DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS A 606,434-patient VA cohort study found GLP-1 receptor agonists associated with reduced incidence of alcohol, cannabis, cocaine, nicotine, and opioid use disorders compared to SGLT-2 inhibitors over three years. In patients with pre-existing SUDs, GLP-1 use was linked to fewer ED visits, hospitalizations, overdoses, and 50% lower SUD-related mortality.
Clinical Considerations
- GLP-1 receptor agonists reduced composite SUD incidence by 14% and cut opioid use disorder risk by 25% versus SGLT-2 inhibitors across all demographic subgroups
- In patients with pre-existing SUDs, GLP-1 use associated with 31% fewer ED visits and 26% fewer hospitalizations at three years
- Suicidal ideation or attempt reduced by 25% in SUD patients on GLP-1 agonists, countering earlier safety concerns about self-harm risk
- Effect was rapid, sustained, and consistent across semaglutide, liraglutide, and dulaglutide, suggesting a class effect tied to mesolimbic dopamine modulation
Practice Applications
- Favor GLP-1 agonists over other antihyperglycemics in diabetic patients with active or high-risk SUD profiles
- Counsel patients that GLP-1 benefits in addiction are biologically plausible but not yet an approved indication
- Weigh GI intolerance, pancreatitis, and gallbladder risks in shared decision-making for SUD-comorbid patients
- Monitor for emerging RCT data before incorporating GLP-1 agonists into formal SUD treatment protocols
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