From the Desk of a Doctor Newsletter
⚠️ The Science on GLP-1 Drugs and Addiction Is Not What You Have Been Told
GLP-1 Drugs and Substance Use Disorders — here is what the largest study on this topic actually found.
Millions of people are taking GLP-1 receptor agonists like semaglutide for diabetes and weight loss.
Prescriptions have skyrocketed. The drugs have reshaped entire medical specialties. And the list of conditions they appear to influence keeps growing.
But here's what most people aren't being told:
The largest study ever conducted on GLP-1s and addiction just found that these drugs may reduce the risk of developing substance use disorders — across six different substances simultaneously.
The Study
Researchers at the VA Saint Louis Health Care System analyzed data from over 600,000 US veterans with type 2 diabetes, comparing those who started GLP-1 receptor agonists against those who started SGLT-2 inhibitors — another diabetes medication used as an active comparator. (PMID: 41781010)
The paper was published March 4, 2026 in The BMJ.
They looked at whether GLP-1 drugs affected the risk of developing:
Alcohol use disorder
Cannabis use disorder
Cocaine use disorder
Nicotine use disorder
Opioid use disorder
Other substance use disorders
The finding across every single one of these categories: meaningful, consistent risk reduction.
The Findings 📉
✅ 18% lower risk of alcohol use disorder in GLP-1 users
✅ 14% lower composite risk of developing any substance use disorder
✅ 20% lower risk of cocaine use disorder
✅ 25% lower risk of opioid use disorder
⚠️ Among people with pre-existing substance use disorders, GLP-1 users had 50% lower addiction-related mortality
⚠️ SUD-related ER visits were 31% lower and hospitalizations 26% lower in that same group
That last point is worth sitting with. These are not marginal differences. And they appeared consistently across substances, subgroups, and both study protocols.
Why This Matters
GLP-1 receptors exist throughout the brain's reward and craving circuitry — not just in the gut or pancreas.
The leading theory is that these drugs dampen the dopamine-driven reward response underlying compulsive substance use. That would explain why the effect appeared across six different substance types rather than just one.
No existing addiction treatment works that way. Most target a single substance or a single pathway. A drug that appears to reduce craving and compulsive behavior broadly is a different kind of finding entirely.
Takeaway
This was an observational study, not a randomized controlled trial. It cannot prove causation, and the population was predominantly male veterans. Randomized trials are still needed before GLP-1s are formally used for addiction treatment.
But the consistency of the signal — across six substances, two protocols, and hundreds of thousands of patients — is not easy to dismiss.
If you or someone you know is struggling with substance use, this is not a reason to seek out a GLP-1 prescription tomorrow.
It is a reason to watch this space closely. And to have a conversation with your doctor about what the emerging evidence might mean for your situation.
The goal is always to make sure the treatment matches the science.
— Dr. Myro Figura, M.D.
Referenced study link: PMID: 41781010
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About the Author
I’m Dr. Myro, a board-certified doctor and med school educator who somehow ended up with over 6 million followers watching my science videos on
YouTube,
Instagram,
TikTok,
and Facebook.
I’ve published 60+ scientific abstracts and even written a book, but this newsletter is my favorite project. Here I get to share the good stuff — simple, actionable health tips delivered twice a week. Happy to have you here.
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