Could Semaglutide Offer An Alternative Solution to Opioid Use Disorder?

Approximately 100,000 drug overdose fatalities occur in the US every year. Although it has been reported that 2024 drug overdose deaths are down for the first time in decades, there is still much work to do.¹

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Current management of opioid use disorder (OUD) consists of a number of effective pharmacologic options, but the patient population remains undertreated. Only around 25% of individuals with OUD receive treatment, and almost 50% stop treatment within 6 months. Researchers have now shifted their attention to the glucagon-like peptide-1 receptor agonist (GLP1-RA) semaglutide (Ozempic; Novo Nordisk) as a potential alternative treatment for OUD.²

In previous studies, semaglutide was found to modulate dopamine reward signaling and decreased drug rewards (specifically heroin) in rodents. Additionally, empirical studies have also demonstrated therapeutic benefits of GLP1-RAs in those with alcohol and nicotine use disorders.²

In a cohort study with findings recently published in the Journal of the American Medical Association, semaglutide was compared with other antidiabetic medications (e.g. insulin, metformin, sulfonylureas, thiazolidinediones) in treating high-risk opioid overdose patients with comorbid type 2 diabetes and OUD.² The primary outcome analyzed was the number of opioid overdoses reported over a 12-month period.

The study included 33,006 eligible patients, 3034 of whom were prescribed semaglutide. The semaglutide patient population had a mean age of 57.4 years and 56.5% were female.²

According to the study findings, semaglutide was associated with a significantly lower risk of opioid overdose at the 1 year follow up compared with the rest of the antidiabetic medications. This included a comparison against other GLP1-RAs liraglutide (Victoza; Novo Nordisk) and dulaglutide (Trulicity; Lilly).²

Limitations of the study include potential unmeasured or uncontrolled cofounders, biases, and others inherent in electronic health records-based observational studies. The authors noted that their results need validation from other data sources and study populations.²

GLP1-RAs continue to be the gift that keeps on giving, with positive findings all across the clinical landscape. Although semaglutide may show some promise as a potential therapeutic tool to combat the opioid epidemic, further research is necessary. Better understanding of the underlying mechanisms of GLP1-RAs will help create a clearer explanation to these results.

REFERENCES

1. Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2024.

2. Wang W, Volkow ND, Wang Q, et al. Semaglutide and Opioid Overdose Risk in Patients With Type 2 Diabetes and Opioid Use Disorder. JAMA Netw Open. 2024;7(9):e2435247. doi:10.1001/jamanetworkopen.2024.35247