Clinical observation and animal studies suggest the new class of weight loss medications like semaglutide and tirzepatide – best known by brand name medications like Ozempic and Zepbound, respectively – might help address substance use disorder as well, yet focused research in this area is limited. This study used a large medical record database to examine whether prescription of these new medications can help.
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Emerging evidence suggests the new class of weight loss medications like semaglutide and tirzepatide (best known by brand name medications like Ozempic and Zepbound) might help people with substance use disorder by reducing the desire to use alcohol and other drugs. These medications mimic naturally occurring hormones produced after eating that stimulate the production of insulin, which decreases blood sugar levels, while also reducing appetite and triggering a sense of “feeling full”, called satiety. It is thought that they work similarly to reduce urges to use alcohol and other drugs. From a theoretical perspective this is plausible because the same brain areas that regulate appetite and food satiety are also implicated in appetitive desire to consume alcohol and other drugs – consumption of both food and alcohol/drugs are considered “appetitive behaviors”.
While some animal studies support clinical observations that these medications also help people reduce or stop alcohol and other drug use, formal human subjects research has yet to be conducted on the relationship between this class of medications and substance use. Of the handful of human subjects’ studies conducted to date, results have been mixed. The researchers in this study examined if semaglutide and tirzepatide are associated with opioid and alcohol use related medical admissions in a large sample of people with opioid or alcohol use disorder.
This was an observational study of 1,321,056 adults included in the Oracle Cerner Real-World Data (CRWD), a large United States (US) repository of electronic healthcare records from 136 US health systems. The study’s goal was to explore associations between prescription of this new class of weight loss medications and opioid poisoning and acute alcohol intoxication episodes in people with either opioid or alcohol use disorder. Data from January 2014 when the FDA first approved these medications, to August 2022 were included in their analyses with comparisons made between people with either alcohol or opioid use disorder who were prescribed these medications vs. not prescribed these medications. Notably the diagnosis had to be present in the patient’s chart before the medication was prescribed to be eligible. Analyses controlled for important individual characteristics like age, gender, race, marital status, region of residence, insurance type, year of encounter, mental health history, and tobacco dependence and sleep apnea history. The researchers also stratified results based on diagnoses of either type 2 diabetes or obesity. While the medication was prescribed presumably to address these two issues given their FDA approvals and clinical indications, the reason for prescription was not captured in the data. Another important variable not captured was whether and the degree to which participants received substance use disorder treatment after diagnosis during the study window (see below for information on study window determination).
A retrospective cohort design was used, comparing patients with a semaglutide/tirzepatide-type weight loss medication prescription to those without, in separate opioid and alcohol use disorder cohorts. The target encounter was defined as the first instance of a semaglutide/tirzepatide-type weight loss medication prescription or a randomly selected encounter for patients without such prescriptions, occurring subsequent to a diagnosis of alcohol or opioid or use disorder. Follow-up data was explored for a minimum of 7 days and up to 2 years following the target encounter date.
The study sample included 817,309 patients with alcohol use disorder and 503,747 patients with opioid use disorder. The alcohol use disorder sample was on average 47 years old, 32% female, 71% single, 62% non-Hispanic White, and 29% reported Medicaid for insurance, while 9% of the cohort had a mental health condition history in addition to alcohol use disorder. The opioid use disorder sample was on average 51 years old, 51% female, 67% single, 73% non-Hispanic White, and 31% reported Medicaid for insurance. Around 50% of the cohort had a mental health condition history in addition to opioid use disorder and 12% had received medications for opioid use disorder.
Weight loss medication was not commonly prescribed in this substance use disorder sample
Prescription of these diabetes/weight-loss medications was relatively rare among those with alcohol or opioid use disorder based on clinical diagnosis present in their medical record (see Figure below). Rates were 0.7% among those with alcohol use disorder and 1.6% for those with opioid use disorder – presumably in those with comorbid diabetes/weight issues and substance use disorder.
Weight loss medication was associated with fewer alcohol intoxication episodes
In the alcohol use disorder sample, those with a semaglutide/tirzepatide-type weight loss medication prescription were on average age of 55 years of age and were 35% female compared to an average age of 47 years and 32% female for those without a prescription. One in 6 (17%) of those with a semaglutide/tirzepatide-type prescription also had history of a mental health condition other than alcohol use disorder versus 9% in those without a prescription.
