A Uniquely High Leverage Opportunity for Philanthropy
Solving addiction is achievable and has a higher ROI than nearly any charitable initiative.
It’s hard to make a large impact with giving, but it’s possible
Most attempts to fix complex social problems don’t work. Charitable programs will often show exciting results in small pilot projects with charismatic leaders, but then fail to replicate. It's extremely difficult to find leverage points.
But sometimes, very rarely, there is a way to break through and change the world. Philanthropists, and really anyone donating to a cause, dream of opportunities that:
Address a big and urgent need
Have a high probability of success and measurable outcomes
Make a large population or ecosystem-level impact
Work at a root cause level, with cascading positive effects
Use one-time funding to make permanent positive changes
(sometimes the most important, but you have to read below first)
Hitting even a few of these is a big win. It’s nearly impossible to hit all of them, but it does happen– the development of antibiotics and vaccines had dramatic and far-reaching effects on health, society, and lifespan. These one-time investments in medical breakthroughs had vast impacts across entire societies. That’s why the largest philanthropic donors often focus on these types of opportunities– Gates, Zuckberberg, Bloomberg.
Giving to addiction has felt completely futile
49M people in the US live with addictions. It’s a massive problem – alcohol, opioids, cigarettes, cocaine, and meth drive more deaths every year in the US than cancer or heart disease. Addiction causes disability for millions of Americans, rips apart families and communities, leaves hundreds of thousands of children traumatized or orphaned, and damages society; 60% of crime is related to drugs or alcohol.
Despite these harms, charitable giving around addiction has had very little leverage– rehab programs have low success rates, deterrence programs don’t work, policy interventions are a partisan tug of war, and while programs like Narcan distribution do save lives, they don’t address the core addictions driving usage. Over the past two decades, most private donors to addiction treatment and advocacy have pulled back after failing to find any traction. t
The core problem is that addictions happen in the brain, but we don’t have effective and appealing treatments– only 3% of people with substance use disorders receive medication, and there hasn’t been a new mechanism of action approved in 20 years. Even as we fight Mexican cartels and our own citizens over the horrific rise in methamphetamine use, there are still zero FDA approved medications for meth or cocaine addiction. To really make sure that sinks in– 34,000 overdose deaths last year involved cocaine or meth and there are no medications that treat either and no candidates in phase 3 trials.
An opportunity for a revolution
Addiction science is on the brink of a dramatic breakthrough, one of those accidental discoveries that can change the course of history, like the discoveries of penicillin or X-rays. The same GLP-1 drugs like Ozempic and Zepbound, which were created to treat diabetes, also reduce cravings for addictive foods, alcohol, and substances. The stories of patients’ “food noise”, “booze noise”, and “drug noise“ vanishing are remarkable. Phase 2 trials and retrospective studies show big reductions in consumption and harm for alcohol, opioid, cigarette, meth, cocaine, and even marijuana addictions. GLP-1s are the first breakthrough in addiction medicine in decades and a chance to dramatically reduce addiction at population scale.
Despite all this, pharma companies haven't collaborated with researchers on addiction trials, worried that random adverse events in trials of these populations could damage the reputation of their golden geese. Some (Eli Lilly) have announced their intent to research other GLP-1s for alcohol addiction or smoking, but they are moving very slowly. For opioids, meth, and cocaine—the most acutely harmful addictions—it's unlikely any pharma will pursue FDA approvals.
The beginning of the end of addiction
GLP-1s will transform both the efficacy and appeal of addiction treatment. These medicines are wildly popular and the benefits are powerful: GLP-1s help people lose weight (70% of Americans are overweight), are dosed once a week, and reduce cravings to multiple substances at once. Doctors offering these medicines off-label for addiction already see patient eagerness unmatched by any previous treatment. That means scale. Bringing GLP-1s to market will validate the addiction market for biotech and pharma companies, helping to launch a flywheel of further progress. And as new medicines are developed with distinct mechanisms of action, they can be layered on top of each other, further increasing efficacy. This is how we will finally conquer addiction.
