---
type: source
title: "Phase 2 RCT Protocol: Semaglutide for OUD Abstinence in Treatment-Refractory Patients (Grigson/Penn State, NCT06548490)"
author: "Grigson PS et al. / Penn State / Addiction Science & Clinical Practice"
url: https://pmc.ncbi.nlm.nih.gov/articles/PMC12154142/
date: 2025
domain: health
secondary_domains: []
format: peer-reviewed study
status: processed
processed_by: vida
processed_date: 2026-04-24
priority: medium
tags: [glp-1, semaglutide, opioid-use-disorder, OUD, addiction, clinical-trial, Phase-2, VTA-dopamine, reward-circuit, NCT06548490]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Protocol publication for a Phase 2 randomized, double-blind, placebo-controlled clinical trial evaluating semaglutide for opioid use disorder.

**Trial registration:** NCT06548490

**Design:**
- 200 participants with treatment-refractory OUD
- Outpatient population already receiving standard MOUD (buprenorphine or methadone)
- Three sites (NIH-funded)
- 12-week treatment period
- Double-blind, placebo-controlled

**Primary endpoint:** Opioid abstinence (confirmed by urine drug screens + self-report)

**Background:**
- Rodent models: GLP-1 RAs reduce opioid self-administration
- Residential OUD population: GLP-1 RAs decrease craving measures
- No completed controlled trial for outpatient OUD as of protocol publication (2025)
- Real-world data (Qeadan 2025): 40% lower opioid overdose rate in GLP-1 RA users

**Concerns noted:**
- Side effects: pancreatic cysts, pancreatic cancer risk, hypoglycemia, muscle cramps, cognitive slowing
- Adding GLP-1 to MOUD (buprenorphine/methadone) background — drug interaction considerations
- Population is treatment-refractory — higher difficulty achieving abstinence

**Current status:** Protocol published; trial ongoing; NO RESULTS AVAILABLE as of April 2026.

## Agent Notes

**Why this matters:** This is the only active well-powered Phase 2 RCT for GLP-1 in OUD. Its results (expected 2026-2027) will determine whether the Qeadan 2025 real-world signal holds up under controlled conditions. If the trial shows significant opioid abstinence improvement, the GLP-1 reward circuit mechanism claim becomes "likely" confidence. If null, the mechanism may be specific to food/alcohol reward circuits.

**What surprised me:** The trial is specifically for TREATMENT-REFRACTORY patients — those who are not achieving abstinence with buprenorphine or methadone. This is a high-need, hard-to-treat population. A positive result here would be especially meaningful.

**What I expected but didn't find:** Results. This is protocol-only.

**KB connections:**
- The pending results will directly inform whether the GLP-1 reward circuit claim can extend to opioids (currently experimental based on Qeadan observational + animal models)
- Active monitoring thread — check for results Q3/Q4 2026 or early 2027

**Extraction hints:**
- Do NOT extract as a claim — this is protocol only
- Archive as a monitoring item: "Phase 2 RCT underway, results expected 2026-2027"
- When results publish, this becomes a primary source for the OUD extension of the reward circuit claim

**Context:** Grigson is a leading addiction neuroscience researcher at Penn State. NIH-funded Phase 2 trial with OUD-focused design.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: GLP-1 reward circuit mechanism claim — OUD extension (pending)
WHY ARCHIVED: Protocol-only source. Monitor for results. This trial will resolve whether the GLP-1 mechanism extends to opioid abstinence in treatment-refractory patients. Do not extract now.
EXTRACTION HINT: No extraction yet. Flag as monitoring item. Revisit when trial results publish (expected 2026-2027).