The researchers found that those with a semaglutide/tirzepatide-type weight loss medication prescription were 50% less likely to have documented alcohol intoxication relative to those without a prescription after controlling for individual characteristics (see Figure below). When stratified by cooccurring medical conditions, those with type 2 diabetes were 49% less likely to have a recorded alcohol intoxication episode, while those with obesity and both type 2 diabetes and obesity were 42% less likely, relative to those without a semaglutide/tirzepatide-type medication prescription.
Weight loss medication was associated with fewer opioid poisonings
In the opioid use disorder cohort, people with a semaglutide/tirzepatide-type medication prescription had an average age of 58 years and were more likely to be female and married/partnered compared to those without a prescription. They were also less likely to experience a documented opioid poisoning event over the study window, with 7% having such an event, versus 16% for those without a prescription (see Figure below).
After controlling for individual characteristics, this translated into a 40% lower rate of opioid poisoning. Results were similar when stratified by cooccurring medical conditions, with a 38% lower rate of opioid poisoning in those with type 2 diabetes and a semaglutide/tirzepatide-type prescription, 33% lower among those with obesity, and 35% lower among those with both type 2 diabetes and obesity.
Across the study window, for those without a semaglutide/tirzepatide-type weight loss medication prescription, the rate of opioid poisoning per 10,000 patients was 81 at month zero and decreased to 52 at month 24, while for those with a prescription, opioid poisonings were 30 in 10,000 at month zero and 17 in 10,000 at month 24.
While there are FDA approved medications for alcohol and opioid and use disorders, the idea that popular, commonly prescribed weight loss medications might also help people with substance use disorder reduce or stop consuming alcohol and other drugs is of potentially major clinical and public health significance. While the researchers in this study utilized pre-existing data available to them and did not directly measure alcohol or opioid use, they found clinically meaningful associations between semaglutide/tirzepatide-type weight loss medication prescription and reductions in alcohol intoxication and opioid poisoning events in patients at risk for these deleterious health outcomes. These findings are correlational – it is possible that individuals more attuned to their health and well-being both sought out these weight loss medications and were more likely to reduce their substance use – they cannot be used to establish causation. However, they provide some preliminary compelling data suggesting future randomized trials are warranted.
It will be important for future studies to explore how substance use disorder severity affects the weight loss medications/substance use relationship – something the researchers were not able to explore in the present study. Any protective effects of these medications differ at different levels of addiction severity, though their medical record-based outcomes were likely capturing people with more severe opioid and alcohol use disorder, since they were presenting to clinics and hospitals with alcohol intoxication and opioid poisoning. If these medications can reduce substance use in people with severe substance use disorder, in theory they could have greater effect on people with mild or moderate substance use disorder, for whom substance use may be more malleable, but future studies will need to test this.
Preliminary findings show a correlation between semaglutide/tirzepatide-type weight loss medications and lower alcohol and other drug use; however, more research is needed to determine if this observed association is causative and not a result of a third, unmeasured variable.
Qeadan, F., McCunn, A., & Tingey, B. (2024). The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis. Addiction, 120(2), 236-250. doi: 10.1111/add.16679.
l
Emerging evidence suggests the new class of weight loss medications like semaglutide and tirzepatide (best known by brand name medications like Ozempic and Zepbound) might help people with substance use disorder by reducing the desire to use alcohol and other drugs. These medications mimic naturally occurring hormones produced after eating that stimulate the production of insulin, which decreases blood sugar levels, while also reducing appetite and triggering a sense of “feeling full”, called satiety. It is thought that they work similarly to reduce urges to use alcohol and other drugs. From a theoretical perspective this is plausible because the same brain areas that regulate appetite and food satiety are also implicated in appetitive desire to consume alcohol and other drugs – consumption of both food and alcohol/drugs are considered “appetitive behaviors”.
While some animal studies support clinical observations that these medications also help people reduce or stop alcohol and other drug use, formal human subjects research has yet to be conducted on the relationship between this class of medications and substance use. Of the handful of human subjects’ studies conducted to date, results have been mixed. The researchers in this study examined if semaglutide and tirzepatide are associated with opioid and alcohol use related medical admissions in a large sample of people with opioid or alcohol use disorder.
