New findings and concerns about weight loss drugs

In recent years, a groundbreaking class of weight loss drugs known as GLP-1’s has been making waves in the United States healthcare system. These drugs, such as Eli Lilly’s Mounjaro and Novo Nordisk’s Wegovy, are not only transforming the landscape of weight loss but are also showing potential applications in treating conditions like substance abuse.

In this article, we will look into the promising aspects of GLP-1s and the emerging challenges revealed by discussions at the Reuters Events Total Health conference in Chicago and data from poison control centers.

Potential as an addiction treatment drug

The class of drugs that GLP-1s belong to mimic the action of the GLP-1 hormone, regulating blood sugar, slowing digestion, and suppressing appetite. The United States Food and Drug Administration (FDA) has been closely monitoring the progress of these drugs, with Eli Lilly’s Mounjaro and Novo Nordisk’s Wegovy leading the way. The FDA says that Eli Lilly could begin selling tirzepatide for weight loss, making it the second obesity drug in this class.

Lawrence Tabak of the U.S. National Institutes of Health (NIH) emphasizes that while studies are ongoing, these drugs open up new possibilities for controlling conditions beyond obesity, including metabolism and potentially treating addictive disorders. While most of the early trials centered around these drugs fighting addiction were disappointing, those studies used less potent versions of the drug. 

Currently, there are at least nine phase 2 clinical trials in progress or in the planning stages to assess the potential of the potent compound semaglutide and its chemical derivatives in assisting patients in reducing their consumption of cigarettes, alcohol, opioids, or cocaine.

These medications mimic the actions of the hormone glucagon-like peptide-1. By activating its receptors in the pancreas, they promote the release of insulin and induce other positive responses, elucidating their role in assisting individuals with diabetes. 

In addition to being generated by various brain structures, GLP-1 interacts with receptors in specific regions of the brain. These areas are integral to our reward pathways, shaping our inclination toward pleasurable pursuits such as indulging in tasty food or socializing with friends. 

Scientists working on these studies believe that GLP-1 analogs contribute to weight loss by, in part, suppressing the activity of this system. This same mechanism may account for the reduced motivation to consume alcohol and smoke reported by individuals taking these medications.

With that being said, only two clinical trials have indicated the potential of these drugs in reducing addiction so far. In a study led by Luba Yammine, a clinician, and researcher at the University of Texas Health Science Center at Houston, it was found in 2021 that 46 percent of patients who used nicotine patches and received weekly injections of exenatide, a first-generation GLP-1 analog, successfully quit smoking, compared to 27 percent relying solely on patches.

Current trials being conducted on the effectiveness of this drug for substance use disorders also utilize techniques to measure brain activity such as electroencephalography and functional MRI (fMRI). To date, the sole published study capturing such data for individuals undergoing GLP-1 agonist treatments for addiction is the clinical trial conducted by Fink-Jensen and colleagues. Employing fMRI, the researchers gauged the activity of three brain structures associated with the reward system while patients observed pictures of alcoholic drinks. The findings were inconclusive. 

While patients taking exenatide demonstrated reduced activity in the ventral striatum compared to those receiving a placebo, the activity in two other regions remained unaffected. The researchers anticipate that the latest study will shed more light on the drugs’ impact on brain circuits.

Rise in accidental semaglutide overdoses

With all that being said, there is concern related to the growing trend of accidental overdoses of semaglutide, the active ingredient in Wegovy and Ozempic. Calls to poison control centers have surged, nearly doubling in 2023 compared to the previous year, with a staggering 1,500 percent increase since 2019.

Julie Weber, a registered pharmacist and director of the Missouri Poison Center, attributes this rise to the overall increase in the use of medications containing semaglutide. Most overdoses result in gastrointestinal issues, headaches, dizziness, or shaking. However, in severe cases, extreme vomiting can lead to dehydration and electrolyte imbalances. 

As more of these injected drugs that contain semaglutide have entered the market, accidental overdoses have risen dramatically. Gary Smith, MD, DrPH, director of the Center for Injury Research and Policy at Nationwide Children’s Hospitals, explains the increase in calls to poison control is due to unintentional medication errors. 

Joseph Lambson, director of the New Mexico Poison and Drug Information Center, highlights that both Ozempic and Wegovy are sold as pens with preselected doses, aiming to limit the potential for accidental overdoses, but this does not mean an overdose is impossible, especially if individuals do not select the correct dose. 

Persistent shortages and high demand for these drugs might indirectly contribute to overdoses, as people turn to compounded forms of semaglutide, requiring them to use needles and syringes, increasing the risk of dosing errors.

Lambson emphasizes that while no deaths have been reported, 43 percent of those calling about accidental semaglutide overdoses required immediate medical attention. This concerning statistic shows the importance of addressing the rising popularity of GLP-1s and the potential risks associated with their use.

Individuals experiencing symptoms of a semaglutide overdose, including nausea, vomiting, or abdominal pain, seek guidance from their healthcare provider or reach out to their local poison control center.

This precautionary step is essential in navigating the potential complexities and ensuring the well-being of individuals undergoing treatment with semaglutide-containing medications.

This rise of GLP-1s presents a dual narrative in the realm of healthcare, promising groundbreaking solutions for weight loss and metabolic control while raising concerns about unintended consequences and accidental overdoses. 

The surge in calls to poison control centers reveals a pressing issue that demands attention and proactive solutions. The increased demand for GLP-1s and the alarming rise in overdose-related calls serve as a poignant reminder of the delicate balance required in embracing medical innovation. 

As researchers and healthcare professionals continue to explore the potential applications of these drugs, it becomes essential to strike a balance between innovation and caution, ensuring that the benefits of GLP-1s are realized without compromising patient safety. The journey of GLP-1s in healthcare is an evolving story that requires careful monitoring, research, and collaboration to unlock the full potential of these drugs.