A growing set of evidence suggests that using semaglutide could lead to decreased substance use, and a large new study shows a promising link between the medication and tobacco use. But experts emphasize that much more research is needed before using the medications off-label for smoking cessation.
In a study published Monday in the journal Annals of Internal Medicine, researchers tracked the medical records of more than 200,000 people who started medications to treat type 2 diabetes, including nearly 6,000 people using semaglutide medications such as Ozempic.
Over the course of a year, people who started using semaglutide were significantly less likely to have medical encounters for tobacco use disorders, prescriptions for medications for smoking cessation or counseling for smoking cessation than those who started other diabetes medications such as insulin and metformin.
The study authors note that the reasons individuals might be less likely to seek medical treatment for tobacco use disorder vary widely; it could suggest that their tobacco use decreased or that they’ve become less willing to seek help to quit smoking, for example.
There might be a mix of medication-driven and patient-driven change, said Dr. Disha Narang, an endocrinologist and director of obesity medicine at Endeavor Health in Chicago, who was not involved in the new research.
“If I have a patient with type 2 diabetes who is on one of these agents and they do have a history of smoking, oftentimes, our visits involve a conversation about tobacco cessation,” she said. “These folks might start paying special attention to their long-term health and changing some habits because they are being treated for diabetes.”
Also, the new study did not measure the severity of tobacco use, such as the number of cigarettes consumed per day, cravings or withdrawal.
Understanding how semaglutide affects these factors is “crucial” to determining whether the medications could be used for smoking cessation, said Dr. Nora Volkow, director of the National Institute on Drug Abuse and a co-author of the new report. Also, more work would be needed to understand appropriate dosage and adverse effects before using the blockbuster drugs in new way, she said.
But other early research suggests that semaglutide and other GLP-1 medications could interact with the brain’s reward system in a way that helps modulate cravings, whether for food, nicotine, alcohol or other drugs.
“The main driver of why many of us overeat relates to those reinforcing positive responses that we get from eating certain foods. And it’s the same circuit for foods as for drugs,” Volkow said.
Although key questions remain, Volkow said she is struck by how consistent the findings have been when it comes to the relationship between semaglutide use and decreased substance use – across different substances and among different patient groups. The new study found similar links among those with and without obesity.
“A signal like this one cannot be ignored, particularly because of how consequential it could be if, in fact, we can have now a new medication for treating smoking cessation,” she said. “That could have a tremendous impact on health.”
Smoking rates in the United States have decreased over time, but cigarette smoking remains the leading cause of preventable disease and death, according to the US Centers for Disease Control and Prevention. A recent study from the American Cancer Society found that smoking contributes to nearly 1 in 5 new cancer cases and nearly a third of cancer deaths each year.
But fewer than 1 in 10 adult cigarette smokers succeed in quitting each year, according to the new study, and options for smoking cessation treatment haven’t changed much in decades.