Ozempic is Showing Us That a Cure for Addiction is Possible

If we can modify addictive drive biologically, we can make dramatic strides in treatment.

We’ve Been Afraid to Admit that Addiction Might Be Curable

Curing addiction has often been understood as beyond the reach of medicine. Dependencies on opioids and other substances so often begin due to psychological traumas, stresses, and pain. ‘Yes,’ thoughtful people will say, ‘addiction is a disease but how can you solve a disease with medication if the disease starts with society, with trauma, or in the soul?’ Yet, what makes addiction unique is the spiral of compulsive repetition that goes beyond the precipitating circumstances. Addiction self-reinforces, magnifying and entrapping individuals in a behavioral loop, almost always worsening their underlying challenges and taking them further from healing.

There’s a reluctance by many people to say that addiction can be “cured” because even when someone has been free of a substance or behavior for years, there’s a sense that the risk of recurrence is always nearby. There are popular approaches to addiction recovery that identify addiction as a lifelong state of being, even if the addictive behavior is decades in the past.  And there’s an even greater reluctance, by nearly everyone, to entertain the possibility that addiction might someday be cured with medication: a fear of giving false hope and a fear of distracting from solutions that are urgently needed right now, when over a hundred thousand people in the United States are dying every year from opioid and stimulant overdoses, another hundred thousand from alcohol, and nearly half a million from cigarettes. The concept of a ‘cure’ sounds vague, hard to define, and above all, unrealistic and unhelpful.

But reluctance can evaporate when the world changes, and right now, something very big is happening in addiction science.

For decades, there have been treatments that either satisfy or reduce desires for specific substances or that moderately reduce cravings and increase abstinence for a specific class of substances. These treatments, like Suboxone, methadone, VIVITROL, bupropion, and others, are considered the gold standards of current treatment and are vastly underutilized, yet they often come with significant limitations, side effects, or complications, for both individuals and society. It feels difficult for many people to say that someone on long-term methadone has been functionally cured of their addiction when it’s clear that there is still a type of dependence in place. Harm reduction advocates are absolutely right in insisting that methadone and buprenorphine are valuable tools and should be more widely used – anything that reduces the harms of dependency should be celebrated and have no stigma surrounding it.  Discussing methadone as a cure becomes even more challenging in the United States, where we needlessly limit access, forcing many people back to black-market opioids.

As we strive to improve access to existing medications, there is also an urgent need for new medicines that can do even more for patients and bring us closer to curing this disease for both individuals and society. For example, the development of non-addictive painkillers has been radically underfunded, despite the incredible potential to prevent a huge portion of opioid addictions from beginning when people receive medical treatment. Providers should not be forced to choose between relieving the pain and suffering of a patient and putting them at risk of addiction.  

And if we could go a step deeper and directly reduce addictive drive across substances, we would begin to touch that almost philosophical question of whether addiction can be functionally cured and what it would mean to do so.

We may be crossing that threshold.

It’s Now Clear that Addiction is Directly Biologically Modifiable

In the past year, we’ve seen the most convincing evidence to date that addiction can be directly and broadly biologically modified. GLP-1 drugs, originally developed for diabetes and now exploding in popularity for treating obesity, are showing that some of the deepest human drives, starting with hunger, can be altered.  Just a few years ago, this was considered by many people to be impossible to do safely– diet pills were notorious for being either useless or dangerous.  

This quote from Oprah about her experience taking a GLP-1 drug captures the deep power of these treatments:

“All these years I thought all of the people who never had to diet were just using their willpower and for some reason, stronger than me…And now I realize, y’all weren’t even thinking about the food. It’s not that you had the willpower, you weren’t obsessing over it, that’s the big thing I learned.”

The disappearance of “food noise” for people who take these medicines is changing how our whole society understands eating and willpower. The new GLP-1s come with side effects and limitations, including nausea and the risk of excessive muscle loss, but potential fixes for these issues are being worked on and already the drugs seem to substantially reduce all-cause mortality for diabetes patients. 

Remarkably, beyond this expected effect of reducing hunger, we’ve seen a wave of anecdotal reports, and now, early empirical evidence, that these same drugs dramatically reduce addictive behaviors such as drinking, smoking, substance use, and maybe even shopping, phone scrolling, and gambling. See our GLP-1 News Roundup for some of the most compelling recent research. 

This is a big deal. There has not yet been a reckoning with the incredible opportunity that addiction-reduction creates for our collective future. Regardless of whether these particular drugs become widely deployed addiction treatments, the knowledge that a biological intervention capable of broadly reducing addiction is scientifically possible has become impossible to deny. A functional cure is clearly possible, so why aren’t we moving full speed ahead to develop and test new medications, and get them to doctors and patients?