This was an observational study of 1,321,056 adults included in the Oracle Cerner Real-World Data (CRWD), a large United States (US) repository of electronic healthcare records from 136 US health systems. The study’s goal was to explore associations between prescription of this new class of weight loss medications and opioid poisoning and acute alcohol intoxication episodes in people with either opioid or alcohol use disorder. Data from January 2014 when the FDA first approved these medications, to August 2022 were included in their analyses with comparisons made between people with either alcohol or opioid use disorder who were prescribed these medications vs. not prescribed these medications. Notably the diagnosis had to be present in the patient’s chart before the medication was prescribed to be eligible. Analyses controlled for important individual characteristics like age, gender, race, marital status, region of residence, insurance type, year of encounter, mental health history, and tobacco dependence and sleep apnea history. The researchers also stratified results based on diagnoses of either type 2 diabetes or obesity. While the medication was prescribed presumably to address these two issues given their FDA approvals and clinical indications, the reason for prescription was not captured in the data. Another important variable not captured was whether and the degree to which participants received substance use disorder treatment after diagnosis during the study window (see below for information on study window determination).
A retrospective cohort design was used, comparing patients with a semaglutide/tirzepatide-type weight loss medication prescription to those without, in separate opioid and alcohol use disorder cohorts. The target encounter was defined as the first instance of a semaglutide/tirzepatide-type weight loss medication prescription or a randomly selected encounter for patients without such prescriptions, occurring subsequent to a diagnosis of alcohol or opioid or use disorder. Follow-up data was explored for a minimum of 7 days and up to 2 years following the target encounter date.
The study sample included 817,309 patients with alcohol use disorder and 503,747 patients with opioid use disorder. The alcohol use disorder sample was on average 47 years old, 32% female, 71% single, 62% non-Hispanic White, and 29% reported Medicaid for insurance, while 9% of the cohort had a mental health condition history in addition to alcohol use disorder. The opioid use disorder sample was on average 51 years old, 51% female, 67% single, 73% non-Hispanic White, and 31% reported Medicaid for insurance. Around 50% of the cohort had a mental health condition history in addition to opioid use disorder and 12% had received medications for opioid use disorder.
Weight loss medication was not commonly prescribed in this substance use disorder sample
Prescription of these diabetes/weight-loss medications was relatively rare among those with alcohol or opioid use disorder based on clinical diagnosis present in their medical record (see Figure below). Rates were 0.7% among those with alcohol use disorder and 1.6% for those with opioid use disorder – presumably in those with comorbid diabetes/weight issues and substance use disorder.
Weight loss medication was associated with fewer alcohol intoxication episodes
In the alcohol use disorder sample, those with a semaglutide/tirzepatide-type weight loss medication prescription were on average age of 55 years of age and were 35% female compared to an average age of 47 years and 32% female for those without a prescription. One in 6 (17%) of those with a semaglutide/tirzepatide-type prescription also had history of a mental health condition other than alcohol use disorder versus 9% in those without a prescription.
The researchers found that those with a semaglutide/tirzepatide-type weight loss medication prescription were 50% less likely to have documented alcohol intoxication relative to those without a prescription after controlling for individual characteristics (see Figure below). When stratified by cooccurring medical conditions, those with type 2 diabetes were 49% less likely to have a recorded alcohol intoxication episode, while those with obesity and both type 2 diabetes and obesity were 42% less likely, relative to those without a semaglutide/tirzepatide-type medication prescription.
Weight loss medication was associated with fewer opioid poisonings
In the opioid use disorder cohort, people with a semaglutide/tirzepatide-type medication prescription had an average age of 58 years and were more likely to be female and married/partnered compared to those without a prescription. They were also less likely to experience a documented opioid poisoning event over the study window, with 7% having such an event, versus 16% for those without a prescription (see Figure below).
After controlling for individual characteristics, this translated into a 40% lower rate of opioid poisoning. Results were similar when stratified by cooccurring medical conditions, with a 38% lower rate of opioid poisoning in those with type 2 diabetes and a semaglutide/tirzepatide-type prescription, 33% lower among those with obesity, and 35% lower among those with both type 2 diabetes and obesity.
Across the study window, for those without a semaglutide/tirzepatide-type weight loss medication prescription, the rate of opioid poisoning per 10,000 patients was 81 at month zero and decreased to 52 at month 24, while for those with a prescription, opioid poisonings were 30 in 10,000 at month zero and 17 in 10,000 at month 24.
