News updates: can GLP-1s help people get back to work?

Ozempic reduces alzheimer's risk, street medicine with long-acting antipsychotics, methadone treatment retention, more

At CASPR we view everything through a lens of strategy and scale. We publish news updates like this one once or twice a month— not to provide a comprehensive review of addiction science and policy— but to pull out the 3-5 new pieces of information that we think have the highest impact and ability to reframe how people approach this field of work.

💉 NY Times: Under an L.A. Freeway, a Psychiatric Rescue Mission

Street psychiatry offers a radical solution: that for the most acutely mentally ill, psychiatric medication given outdoors could be a critical step toward housing. Dr. Rab, a medical director of Los Angeles County’s Homeless Outreach & Mobile Engagement program, describes the system his team has built as an outdoor hospital, or sometimes as a “DoorDash for meds.”

This approach— long acting anti-psychotics— is extremely promising. Because GLP-1s are once-weekly injections and don’t require clinician administration, they offer tremendous promise for treating people who are homeless on the street and living with single or polysubstance addictions. We have proposed the GRACE model, a GLP-1 based harm reduction and treatment bridge that could be provided through street outreach. Unlike buprenorphine, GLP-1s can be initiated immediately, without detox. We are hoping to find research partner soon to test this model.

Speaking of buprenorphine…

⚕️JAMA: Buprenorphine patients are 58% more likely to discontinue treatment than methadone patients

A new long-term retrospective study in JAMA finds much longer treatment retention for methadone vs buprenorphine. The study did not look at what happens after treatment is discontinued. Treatment retention is considered essential for abstinence and death rates generally double after treatment discontinuation of opioid agonist therapy. This is a potentially huge finding.

But— could there be confounders? Are people who are more likely to successfully exit from treatment more likely to choose buprenorphine in the first place? Do people who doctors initiate on methadone already have higher stability (since they typically need to go to a clinic daily to receive it)? Or, as one particularly blunt advocate in the field put it to me, “Yeah of course they had less treatment discontinuation, they are still getting high everyday.”

I’d love to hear from some of our readers who work in clinics and who research in this area about how they interpret this result and if it will influence their practice. (And thank you to all the readers who emailed me in reply to my question about ways to increase pharma activity in addiction medicine development.)

🧠 Semaglutide patients with diabetes are 67% less likely to develop Alzheimer’s disease than patients who just take insulin

A new retrospective study from our favorite duo, Rong Xu and Nora Volkow (et al), shows a huge reduction in the Alzheimer’s risk among semaglutide patients. This is in line with previous reports and a phase 2 trial of liraglutide. A phase 3 trial of semaglutide for Alzheimer’s disease is underway. It seems overwhelmingly likely that a phase 3 will show reduced risk for people with diabetes or obesity (both are huge risk factors) but the more interesting question is whether it will also show efficacy in normal weight non-diabetic individuals.

Why are we writing about this brain disease? Because part of the high potential of GLP-1s for addiction treatment is due to their broad mental health benefits, including reductions in anxiety, depression, and suicidality. GLP-1s are wholistic treatments for addiction— reducing craving across substances and improving mental health.

JAMA: GLP-1s are associated with reduced risk of suicidality in teenagers

Another new study. Is it possible that GLP-1s are more effective than lithium for suicide prevention?

👷‍♀️ Reuters: Britain to study use of Lilly's weight loss drug to get people back to work

Britain is doing a study with Novo Nordisk that will give Wegovy (semaglutide) to people who are unemployed and have obesity and see how it affects their health and work readiness.

The impacts on health are fairly predictable— they will be good. But the potential impact on employment and productivity is a very interesting question. Because GLP-1s are so expensive (though much cheaper in the UK vs the USA) it has been hard for some health systems to provide wide access to patients, even though it is clear patients would benefit. If governments are able to show that GLP-1s can reverse disability and unemployment— through weight loss, mental health improvements, and reductions in addiction— it would demonstrate cost savings and tax revenues that could financially justify increasing the availability. Novo, of course, would be delighted with such a finding.

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