That quiet sound you don’t hear is the major pharmaceutical companies not testing GLP-1 agonists such as Zepbound, Wegovy, and Ozempic, for their effectiveness against substance use disorders. That’s the conclusion of Bloomberg staff writer, Lisa Jarvis, in an article last week on the failure of pharmaceutical companies to fund this research. She writes:

Bloomberg Intelligence expects that global obesity drug sales could cross $93 billion in 2030. In comparison, the opioid and alcohol dependence treatment Vivitrol had sales of $400 million in 2023. Right now, academic and government researchers seem to be the only ones studying GLP-1 drugs in treating addiction, whether that’s to alcohol, tobacco, cannabis or opioids.

The former editor of Chemical and Engineering News, Jarvis is not fooled by Novo Nordisk’s tiny trial of semaglutide against liver disease caused by alcohol use disorder. She says big pharma doesn’t see an easy path to profitability with addiction treatment like it does with obesity treatment. Very likely, the drug companies expect public demand for addiction treatment to compel them to provide the drugs they develop at cost.

In the debate we’ve been having about the effects of semaglutide on the gut versus the brain, Jarvis comes down on both sides: “The drugs mimic a hormone produced in both the gut and the brain, serving as a signal of satiety.” Other pieces of the growing body of evidence in favor of using semaglutide to treat substance use disorder include:

• Impacts reward pathways for food, alcohol and drugs
• Mitigates withdrawal symptoms when addictive substances removed
• Lowers the risk of addiction to alcohol or cannabinoids
• Makes it easier to quit smoking cigarettes

The small, academic studies are in agreement. The anecdotal evidence from people taking Ozempic and other GLP-1 drugs for type 2 diabetes and/or weight loss indicates a pronounced impact on substance use disorders. However, getting regulatory approval to use semaglutide as a treatment for substance use disorders would require “much larger studies,” according to Jarvis, and “the financial heft and clinical expertise that only big pharma can provide.”

There are many reported side effects from using semaglutide that have yet to be cataloged or dealt with. The main one is intestinal discomfort, which is bad enough to cause a significant percentage of people to discontinue use. There are almost no studies on GLP-1 agonists against substance use disorders in non-obese persons. Would it cause them to lose too much weight? GLP-1 drugs have been known to cause suicidal ideation; do they take the pleasure out of living?

According to the publication Clinical Trials Alert, only 20% of all clinical trials on drugs treating substance use disorders are non-academic, private companies — a far lower percentage than for drugs treating other disorders. The publication concludes, “The pharmaceutical industry is lagging behind in the clinical arena of addiction treatments.” The main reasons for the malaise, according to the article, are:

• questionable profitability
• the stigma surrounding the target audience
• complexity of clinical trial design
• unpredictable patient population

“Treating addiction entails a lengthy and complicated journey, requiring trial and error over an extended period of time,” explains the article in Clinical Trials Alert as to why big pharma is hesitant to invest in addiction treatment studies. 

Participants in the trials suffer from substance use disorders. They often have transportation difficulties, communication difficulties, and financial difficulties. Fortunately, the practice of contingency management — paying people to maintain treatment schedules — has gone through trials and has proven quite effective.

Written by Steve O’Keefe. First published June 27, 2024.

Sources:

“Ozempic’s Addiction-Fighting Potential Is Being Ignored,” Bloomberg, June 20, 2024.

“Is pharma neglecting the unmet need of substance use disorder therapies?” Clinical Trials Alert, September 22, 2022.

Image courtesy PxHere, used under Public Domain.