A Clockwork Ozempic?

MSNBC anchor, Chris Hayes, hosts a popular podcast called “Why Is This Happening,” where he takes on particularly tough issues. On January 15, 2025, show, Chris interviews Nicholas Reville, co-founder and executive director of CASPR, the Center for Addiction Science, Policy and Research.
CASPR is different. The organization is aiming for a transformational moment in the treatment of substance use disorders. The CASPR website opens with a blunt, two-sentence mission statement:
Breakthrough medicines can solve addiction at scale. CASPR works to advance research, policy, and innovation to bring better options to patients worldwide.
Not only does the website begin with a strong statement, it ends with one, too: “CASPR is a 501(c)3 non-profit organization. We are a real non-profit, not funded by industry. We receive no funding directly or indirectly from pharmaceutical or other healthcare businesses.” So they are advocates for breakthrough medications to treat addiction, but they decline any funding from drug companies. That’s different.
AddictionNews first wrote about Nicholas Reville three weeks ago, when the Federation of American Scientists released “An Innovation Agenda For Addiction: Breakthrough Medicines That Scale,” a piece written by Nicholas Reville and advocating for specific policy changes to turbocharge research into addiction recovery medications.
The main policy recommendation in the “innovation agenda” is to extend the Priority Review Voucher (PRV) program to medications for substance use disorders (SUDs), to incentivize drug manufacturers to do more randomized control trials on addiction drugs. At the top of the wishlist are GLP1-RA drugs, such as Ozempic, Wegovy, Mounjaro, and Zepbound, currently approved by the Food and Drug Administration (FDA) for treatment of Type 2 diabetes and obesity.
In the podcast, Reville explains to Chris Hayes how all previous drugs developed to treat obesity have either done very little and/or have dangerous side effects. GLP1-RAs were developed to treat diabetes and that’s when scientists realized they could also be used to safely treat obesity. In a similar way, the experience with using GLP1-RAs to treat diabetes and obesity has revealed their potential to treat substance use disorders.
Reville says of GLP1-RAs, “We’re also seeing that there’s a side effect of reducing craving for other substances and not just other substances, but even other behaviors.” Reville sees in GLP1-RA research the hope that we can refine safe and effective medications that make a big difference for those suffering from SUDs. However, the funding still isn’t there:
Nicholas Reville: […] addiction is driving more deaths than really any other cause. And yet addiction drugs get less than 0.5% of the investment from pharmaceutical companies for drug development that cancer drugs get.
Chris Hayes: One two-hundredth of the amount on cancer.
Nicholas Reville: Less than one two-hundredth.
People considered obesity a problem of willpower, not a problem solvable with a drug. Similarly, people see substance abuse as a willpower problem, not something that can be solved with a pill. GLP1-RAs could flip the script on addiction treatment the same way they have for obesity and Type 2 diabetes.
Reville points to the HIV epidemic, where in the early years, people were told to be careful, use condoms, practice safe sex, exercise willpower, and none of that worked until they developed drugs to treat HIV. He is saddened to see how little of the opioid settlement funds have gone to the development of non-opioid painkillers. Reville tells Hayes:
We have tremendous retrospective studies that show that people who receive a GLP-1 drug like Ozempic for something like diabetes or for weight loss, go on to have a 50% lower chance of developing an alcohol use disorder or having an opioid overdose.
It’s interesting that the conversation between Reville and Hayes does not get into how GLP1-RAs work. At one point, Reville says, “What we’re seeing is that this class of medication is reducing craving, not just for food, but for everything. And that there’s some kind of a craving mechanism in the brain that can just be reduced.” But is it in the brain? Or is it in the gut?
There is evidence that GLP1-RAs cause a somewhat continuous state of subclinical nausea. Reville mentions people taking GLP1-RAs for weight loss or diabetes who can no longer drink more than a beer or two without feeling sick. It’s like Alex in the movie A Clockwork Orange, the teenage criminal who is conditioned off violence and gets sick to his stomach whenever he has a violent thought. Are GLP1-RAs a clockwork Ozempic, changing people’s lifestyle habits by making them sick to their stomachs? Stay tuned.
Written by Steve O’Keefe. First published January 29, 2025.
Sources:
“Weight Loss Drugs for Curing Addiction? with Nicholas Reville,” Why Is This Happening, MSNBC, January 15, 2025.
“An Innovation Agenda For Addiction: Breakthrough Medicines That Scale,” Federation of American Scientists, January 6, 2025.
“GLP-1s for Reducing Addiction: Everything you need to know,” Recursive Adaptation, November 12, 2024.
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