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Sometimes, the drugs that transform our society are stumbled upon by pure happenstance.
Viagra was initially developed to treat chest pain, until clinical trial participants reported a surprising – though not entirely unwelcome – side effect.
Minoxidil was first produced for hypertension, but when its impacts on male pattern baldness became an open secret, researchers were forced to pivot, with the topical medication now one of the most common treatments for hair loss.
“In research, they call it repurposing,” Paul Haber, conjoint professor of medicine at the University of Sydney said. “It’s quicker and cheaper than developing a drug from scratch – if it does actually work.”
GLP-1 drugs – which market under brand names including Ozempic, Trulicity, Wegovy and Mounjaro – have already been repurposed.
Initially developed for diabetes, the peptides’ effect on appetite, cravings and “food noise” saw them explode in popularity in recent years as a weight-loss drug.
Now, researchers are questioning whether those same properties could be used to treat drug and alcohol addiction, and will explore the topic as part of the National Drug and Alcohol Research Centre’s (NDARC) annual research symposium on Friday.
Glucagon-like peptide-1 – or GLP-1 – is a naturally occurring gut hormone that controls digestion, blood sugar, and appetite. It slows the rate at which food leaves the stomach and helps signal fullness to the brain.
GLP-1 receptor agonists – such as Ozempic – stimulate these same biological pathways, but for much longer periods, suppressing appetite and slowing digestion.
“Addiction can be likened to an abnormal appetite for a drug,” Haber said. “So, for some time now, there’s been this question that they may alter the appetite for addictive substances, particularly alcohol.”
A randomised control trial recently published in The Lancet found GLP-1 receptor agonists had “robust therapeutic effects” in treatment-seeking participants with both obesity and alcohol use disorder.
GLP-1s were associated with a 41.1 percentage point reduction in heavy drinking days, compared with a 26.4 point reduction in patients taking a placebo.
“It’s sort of giving people a stop button,” said GP and addiction specialist Dr Chris Davis.
“Often, people complain that when they start drinking, they can’t stop, and it makes sense that GLP-1s work for addiction in the same way as they reduce appetite … you’re not getting that desire to keep drinking.”
However, Davis said existing treatments that help reduce the urge to drink, such as naltrexone, had already been proven to be safe and effective.
“One of the things that we haven’t studied yet is what happens when we stop Ozempic,” he said, pointing to research that found people regained an average 60 per cent of their lost weight after cessation.
“That [rebound] may well happen with your addictive behaviour or substance use,” Davis said.
NDARC’s director, Professor Michael Farrell, said the emerging area of research was moving “at a very high speed,” but was still in a preliminary stage.
“The question for us is: How do we figure out where we need to go with this, from a research, clinical and policy perspective?”
A landmark study published earlier this year in the BMJ analysed the observational data of more than 606,000 US veterans with type 2 diabetes.
It found GLP-1 receptor agonists consistently reduced the risk of developing a new substance use disorder, with alcohol, cannabis, nicotine, cocaine and opioid use all incorporated in the study.
In people with a pre-existing addiction, GLP-1 use was also associated with a reduced risk of adverse clinical outcomes, such as emergency department visits, hospital admissions, mortality, and overdose.
Farrell said existing drugs for opioid dependence treatment, such as buprenorphine, also worked by reducing cravings and withdrawal symptoms.
He said future studies should examine how existing and emerging pharmacological interventions could be combined with lifestyle changes.
Chief executive of the NSW Users and AIDS Association Dr Mary Ellen Harrod said she was doubtful about the real-world impact of using medicine to treat addiction.
“I tend to think of [drug dependence] as a lot more complex than a brain disorder,” she said. “It’s your social circumstances, your past trauma, all those things have probably a lot more to do with it.”
Davis also raised concerns about the high levels of crossover between eating disorders and substance use disorders.
“If someone’s just getting Ozempic online for their drinking, and they’re not eating well, or they have an underlying eating disorder, it could be significantly detrimental to their health,” he said.
“Plus, the evidence still isn’t there yet, so this isn’t a licensed use of this medication,” Davis said.
Haber said conclusive results and a potential wider roll-out of GLP-1s as a treatment option for addiction were still five to 10 years away.
For free and confidential advice about alcohol and other drugs, contact the National Alcohol and Other Drug hotline on 1800 250 015.
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