New study shows 68% drop in prescriptions for smoking cessation for patients taking Ozempic vs insulin
In a patient health record study, semaglutide was associated with strong reductions in indicators of tobacco use among diabetes patients with a history of tobacco use disorder.
Growing evidence from randomized controlled trials, dramatic patient and provider reports, and patient health record studies shows a strong reduction in smoking for people taking GLP-1 medications like Ozempic, Wegovy, Mounjaro, or Zepbound. Even Morgan Stanley found a large reduction in a market survey they did. Existing evidence on GLP-1s for smoking cessation is reviewed in our comprehensive, and regularly updated, article, GLP-1 for Addiction: the Medical Evidence for Opioid, Nicotine, and Alcohol Use Disorder.
A new patient health record study published today in the Annals of Internal Medicine finds dramatic reductions in prescriptions of smoking cessation medication for people taking semaglutide (Ozempic) compared to other diabetes medications. The study population was diabetes patients with existing tobacco use disorder (TUD).
Compared to insulin alone, diabetes patients who began taking semaglutide were then 68% less likely to receive a prescription for a smoking cessation medication. The result was the same in patients that have or do not have obesity.
Compared to metformin and other diabetes medications, the reduction ranged from 38-55% and even compared to earlier generation GLP-1RAs (albiglutide, dulaglutide, exenatide, liraglutide, and lixisenatide), semaglutide showed a 34-38% reduction. This is notable because exenatide has already been shown in a randomized trial to reduce smoking, and it appears that semaglutide has a stronger effect, which would be consistent with its stronger effect for weight loss.
Here’s the key table from the study:
The study also saw reductions for semaglutide patients in medical visits related to a TUD diagnosis and counseling sessions for TUD. However, because the full study population had a TUD history, these metrics may include follow up appointments for TUD, even if the patient has already stopped smoking, which would actually underestimate the effect of the semaglutide reduction in smoking.
The study comes from Dr. Rong Xu’s lab at Case Western and Dr. Nora Volkow, who runs the National Institute of Drug Abuse, is one of the coauthors. The study adds to a rapidly expanding pool of evidence that GLP-1RAs reduce craving and consumption across substances.
A 200 person randomized trial is in progress
Dr. Luba Yammine, who ran the trial on exenatide and smoking cessation, described to JAMA Medical News how she became interested in this area:
As a clinician, family nurse practitioner Luba Yammine, PhD, MSN, sees patients with substance use disorders, including many who smoke.
She couldn’t help but notice something surprising when she prescribed a particular class of medications to treat patients with type 2 diabetes.
“All of a sudden they’d quit smoking,” Yammine recalled in an interview. “That sort of prompted my dive into the literature.”
Dr. Yammine is currently running a new 200-person study that will track semaglutide and smoking cessation and should provide definitive evidence.
GLP-1 medications are poised to revolutionize addiction treatment
GLP-1RAs are the most significant breakthrough in addiction medicine in decades. This class of medicines have the potential to drive large population scale reductions in addictive behaviors by dramatically expanding the number of people interested in taking medication for addiction and by de-stigmatizing addiction treatment.
Even as physicians have begun prescribing these drugs off-label for addiction, Novo Nordisk and Lilly have refused to run Phase 3 trials of their GLP-1 drugs. Phase 3 trials are necessary to achieve the FDA indications that will unlock insurance coverage for people struggling with addiction. In this gap, the public will have to step up to run these trials. This means significantly reorienting research and funding programs towards this opportunity. CASPR is building a coalition to pursue such a study.
Addiction – to cigarettes, alcohol, opioids, and stimulants – kills more Americans every year than cancer or heart disease, but medication development is radically underfunded relative to the disease burden. Current public policies for addiction are failing, in part because existing medicines have not been embraced by patients. To address addiction at a population level, we have argued for putting focus on medications and strategies that can be effective at scale.