While there are FDA approved medications for alcohol and opioid and use disorders, the idea that popular, commonly prescribed weight loss medications might also help people with substance use disorder reduce or stop consuming alcohol and other drugs is of potentially major clinical and public health significance. While the researchers in this study utilized pre-existing data available to them and did not directly measure alcohol or opioid use, they found clinically meaningful associations between semaglutide/tirzepatide-type weight loss medication prescription and reductions in alcohol intoxication and opioid poisoning events in patients at risk for these deleterious health outcomes. These findings are correlational – it is possible that individuals more attuned to their health and well-being both sought out these weight loss medications and were more likely to reduce their substance use – they cannot be used to establish causation. However, they provide some preliminary compelling data suggesting future randomized trials are warranted.
It will be important for future studies to explore how substance use disorder severity affects the weight loss medications/substance use relationship – something the researchers were not able to explore in the present study. Any protective effects of these medications differ at different levels of addiction severity, though their medical record-based outcomes were likely capturing people with more severe opioid and alcohol use disorder, since they were presenting to clinics and hospitals with alcohol intoxication and opioid poisoning. If these medications can reduce substance use in people with severe substance use disorder, in theory they could have greater effect on people with mild or moderate substance use disorder, for whom substance use may be more malleable, but future studies will need to test this.
Preliminary findings show a correlation between semaglutide/tirzepatide-type weight loss medications and lower alcohol and other drug use; however, more research is needed to determine if this observed association is causative and not a result of a third, unmeasured variable.
Qeadan, F., McCunn, A., & Tingey, B. (2024). The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis. Addiction, 120(2), 236-250. doi: 10.1111/add.16679.
l
Emerging evidence suggests the new class of weight loss medications like semaglutide and tirzepatide (best known by brand name medications like Ozempic and Zepbound) might help people with substance use disorder by reducing the desire to use alcohol and other drugs. These medications mimic naturally occurring hormones produced after eating that stimulate the production of insulin, which decreases blood sugar levels, while also reducing appetite and triggering a sense of “feeling full”, called satiety. It is thought that they work similarly to reduce urges to use alcohol and other drugs. From a theoretical perspective this is plausible because the same brain areas that regulate appetite and food satiety are also implicated in appetitive desire to consume alcohol and other drugs – consumption of both food and alcohol/drugs are considered “appetitive behaviors”.
While some animal studies support clinical observations that these medications also help people reduce or stop alcohol and other drug use, formal human subjects research has yet to be conducted on the relationship between this class of medications and substance use. Of the handful of human subjects’ studies conducted to date, results have been mixed. The researchers in this study examined if semaglutide and tirzepatide are associated with opioid and alcohol use related medical admissions in a large sample of people with opioid or alcohol use disorder.
This was an observational study of 1,321,056 adults included in the Oracle Cerner Real-World Data (CRWD), a large United States (US) repository of electronic healthcare records from 136 US health systems. The study’s goal was to explore associations between prescription of this new class of weight loss medications and opioid poisoning and acute alcohol intoxication episodes in people with either opioid or alcohol use disorder. Data from January 2014 when the FDA first approved these medications, to August 2022 were included in their analyses with comparisons made between people with either alcohol or opioid use disorder who were prescribed these medications vs. not prescribed these medications. Notably the diagnosis had to be present in the patient’s chart before the medication was prescribed to be eligible. Analyses controlled for important individual characteristics like age, gender, race, marital status, region of residence, insurance type, year of encounter, mental health history, and tobacco dependence and sleep apnea history. The researchers also stratified results based on diagnoses of either type 2 diabetes or obesity. While the medication was prescribed presumably to address these two issues given their FDA approvals and clinical indications, the reason for prescription was not captured in the data. Another important variable not captured was whether and the degree to which participants received substance use disorder treatment after diagnosis during the study window (see below for information on study window determination).
A retrospective cohort design was used, comparing patients with a semaglutide/tirzepatide-type weight loss medication prescription to those without, in separate opioid and alcohol use disorder cohorts. The target encounter was defined as the first instance of a semaglutide/tirzepatide-type weight loss medication prescription or a randomly selected encounter for patients without such prescriptions, occurring subsequent to a diagnosis of alcohol or opioid or use disorder. Follow-up data was explored for a minimum of 7 days and up to 2 years following the target encounter date.
The study sample included 817,309 patients with alcohol use disorder and 503,747 patients with opioid use disorder. The alcohol use disorder sample was on average 47 years old, 32% female, 71% single, 62% non-Hispanic White, and 29% reported Medicaid for insurance, while 9% of the cohort had a mental health condition history in addition to alcohol use disorder. The opioid use disorder sample was on average 51 years old, 51% female, 67% single, 73% non-Hispanic White, and 31% reported Medicaid for insurance. Around 50% of the cohort had a mental health condition history in addition to opioid use disorder and 12% had received medications for opioid use disorder.
