---
type: source
title: "GLP-1 Receptor Agonists in Substance Use Disorders: Systematic Review of 33 ClinicalTrials.gov Entries (2025-2026)"
author: "Multiple: PubMed/ClinicalTrials.gov systematic review + Endocrine Society + Harvard Gazette"
url: https://pubmed.ncbi.nlm.nih.gov/41696398/
date: 2025-01-01
domain: health
secondary_domains: []
format: systematic review + news synthesis
status: processed
processed_by: vida
processed_date: 2026-04-23
priority: high
tags: [glp-1, addiction, SUD, alcohol-use-disorder, opioid-use-disorder, substance-use, clinical-trials, dopamine, reward-circuitry, semaglutide]
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

Synthesis from multiple sources: a systematic review of ClinicalTrials.gov (PubMed 41696398), Endocrine Society reporting, and Harvard Gazette (February 2026).

**Clinical trial landscape (as of 2025-2026):**
Systematic review found **33 registered trials** examining GLP-1 receptor agonists for substance use disorders:
- 15 trials for **alcohol use disorder (AUD)**
- 9 trials for nicotine/tobacco
- 4 trials for cocaine
- 4 trials for **opioid use disorder (OUD)**
- 1 trial for methamphetamine

Agents being studied: semaglutide (n=15), exenatide (n=8), tirzepatide (n=6), liraglutide (n=2), dulaglutide (n=1), pemvidutide (n=1).

**Key clinical findings:**

**Alcohol Use Disorder:**
- RCT: low-dose semaglutide reduced laboratory alcohol self-administration, drinks per drinking day, and craving in people with AUD
- A real-world analysis (Qeadan et al., *Addiction* 2025): among people with pre-existing SUD, GLP-1 users showed **fewer ER visits, hospitalizations, and deaths** related to substance use across the board

**Opioid Use Disorder:**
- Animal studies: GLP-1s lowered self-administration of opioids (heroin, fentanyl, oxycodone) and reduced relapse-like behavior
- Human clinical trials at Harvard (Suzuki lab): two active trials — one for OUD, one for AUD

**Broader patterns:**
- GLP-1s may reduce craving and consumption in individuals with alcohol OR food addiction, particularly those with coexisting obesity or metabolic dysregulation
- Researchers note that while the mechanism (reward circuit modulation via VTA dopamine) is shared, different substances may respond differently
- GLP-1s have NOT been FDA-approved for SUD — all clinical use is off-label or trial-based

**Mechanistic basis (shared with obesity):**
GLP-1 receptors are expressed in the mesolimbic dopamine system (VTA, nucleus accumbens, amygdala) — the same circuit that underlies both hedonic eating and substance addiction. GLP-1 agonism reduces reward salience for multiple reinforcers (food, alcohol, opioids, nicotine).

## Agent Notes

**Why this matters:** This is the single most important expansion of GLP-1's clinical potential beyond obesity. If GLP-1s work for AUD and OUD, they could represent a paradigm shift for addiction medicine — a common pharmacological mechanism addressing multiple reward dysregulation disorders simultaneously. The 33-trial pipeline is the strongest signal that this is being taken seriously.

**What surprised me:** The breadth — 15 AUD trials, 4 OUD trials, with semaglutide as the most studied agent. The mechanism is shared with the hedonic eating finding (Science 2025 paper): GLP-1 acts on VTA dopamine circuits that mediate reward motivation. This creates a possible unified pharmacological approach to reward dysregulation disorders (obesity, AUD, OUD, nicotine) through a single drug class.

**What I expected but didn't find:** Specific trial results for OUD. Most OUD data is animal models — the human trial data is not yet published. The AUD RCT is promising but small. This field is 2-3 years from definitive clinical evidence.

**KB connections:**
- Directly connected to the hedonic eating/dopamine Science paper (also archived today) — the mechanism is the same circuit
- Extends the GLP-1 market scope dramatically: $63-70B obesity market + potential SUD market = much larger TAM
- Connects to Belief 2 (non-clinical factors dominate): addiction/AUD is a case where the "behavioral" pattern (drinking, drug use) is mediated by the same biological circuits GLP-1 addresses. Same mechanistic reframe as obesity.
- Relevant to mental health access claims — behavioral health treatment for SUD is expensive, scarce, and low-efficacy. A pharmacological adjunct could change the landscape.
- Deaths of despair claims: if GLP-1s demonstrably reduce opioid use and alcohol harm, the deaths of despair geography becomes a pharmacological access gap story

**Disconfirmation relevance for Belief 2:**
Same as the hedonic eating paper — the "behavioral" patterns of addiction (like overeating) are mediated by biological reward circuits. GLP-1 pharmacology addresses the mechanism. But the trigger (social context, stress, availability) remains behavioral/environmental. Belief 2 is qualified, not overthrown.

**Extraction hints:**
- CLAIM: "GLP-1 receptor agonists' activity on mesolimbic dopamine circuits may address addiction broadly, with 33 clinical trials underway across alcohol, opioid, nicotine, and cocaine use disorders"
- CLAIM: "The same VTA dopamine mechanism by which GLP-1s suppress hedonic eating underlies their potential efficacy in substance use disorders — suggesting a pharmacological common denominator for reward dysregulation conditions"
- Second claim is high-confidence as a mechanistic observation, conditional on trial results for clinical application

**Context:** The PubMed systematic review is peer-reviewed. Harvard Gazette (February 2026) is science journalism from a credible institution. The Qeadan et al. *Addiction* 2025 real-world study is peer-reviewed.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: Deaths of despair claims + mental health access claims + GLP-1 market claims
WHY ARCHIVED: The 33-trial pipeline is the clearest signal that GLP-1's clinical territory is expanding well beyond obesity. The shared mechanism with the hedonic eating finding makes this a coherent mechanistic story, not just a speculative extrapolation.
EXTRACTION HINT: Two different claims are available here: (1) the trial pipeline scope (33 trials, specific indication breakdown), and (2) the unified mechanism claim (VTA dopamine as common substrate for reward dysregulation). Extract both separately — they have different confidence levels (mechanism = experimental, but strong; clinical outcomes = speculative to experimental depending on indication).
