Emerging Evidence on GLP-1 Drugs and Addiction
Evidence is accumulating that GLP-1 drugs, initially developed for weight loss and diabetes treatment, may also be effective in treating addiction. Reports indicate that these drugs can reduce not only food cravings but also cravings and desires more broadly. Earlier this month, a study involving patients undergoing diabetes treatment suggested that those using GLP-1 drugs were less likely to develop addictions to various substances. Additionally, patients already using addictive substances appeared to have about half the risk of overdose or drug-related death if they were also taking the GLP-1 drug.
This development opens an exciting avenue for future research. GLP-1 drugs operate partly by affecting satiation and reward centers in the brain. It is plausible that problematic cravings for food and drugs share similar biological mechanisms. Future medications may be more powerful or more specifically targeted to either food or drug cravings. Meanwhile, it is reasonable to anticipate that existing weight-loss drugs will eventually be recommended or prescribed off-label for addiction treatment. This prospect invites a reconsideration of our approach to these remarkable medicines.
Stigma Surrounding Obesity Versus Addiction
To state it plainly, drug addiction is widely recognized as an illness, whereas obesity, despite some progress, is not yet fully accepted as such. Since the introduction of GLP-1 agonist drugs, many critics have argued that using them for weight loss represents a form of avoidance—a solution to a problem that should be addressed through willpower and personal strength. This perspective ranges from opinion pieces claiming that weight loss through medication is a cop-out, to policies in countries such as Germany that permit GLP-1 drugs to treat diabetes but not obesity in general. A government spokesperson there stated that weight loss is "a matter of individual responsibility and personal lifestyle."
There are certainly drawbacks to GLP-1 agonists. They are costly and can cause unpleasant side effects. Moreover, rare but serious complications may still emerge. A recent study suggested that these drugs carry certain risks. The chief medical officer for England, Prof Chris Whitty, recently cautioned against viewing prescriptions of GLP-1 drugs as an alternative to the broader public health measures he believes are urgently needed. He is correct in emphasizing that achieving true health requires more than just medication.
Pragmatism and Public Choice
Nonetheless, it is important to adopt a pragmatic perspective and acknowledge that many people have already chosen to use these drugs. Approximately 4 million Americans and about 200,000 people in the UK have taken a GLP-1 drug. While these medications should not be prescribed merely to lose a few pounds for a holiday, it is difficult to imagine another drug treating a serious health condition—such as obesity—that faces comparable stigma.
Lessons from Addiction Treatment
The overlap between obesity treatment and addiction treatment offers instructive parallels. When methadone and suboxone were introduced as treatments for opioid addiction, there was significant resistance based on the belief that abstinence was the only path to recovery. Few hold that view today. Once society became less moralistic about addiction, it became possible to adopt a pragmatic approach to treatment. If GLP-1 drugs also prove effective in treating addiction, this should prompt reflection on the aversion to their use for an illness with significant health consequences.
As the former head of the US Food and Drug Administration, David A Kessler, writes in his recent book Diet, Dopamine, and the Biology of Obesity,
"the fact that the new anti-obesity drugs are highly effective underscores the fact that being overweight or obese is not a product of lack of discipline or willpower"
and that if a drug can target obesity,
"it is instead a matter of biology".
This understanding is a lesson learned from addiction, and it is time to extend that knowledge to obesity treatment.
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