Semaglutide (Ozempic) May Help Reduce Cannabis Use

While medications are initially created and clinically tested to achieve Food and Drug Administration (FDA) approval for a specific medical condition, physicians often find that a new drug is useful in additional unexpected ways. For example, bupropion (Wellbutrin) was approved as an antidepressant in 1985. Within a few years, it was noted that patients taking bupropion were reporting a decrease in their tobacco use, and by 1997, Wellbutrin received FDA approval as a safe and effective smoking cessation aid (Zyban).

Researchers including Nora Volkow, the director of the National Institute on Drug Abuse, now report[i] indications that semaglutide (Ozempic), which increases insulin secretion, may have uses beyond its 2017 FDA approval for obesity and type 2 diabetes. Patients taking semaglutide unexpectedly reported reduced desire for alcohol and tobacco. Preclinical (i.e., animal) studies quickly confirmed that semaglutide does, in fact, decrease alcohol and nicotine and possibly opioids and cocaine consumption. Wang, Volkow, et al. devised a real-world human study using electronic health records to investigate whether semaglutide also impacts cannabis use.

The study divided 85,223 patients with obesity and 596,045 patients with type 2 diabetes into two groups: Those who had been prescribed semaglutide and those who had not. They then asked two questions. For those patients who had no record of a diagnosis of cannabis use disorder (CUD) before the study period, was the use of semaglutide associated with any difference in the incidence of a new diagnosis of CUD? Secondly, if patients’ records did contain a diagnosis of CUD before the study period, was the use of semaglutide associated with any difference in the continuation of a CUD diagnosis during the study period? In brief, does semaglutide decrease the incidence or recurrence of CUD?

The answers to these questions are expressed in hazard ratios (HR). An HR of 1 means no difference was found between the two conditions. An HR of .7 would mean that there is a 30% lower risk associated with the variable being studied. Wang, Volkow, et al. found obese patients with no prior CUD diagnosis who received semaglutide had a 44% lower risk for a CUD diagnosis during the study period than those not receiving semaglutide (HR: 0.56).

Obese patients whose records did show a CUD diagnosis prior to the study period were 38% less likely to have a recurrent CUD diagnosis during the study period if they received semaglutide compared to those not receiving the medication (HR: 0.62).

These results were confirmed in the much larger population of type 2 diabetes patients who received semaglutide. Those with no prior CUD who received semaglutide had a 60% lower incidence of a new diagnosis of CUD during the study period than those not receiving the medication (HR: 0.40). Those with prior CUD who received semaglutide had a 34% lower rate of recurrent CUD (HR: 0.66).

While the absence of any substantially effective medication for assisting the treatment of CUD immediately brings attention to semaglutide's potential, the study’s authors prudently conclude that “Further preclinical studies are warranted to understand the underlying mechanism and randomized clinical trials are needed to support its use.”

We have no idea how semaglutide impacted obese and diabetic patients to decrease their cannabis use. Is the effect somehow due to the medication’s impact on obesity and diabetes, or does a distinctly different, more generalized impact exist?

Perhaps two elements support an optimistic perspective: First, semaglutide's impact on cannabis use was not a placebo effect since no one taking it was biased toward thinking it would alter their relationship to cannabis. Second, it is not known whether anyone experiencing a reduction in cannabis consumption was particularly interested in this outcome; the effect was incidental to the purpose for which the medication was prescribed.

We can only wait now for someone to conduct a double-blind controlled study of patients enrolled in a cannabis use disorder treatment program to learn whether semaglutide can take its place as an effective medication-assisted treatment. This would be a welcome advance.