Beyond GLP-1, there are other reasons for excitement in the world of addiction research: breakthrough treatments are in development for non-addictive painkillers, fentanyl vaccines, psychedelic therapy, and longer-term opioid management medications. We don’t know which of these will become clinically available or scalable enough to make a dent in the acute opioid crisis and there is no doubt that the field needs even more treatments entering the pipeline– brain-related drugs are notoriously difficult to get through trials and FDA approval compared to other drug classes (~5% likelihood of getting through Phases 1, 2, and 3, versus ~20% for targeted cancer drugs).  

But whether we succeed in bringing breakthrough treatments to patients depends not on what’s possible– we can see that breakthroughs are possible– but instead success depends almost entirely on how hard we, as a society, pursue these and other potential innovations. The history of medical science is one of miracles achieved through concentrated collective effort – when we put our money and energy and urgent attention towards developing treatments for illnesses that show tractability, we often succeed in making remarkable progress, and sometimes, remarkably quickly.  For a few examples, see HAART for HIV, mRNA vaccines for COVID, and gene therapy for sickle cell. Unfortunately, the field of addiction medication is radically underfunded compared to the price it exacts on our bodies and communities. The opioid crisis alone costs the United States over $1.5 trillion dollars a year, but we spend an absolute pittance on drug development for addiction and non-addictive painkillers, something in the range of $1B in public funding and virtually nothing in private investment compared to other major diseases. If this were to change, could we find a cure?

Here’s data from the WHO showing the top 10 causes of Disability-Adjusted Life Years (DALYs) per 100,000 population, with drug use disorders ranking as the second-highest disease burden in the United States:

Source: World Health Organization, Global Disease Burden, 2019

And here’s a graph from an industry report showing the radical under-investment in addiction and pain treatments in the private sector:

Source: BIO Report, The State of Innovation in Pain and Addiction

Is it any surprise that we’ve made huge strides in cancer and heart disease treatment but transformative treatments for addiction are not showing up in doctors’ offices?

If the public and private sector investment picture were to change, we could make rapid and transformative progress. It’s both socially and financially reckless to neglect the pursuit of true and lasting medical solutions.

While we don’t know which particular treatments will make it through the pipeline, the most important milestone has already been crossed — clear evidence that medication can strongly reduce addictive drive. This should be a wake up call to policymakers that now is the time to make curing addiction a national and global priority. 

Beyond the science itself, our drug approval and insurance systems currently disincentivize the deployment of new medications — for example, insurance companies will only cover a new non-addictive painkiller if a particular patient has been shown not to respond to existing opioid painkillers. This, in turn, means that pharmaceutical companies don’t invest in developing non-opioid painkillers, knowing their sales will be limited. And it means that health insurance companies are pushing a negative externality onto society by defaulting people to opioids as first-line drugs, thereby pushing more people unnecessarily towards opioid addiction with all its cascading harms and costs. We can, and should, fix all of this without spending much more money and we will be proposing some policy options in upcoming articles. 

In short, if we are serious when we say “addiction should be treated as a disease”, then we should pursue medical treatments with the same focus and intensity that we do for other diseases of similar medical scale and impact.  We should fight for a cure.  We have an opportunity to chart a course towards solving one of the deepest and oldest scourges of our society – what a world-changing achievement it would be if we did.

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We’re a new non-profit, mostly-volunteer, focusing on the research and policy aspects of the incredible opportunity that emerging addiction treatments are creating to finally provide sustainable, long-term solutions for the addiction crisis. We believe there is a tangible chance to get dramatically better medications into the hands of the dedicated providers who tirelessly support the individuals  struggling with, and sometimes drowning under, the weight of addiction. Providers and patients need better tools as soon as possible and we, as a society, need a much better solution than the endless drug war and the destruction it has caused around the world.

We are witnessing powerful new developments, and our goal is to bring a strategic and systems perspective to the conversation. We are convinced that there must be a dramatic shift in funding and energy focused on finding new treatments, and we’ll be writing about that in depth soon. 

We’re trying to create the addiction science and medicine newsletter that we would love to read ourselves.

We will be publishing weekly roundups of addiction medicine news, strategic policy approaches, and industry developments. We’ll also be publishing detailed articles and essays about the science and status of potential breakthrough treatments, funding for addiction, system dynamics, costs, approval pipelines, and emerging opportunities. We have a couple of excellent data scientists on the team and we’re looking forward to sharing  original data visualizations along with Roundups of the most interesting data we come across.

Please subscribe! Nearly everything we do will be free.  And don’t miss our first news roundup–  Will GLP-1 Drugs Revolutionize Addiction Treatment?

Most of all, we hope you will share our articles will colleagues and friends.

We’re looking to connect with more MD and PhD allies and policy experts who resonate with our approach.  We’re also open to more volunteers with related expertise who are interested in systematically researching these topics and advocating for larger public investment in addiction treatment development.  Please be in touch if this is you: curingaddiction@substack.com