Addiction Predictions for 2025 and Beyond

Predictions on painkillers, GLP-1s for addiction, compounding and more.

Predictions are fun and a good way to try to pull your intuitions into something more concrete. Plus ‘addiction predictions’ rhymes.

I’m including percentages to indicate my confidence level. An asterisk means that the prediction outcome is admittedly vague / hard to measure.

Addiction Predictions for 2025

• Suzetrigine, a novel non-opiod painkiller, will be FDA approved for acute pain in January 2025: 90% chance.

• Suzetrigine will be seen as a modest step forward for pain management but will spark excitement and vision towards a future of opioid-free outpatient pain management: 70% chance*.

• Two or more Phase 2 RCTs will report results showing a large drop in heavy drinking among people with AUD who take semaglutide or tirzepatide: 90% chance.

• “Micro-dosing” GLP-1s (for weight, addiction, hormonal regulation, brain health, etc) will grow from a small niche to a large trend: 70% chance*. Micro-dosing will serve as the psychological bridge that lets alternative medicine advocates embrace GLP-1s. The trend could stall within the US if compounding of semaglutide is shut down.

• Semaglutide compounding will be shutdown: 50% chance. The law and Novo’s business interests point to a shutdown, but Makary (upcoming FDA head) was CMO of a compounding service and the many millions of people who are currently taking compounded semaglutide will be driven to unregulated gray market alternatives from China if compounding is stopped.

• At least one telehealth service will begin offering compounded semaglutide off-label for substance use disorders: 60% chance. (I would have a higher likelihood if it wasn’t for the risk of compounding being shut down at some point in 2025.)

• Incretins as the future of addiction medicine will go from what was a niche belief at the beginning of 2024 to the mainstream position of addiction experts by the end of 2025: 70% chance*. But it will continue to take a long time for research in the field to pivot proportionally to the opportunity.

• Overdose deaths will continue to drop in 2025 vs 2024, by at least 5%: 75% chance.

• The overdose death drop from 2024 to 2025 will be lower in percent terms than the drop from 2023 to 2024: 70% chance.

• Someone you know personally will tell you that they drink a lot less since starting a GLP-1: 96% chance.

Predictions for 2026 and Beyond…

• Novo Nordisk’s EVOKE trials of semaglutide for Alzheimer’s report positive results in late 2025 or 2026. They will show reduced Alzheimer’s incidence in people taking semaglutide, including individuals without diabetes or obesity: 80% chance.

• Success of EVOKE will eliminate most of the remaining resistance towards GLP-1s as a ‘crutch’ or ‘bandaid’ for people with diabetes or obesity: 70% chance*.

• GLP-1 micro-dosing will explode globally in 2027, after semaglutide becomes generic outside the US in 2026 and gets cheaper: 70% chance.

• In 2027, there will be at least one additional novel non-opioid medication approved for acute pain: 60% chance.

• In 2027, the US will show a downward trend in alcohol consumption that will be meaningfully attributable to the increased population-wide use of GLP-1s: 70% chance.

• By 2028, a trial will report results showing a reduction in both homelessness and arrest rates among high-risk people treated with a GLP-1: 75% chance.

• In 2028 or 2029, there will be the first FDA approval of a GLP-1 for an SUD, and it will be for alcohol use disorder: 75% chance.

Let’s see how I do!

If anyone disagrees and wants to make a bet with me on any of these (or just talk me out of it), be in touch– could be fun.