Evidence continues to mount suggesting that GLP-1 drugs may help people cut back on cigarettes, drinking and opioid use. As the medications — which include semaglutide and tirzepatide — have grown in popularity, anecdotal reports have emerged of people who said they no longer felt the urge to drink alcohol or use drugs while taking a GLP-1. Peer-reviewed studies have since followed.“An accumulating body of studies are showing positive potential for using GLP-1s for substance use,” said Christian Hendershot, director of clinical research at the USC Institute for Addiction Science in Los Angeles. Most of this research has focused on people with alcohol use disorder. A new study, published Wednesday in The BMJ, casts a much wider net, looking at the effects GLP-1s have on other substance use disorders, including cannabis, cocaine, nicotine and opioids.In the study, researchers analyzed patient records from more than 600,000 people in a Department of Veterans Affairs database. The average age was about 65 and men made up 90% of the people in the study.All of the patients had Type 2 diabetes and either took a GLP-1 or another diabetes drug called a sodium-glucose cotransporter-2 inhibitor, or SGLT2.Using the data, the researchers simulated seven clinical trials, testing what effect GLP-1s appeared to have on people with existing substance use disorders, as well as whether they appeared to prevent substance use disorders from developing. In a randomized clinical trial, people are recruited and then either assigned a drug or a placebo and then tracked for the study period. The process takes years. So-called emulated target trials, which use the same methods to analyze already collected data, can give information more quickly.“I think of it as the strongest form of observational evidence, but still something we want to confirm with randomized trials,” Fares Qeadan, an associate professor of biostatistics at the Loyola Parkinson School of Health Sciences and Public Health in Chicago, told Jattvibe News in an email. Qeadan wrote an editorial published alongside the study. The new results showed that among people with pre-existing substance use disorders, there were fewer emergency room visits, hospitalizations and deaths related to their substance use across the board. That means that GLP-1 drugs may not just be promising treatments for alcohol use disorder, but also for other substance use disorders. The fact that the results were consistent across substance types — alcohol, opioids, stimulants — “really elevates the notion that these medications are really acting on the root causes of all of these addictions,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis, who led the study.“Here is a trial with 600,000 people studying not only opioids or nicotine or alcohol, but all of them. So it’s unlikely to be a coincidence or chance finding,” Al-Aly said. About 50 million people in the United States are living with a substance use disorder, but few receive treatment, according to the National Institute on Drug Abuse.A medication that treats multiple substance use disorders is needed, said Alex DiFeliceantonio, an assistant professor at Virginia Tech’s Fralin Biomedical Research Institute. The Food and Drug Administration has approved different medications to treat alcohol, opioid and nicotine use disorders, but none exist for cannabis, stimulants such as cocaine or sedatives such as benzodiazepine.“Even with the drugs we have for alcohol use disorder and opioid use disorder, relapse rates are really high,” said DiFeliceantonio, who was not involved in the study. The new research also suggested that using a GLP-1 drug over another type of medication could help prevent someone from developing a substance use disorder, though some experts said this finding was weaker than the data showing the drugs may be able to help treat existing disorders. “Most people are talking about this from a treatment standpoint,” said Hendershot, who wasn’t involved with the new research. He added that the average age in the study was 65. “Most people would have developed a problem with substance use before that point.”However, the study did show that GLP-1 drugs could reduce the chances of a substance use disorder resurfacing, he said. Researchers are still working out how these could also curb drug and alcohol use. The theory is that GLP-1 drugs work on the reward signaling part of the brain.“In obesity, when people take GLP-1 agonists, they describe the quieting of food noise, that constant chatter in their brain saying, ‘I’m thinking about what to eat,’” Al-Aly said. “I think something similar is happening with that preoccupation with needing a substance. It quiets.”Hendershot said a slew of clinical trials is already underway to test this theory with more rigor. Those results, which he said will roll out over the next few years, will give a clearer answer to whether GLP-1 drugs could help treat drug and alcohol addiction. Even then, the medication likely will not work for everyone. “Substance use disorders are complex conditions. There are different reasons people develop substance use disorders and why some treatments may be more effective for some than others. It’s difficult to develop any one medication, especially for substance use disorder, that works for everyone,” he said.