Seven fewer people per 1,000 on GLP-1s developed a substance use disorder

Among more than 600,000 people with type 2 diabetes in US veterans' health records, those on GLP-1 medicines developed substance use disorders less often: about seven fewer people per 1,000 across three years than people taking a different class of diabetes drug. The analysis, published in The BMJ, also reported a 50% drop in deaths involving drugs and a 25% drop in suicidal ideation among those already diagnosed.

Researchers called the breadth of the effect the promising part, because the pattern held across alcohol, cannabis, cocaine, nicotine and opioids, including two for which no medicine exists today. These drugs act on the gut and the brain at once, which is how they quiet appetite, and reward circuitry is the plausible bridge to substances. Several well-powered randomized trials on alcohol use are due to report within six months.

Records cannot separate the drug from the person taking it. People who start these medicines may be more motivated to change behavior or followed more closely by their doctors, one epidemiologist noted, and the veterans' data skews older and mostly male, so how far the finding travels is still unknown. Whether any of it belongs in addiction care is a question for those trials and for a qualified clinician.

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