cut back smoking.
However, people receiving GLP-1 agonist dulaglutide drank 29% less alcohol than those on the placebo. Over 90% of individuals on this study also had obesity.
Smaller studies have checked out GLP-1 agonists short-term for cocaine and opioidswith mixed results.
There are currently many other clinical studies of GLP-1 agonists and alcohol and other addictive disorders underway.
While we await findings from larger studies, it’s difficult to interpret the conflicting results. These differences in treatment response may come from individual differences that affect addiction, including physical and mental health problems.
Larger studies in broader populations of individuals will tell us more about whether GLP-1 agonists will work for addiction, and in that case, for whom.
How might these drugs work for addiction?
The exact way GLP-1 agonists act will not be yet well understood, nonetheless along with reducing consumption (of food or drugs), additionally they may reduce cravings.
Animal studies show GLP-1 agonists reduce craving for cocaine and opioids.
This may involve a key are of the brain reward circuit, the ventral striatum, with experimenters showing in the event that they directly administer GLP-1 agonists into this region, rats show reduced “craving” for oxycodone or cocainepossibly through reducing drug-induced dopamine release.
Using human brain imaging, experimenters can elicit craving by showing images (cues) related to alcohol. The GLP-1 agonist exenatide reduced brain activity in response to an alcohol cue. Researchers saw reduced brain activity within the ventral striatum and septal areas of the brain, which connect with regions that regulate emotion, just like the amygdala.
In studies in humans, it stays unclear whether GLP-1 agonists act directly to cut back cravings for alcohol or other drugs. This must be directly assessed in future research, alongside any reductions in use.
Are these drugs protected to make use of for addiction?
Overall, GLP-1 agonists have been shown to be relatively protected in healthy adults, and in individuals with diabetes or obesity. However unwanted effects do include nausea, digestive troubles and headaches.
And while some persons are OK with shedding weight as a side effect, others aren’t. If someone is already underweight, for instance, this drug won’t be suitable for them.
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In addition, only a few studies have been conducted in individuals with addictive disorders. Yet some unwanted effects could also be more of a difficulty in individuals with addiction. Recent research, as an example, points to a rare risk of pancreatitis related to GLP-1 agonists, and other people with alcohol use problems have already got a better risk of this disorder.
Other drugs treatments are currently available
Although emerging research on GLP-1 agonists for addiction is an exciting development, rather more research must be done to know the risks and advantages of those GLP-1 agonists for people living with addiction.
In the meantime, existing effective medications for addiction remain under-prescribed. Only about 3% of Australians with alcohol dependence, for instance, are prescribed medication treatments resembling like naltrexone, acamprosate or disulfiram. We need to make sure current medication treatments are accessible and health providers know easy methods to prescribe them.
Continued innovation in addiction treatment can also be essential. Our team is leading research towards other individualised and effective medications for alcohol dependence, while others are investigating treatments for nicotine addiction and other drug dependence.
Read the opposite articles in The Conversation’s Ozempic series here.