The highest ROI in philanthropy?
We believe that achieving FDA approval of GLP-1s for addiction is one of the highest ROI opportunities in philanthropy and public health. The first step, and the tipping point moment, is launching phase 3 trials for addiction. After success at phase 3, they will receive FDA approval, insurance coverage, and widespread adoption.
What makes this strategy powerful is being novel in its goal—the first addiction medicine working across multiple substances, including first-ever approvals for cocaine and meth—but mundane in process: these are typical phase 3 trials run by established research organizations, with standard FDA endpoints. The process is de-risked, but the outcome is transformative.
The investment needed is significant—about $25M per trial—but tiny compared to trillions of annual costs from the drug war, treatment, incarceration, and lost productivity. Los Angeles County alone spends nearly $750M annually on substance use prevention and control. The federal government spends tens of billions each year on the drug war, and the opioid crisis alone costs the country over $1 trillion per year. Effective medications that permanently reduce addiction prevalence will save massive amounts of money and allow our families and societies to thrive at a deeper level.
Hitting every goal of high-leverage philanthropy
Going back to the dream list of philanthropic impact above, here’s why giving to GLP-1s for addiction is a uniquely powerful opportunity:
Massive long-term need
Addiction is one of our oldest and most difficult problems—wars have been fought over opium, cocaine, tobacco, and alcohol.
Over 700,000 people die from addiction every year in the US, and more than 10 million worldwide.
Curing addiction is the most near-term intervention that could substantially extend average human lifespan.
The disability is as bad as the deaths— 20+ million disability-adjusted life years annually in the US alone. Decades lost to struggle.
High probability of success
New medicines fail to achieve FDA approval for two reasons: safety or efficacy. As a class, GLP-1s for addiction are highly de-risked. Safety is well established– tens of millions of people take these medicines weekly, with a remarkable safety record. Efficacy in addiction is clear from clinical trials to animal studies, to patient health records.
Huge medical and societal impact
49M Americans have substance use disorders, but only 3% take existing medicines, due to low efficacy and appeal.
The impact will come quickly– these trials are designed to achieve FDA indications over the next 3-6 years.
The downstream damage of addiction is truly massive. Benefits of better medication extend far beyond treated patients—reducing crime, abuse, and intergenerational trauma. 321,000 children lost parents to opioids in the US in the past decade.
Solving a root cause
Addiction happens because we are surrounded by things our bodies didn’t evolve alongside: novel foods (Oreos), drinks (alcohol), chemicals (fentanyl), and behaviors (online gambling). Unless we become a surveillance state, we can't eliminate addiction through policy. Better medicine will restore agency to people, freeing them from addictive drives.
Addictions in the US have risen even as our economy has grown and poverty has declined; it is a root cause problem, not a result of other social factors.
Reducing substance craving gives people immediate relief from addictive urges, ‘drug noise’, and stress. It creates mental space and clarity to rebuild their life and address their personal, spiritual, and psychological challenges.
Permanent impact from a one-time investment
Most philanthropy goes to service organizations–the opportunity to make a one-time investment that permanently changes society is rare. Nothing is more satisfying than knowing your gift lives on permanently. Once a new medicine is created, it continues to exist and spread, preventing generations of struggle and trauma, and bringing families and communities back into balance and harmony together.
The reason I’ve donated to this effort myself and have fully devoted my time to CASPR is for those same five reasons. I want to be working on something that I truly believe has scalable long-term impact.
And remember number 6 from above? Number 6 is something like: ‘Your giving creates an epic legacy.’ Having your name on a building is nice, but it's not often you can help permanently solve a scourge civilizations have battled for thousands of years.