Weight loss medication was not commonly prescribed in this substance use disorder sample
Prescription of these diabetes/weight-loss medications was relatively rare among those with alcohol or opioid use disorder based on clinical diagnosis present in their medical record (see Figure below). Rates were 0.7% among those with alcohol use disorder and 1.6% for those with opioid use disorder – presumably in those with comorbid diabetes/weight issues and substance use disorder.
Weight loss medication was associated with fewer alcohol intoxication episodes
In the alcohol use disorder sample, those with a semaglutide/tirzepatide-type weight loss medication prescription were on average age of 55 years of age and were 35% female compared to an average age of 47 years and 32% female for those without a prescription. One in 6 (17%) of those with a semaglutide/tirzepatide-type prescription also had history of a mental health condition other than alcohol use disorder versus 9% in those without a prescription.
The researchers found that those with a semaglutide/tirzepatide-type weight loss medication prescription were 50% less likely to have documented alcohol intoxication relative to those without a prescription after controlling for individual characteristics (see Figure below). When stratified by cooccurring medical conditions, those with type 2 diabetes were 49% less likely to have a recorded alcohol intoxication episode, while those with obesity and both type 2 diabetes and obesity were 42% less likely, relative to those without a semaglutide/tirzepatide-type medication prescription.
Weight loss medication was associated with fewer opioid poisonings
In the opioid use disorder cohort, people with a semaglutide/tirzepatide-type medication prescription had an average age of 58 years and were more likely to be female and married/partnered compared to those without a prescription. They were also less likely to experience a documented opioid poisoning event over the study window, with 7% having such an event, versus 16% for those without a prescription (see Figure below).
After controlling for individual characteristics, this translated into a 40% lower rate of opioid poisoning. Results were similar when stratified by cooccurring medical conditions, with a 38% lower rate of opioid poisoning in those with type 2 diabetes and a semaglutide/tirzepatide-type prescription, 33% lower among those with obesity, and 35% lower among those with both type 2 diabetes and obesity.
Across the study window, for those without a semaglutide/tirzepatide-type weight loss medication prescription, the rate of opioid poisoning per 10,000 patients was 81 at month zero and decreased to 52 at month 24, while for those with a prescription, opioid poisonings were 30 in 10,000 at month zero and 17 in 10,000 at month 24.
While there are FDA approved medications for alcohol and opioid and use disorders, the idea that popular, commonly prescribed weight loss medications might also help people with substance use disorder reduce or stop consuming alcohol and other drugs is of potentially major clinical and public health significance. While the researchers in this study utilized pre-existing data available to them and did not directly measure alcohol or opioid use, they found clinically meaningful associations between semaglutide/tirzepatide-type weight loss medication prescription and reductions in alcohol intoxication and opioid poisoning events in patients at risk for these deleterious health outcomes. These findings are correlational – it is possible that individuals more attuned to their health and well-being both sought out these weight loss medications and were more likely to reduce their substance use – they cannot be used to establish causation. However, they provide some preliminary compelling data suggesting future randomized trials are warranted.
It will be important for future studies to explore how substance use disorder severity affects the weight loss medications/substance use relationship – something the researchers were not able to explore in the present study. Any protective effects of these medications differ at different levels of addiction severity, though their medical record-based outcomes were likely capturing people with more severe opioid and alcohol use disorder, since they were presenting to clinics and hospitals with alcohol intoxication and opioid poisoning. If these medications can reduce substance use in people with severe substance use disorder, in theory they could have greater effect on people with mild or moderate substance use disorder, for whom substance use may be more malleable, but future studies will need to test this.
Preliminary findings show a correlation between semaglutide/tirzepatide-type weight loss medications and lower alcohol and other drug use; however, more research is needed to determine if this observed association is causative and not a result of a third, unmeasured variable.
Qeadan, F., McCunn, A., & Tingey, B. (2024). The association between glucose-dependent insulinotropic polypeptide and/or glucagon-like peptide-1 receptor agonist prescriptions and substance-related outcomes in patients with opioid and alcohol use disorders: A real-world data analysis. Addiction, 120(2), 236-250. doi: 10.1111/add.16679.
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