Early data regarding the use of GLP-1 medications like Ozempic and Wegovy to treat addiction is “very, very, exciting,” Nora Volkow, the director of the National Institute on Drug Abuse, said Thursday.
But even as she expressed enthusiasm for the new drugs’ potential, Volkow criticized pharmaceutical companies for neglecting a moral imperative to develop new addiction treatments — but acknowledged that the health system more broadly doesn’t incentivize drug companies to treat the U.S. drug crisis with urgency.
“The pharmaceutical industry has never spontaneously embraced us and said, ‘We want to help develop treatments.’ No, no, no,” Volkow said. “We go to them …. and say, please, please, we have an obligation.”
Drug companies’ apathy toward developing addiction medications, and insurers’ unwillingness to pay for them, has created a shortage of options for people seeking addiction treatment, Volkow said.
And while Volkow stressed that existing medications for opioid use disorder like methadone or buprenorphine are both highly effective and underutilized, she argued that in other disease spaces, like depression or hypertension, researchers and public health officials would never be content with just two or three effective treatment options.
“This is a structural problem that we have: That we’ve never considered addiction as a disease that is worthwhile to invest in, despite the very high rate of mortality,” she said. “We need to change those priorities. We need to see that if we don’t tackle the problem of addiction — that if we don’t treat [it] like other diseases, we are going to continue to face this horrific epidemic of deaths.”
Volkow’s remarks came during the STAT Breakthrough Summit in New York City, and focused largely on the potential applications of GLP-1 drugs like Wegovy and Ozempic. Those medications are currently used to treat conditions like obesity and cardiovascular disease, and are being studied as potential treatments for a far wider array of health conditions ranging from Alzheimer’s to fatty liver disease.
The drugs target receptors of the GLP-1 hormone, which has been found to increase insulin production. But over time, scientists have found that the drugs, which have more potent and long-lasting effects than the naturally occurring GLP-1 hormone, act in the brain to suppress food cravings and alter circuits that drive desire. Notably, however, no pharmaceutical companies are currently studying GLP-1s to treat addiction.
Marcus Schindler, Novo Nordisk’s chief scientific officer, said in a recent interview that researchers have found so many different potential uses for GLP-1-based drugs that “we might not engage in all of them. We’re certainly not a company at this point in time that has deep expertise in neurological disorders.”
The company is, however, studying its flagship GLP-1 drug in Alzheimer’s, running two large Phase 3 trials. Schindler said that real-world evidence and preclinical data supported Novo’s decision to run the Alzheimer’s studies: “We felt that is a worthy undertaking to really go after and test.” But for the areas that they chose not to pursue, “we really feel in the long run, we would be missing the competencies,” he said.
In a statement, Eli Lilly said it doesn’t have any studies planned to investigate tirzepatide, the ingredient in Mounjaro and Zepbound, as a treatment for addiction. It “collects and evaluates data about its medicines to see where they may provide benefit beyond their current indications,” Lilly said.
Given the dearth of GLP-1 research focused on addiction, Volkow advocated for a high-quality clinical trial that would more precisely measure the medications’ impact on substance use. So far, some anecdotal data has shown promising results for GLP-1 drugs as addiction treatments. In one recent study, however, side effects forced more than half of participants to drop out before completing the three-week trial, though some did report a reduction in opioid cravings.
“The data looks very, very exciting … but from data to product, there can be a big gap,” Volkow said. Anecdotal reports and data from trials conducted in rats, she added, suggest that researchers should examine the question more deeply. But she also acknowledged GLP-1s’ potential downsides — in particular, muscle loss associated with their use, which could prove problematic for people whose severe addictions may already have left them emaciated.
Overall, however, Volkow said that the medications could prove effective at reducing the desire to consume drugs — largely using the same mechanism through which they reduce people’s appetites.
“It interferes with that incentive, motivational drive, that consumption reinforces and generates in our brain — it just blocks it,” Volkow said. “That is of course extremely important for drugs, because that’s what drugs do: Immediately activates a system, and you just want more and more and more and it escalates. So if you can interfere with that system, this could be a mechanism that would reduce the binging that you see with drug-taking.”
Elaine Chen contributed reporting.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.