What the future can look like and feel like
Last week, I got a call from a very senior executive, ‘Rob’. He told me that he’s had a cannabis addiction for decades and has failed to quit many times, often in dramatic fashion. Recently, after a family death, Rob started drinking heavily, and his wife was growing concerned. Rob had heard that GLP-1s can reduce cravings, but because there’s no FDA approval, he couldn’t get a prescription or coverage. Rob faked his weight and ordered semaglutide from an online service. He said that when he took the first shot, it was “The most mind-blowing psychological experience of my entire life.” All of his cravings and obsessive thoughts instantly vanished. He was floored. Rob is now completely sober.
It's hard to overstate the impact of this moment on him, his wife, and family. He's overcome potentially life-threatening habits and gained emotional security—if cravings return, he can always restart the medication. He never has to ‘hit rock bottom’, or orient his life around an addiction identity– some of the primary reasons people resist accepting treatment. The sense of safety and relief is incalculable.
Imagine parents of a teen who is slipping into too much drinking or drug use. What would those parents give to have a safe, easy, no-stigma path to safety for their child? They would give almost anything.
We don’t have to keep living with addiction as an ever-present threat. We don’t have to accept 700,000 deaths every year. The scientific opportunity we now have is neither long-term nor hypothetical, but it also won’t happen on its own.
Once on the market, sales of GLP-1s for addiction will drive additional treatments— demonstrated demand will bring more companies to compete in addiction, leading to multiple effective and combinable medications for rapid and powerful craving cessation across substances. This is achievable.
How you can support this work
CASPR is supported both by individual donors and private philanthropies like Tyler Cowen’s Emergent Ventures and John Arnold’s Arnold Ventures, both of whom, like us, are obsessed with leverage, evidence, and scale.
My co-founder, Lindsay Holden, and I both have people very close to us who have had 15+ year opioid addictions that have been absolutely devastating. We know how difficult and messy long-term addiction treatment is and how urgent the need is for better treatments.
Lindsay and I met each other through a group of startup founders who have sold their companies. That’s why CASPR runs more like a startup than a typical non-profit– we are ultra-lightweight, no overhead, and focused on scale. And we pursue leverage in everything we do:
Our policy work is strategic and unique: focused on fixing the market failure in addiction medicine through policy that has a real opportunity for passage. See our Innovation Agenda for Addiction, recently published with the Federation of American Scientists and Institute for Progress.
Our studies and pilot programs with GLP-1s are short-term and high impact.
Our core goal of achieving FDA indications for GLP-1s is a focused, ultra high probability shot at a permanent, world-changing win.
From an operational standpoint, I believe CASPR is a strong investment because we are obsessed with getting GLP-1s to patients at scale– coaxing and convincing companies to enter this space, changing federal policy to make addiction medicine more appealing to businesses, launching pilot projects, telling patient stories, running our own research studies, supporting other research studies, and putting together phase 3 trials to achieve FDA approval and wide coverage. Not only do we have a lean and highly effective core team, but we have an incredible advisory board of world-class scientists, doctors, and biotech experts who are regularly giving us hours of their time, simply because they believe CASPR generates high impact.
You don’t even have to give directly to CASPR to move this mission forward. We are in touch with a number of researchers and phase 2 clinical trials of GLP-1s for addiction that are stuck in funding limbo because of the chaos with federal funding. These are trials that could permanently improve addiction treatment, but they can’t get started or can’t enroll enough patients because of funding shortages. We would be delighted to help you connect with research projects to fund, even if the money never comes through our organization.
That said, CASPR is unique in our ability to impact this mission and build towards patient access on a global scale. We think the ROI of philanthropic investment in this cause is as high as any other in the world.
Talk to us
If you are a potential major donor and would like to talk to us about giving opportunities or collaborations, please be in touch. If you know of folks who might be interested in donating --at foundations, family offices, or people with donor-advised funds -- please reach out to them and to us. We would love to discuss our work.
If you simply want to make a quick, one-time, tax-deductible donation of any amount, you can do that too, right here. We are especially grateful for the smaller donations from people who have family members affected by addiction. We understand firsthand how painful that journey is.
Does Rob need to keep using GLP-1 permanently?