Could popular drugs like Ozempic be key to addressing the substance use health crisis?

A class of medications used to treat type 2 diabetes and obesity could help treat substance use disorders. GLP-1s, made popular by brands like Ozempic and Wegovy, show real promise in helping people curb cravings for substances like alcohol and opioids, including fentanyl. 

In the 10 years since it’s been declared, Canada’s toxic drug crisis continues to cost the lives of thousands of people every year. Beyond the crisis, there are also thousands of deaths attributable to alcohol consumption each year. 

Urgent and creative actions are critically needed to address this crisis, and emerging innovative medications may play an important role. At times, there has been reluctance to consider medications as part of the solution to the substance use health problem. The toxic drug crisis has many causes, and overprescribing of opioids like oxycontin played a significant role. While caution is necessary, we must explore new medications to address the crisis effectively. 

Drugs like Ozempic show promise for treating substance use disorders because they disrupt the cycles of neurological reward that create them. Early studies have shown reductions of cravings and use of up to 50%. These drugs influence the brain's reward pathways, reducing cravings and decreasing the desire for substances like alcohol and opioids. However, much more is needed to understand whether this is a generational shift in treatment or a flash in the pan. 

There isn’t enough Canadian research on how GLP-1s could significantly improve outcomes for people wanting to change their alcohol or drug use, but early evidence is promising. To address this roadblock, Canada must prioritize funding and policy amendments to accelerate research. Public education and guidance from regulatory bodies, not pharmaceutical companies, are also essential to address concerns and ensure safe, effective use. 

Beyond research, access to evidence-based care and supports is an ongoing challenge for people seeking care and wanting to improve their health. For people without extended health insurance or access to provincial coverage for substance use disorder treatment, the cost of medicines can be prohibitive. These medications are often expensive, and most provinces do not cover them as part of their public health plans for substance use disorders. 

Expense is also tied to the availability of a drug. In Ontario, for example, public benefit coverage for oral and injectable GLP-1s has been limited to conserve supplies for people with type 2 diabetes, leaving folks who do not have type 2 diabetes without coverage. 

 
As compelling research emerges and demonstrates GLP-1s’ potential in treating substance use disorders, it will be critical for public drug plans across the country to work swiftly to ensure these drugs are appropriately prescribed to people who can benefit from them. Many people find addictions and substance use health care inaccessible; GLP-1s could be another tool in a family doctor’s toolkit, which could significantly expand who has access to treatment. 

Generic versions of brands like Ozempic are also expected in Canada as soon as next year, well before they’re set to become available in the U.S. This change can help reduce our collective cost burden, but we need clear data to understand who can actually benefit from the drug.  

Canada is exploring ways to update its drug approval process to make it easier for new medications to reach patients, while continuing to make sure they're safe and effective. The ongoing review of the Controlled Drugs and Substances Act regulations provides a timely opportunity to address these issues and could encourage drug companies to invest in research without weakening important health protections. By ensuring research happens in Canada, we can also make sure it is inclusive of factors like race and gender. 

As is the case with many areas of health care, medications must often be prescribed along with psychologic treatment and social supports. This means continued long-term investment in community-based programs, psychotherapy, peer support and harm reduction initiatives that support a person’s health. An approach that includes both medical and non-medical supports will ensure that individuals have the full range of tools they need to get and stay healthy. 

Dr. Alexander Caudarella, MDCM CCFP AM ABAM(d) is the CEO of the Canadian Centre on Substance Use and Addiction and Dr. Kim Corace, PhD, C. Psych., is Vice President, Innovation and Senior Scientist, Canadian Centre on Substance Use and Addiction.