GLP-1 Receptor Agonists Linked to Reduced Substance Use Disorder Risk

New research indicates that glucagon-like peptide-1 (GLP-1) receptor agonists, medications primarily used to treat type 2 diabetes, may also be associated with a reduced risk of developing substance use disorders (SUDs). A study published in The BMJ on March 4, 2026, revealed a consistent association between the use of these agonists and lower risks across various substances, including alcohol, cannabis, cocaine, nicotine, and opioids.

Study Details and Findings

Researchers at the VA Saint Louis Health Care System, led by Miao Cai, PhD, analyzed data from over 606,000 US veterans with type 2 diabetes. The study employed an emulation of eight parallel, new-user, active-comparator target trials using electronic health records. Participants were followed for up to three years.

The primary trial included 524,817 individuals initiating either GLP-1 receptor agonists (124,001) or sodium-glucose cotransporter-2 (SGLT-2) inhibitors (400,816). A secondary analysis focused on 81,617 individuals, with 16,768 initiating GLP-1 receptor agonists and 64,849 initiating SGLT-2 inhibitors, examining outcomes related to pre-existing SUDs.

Compared to SGLT-2 inhibitors, GLP-1 receptor agonists were associated with:

• Reduced risk of alcohol use disorder (hazard ratio 0.82)
• Reduced risk of cannabis use disorder (hazard ratio 0.86)
• Reduced risk of cocaine use disorder (hazard ratio 0.80)
• Reduced risk of nicotine use disorder (hazard ratio 0.80)
• Reduced risk of opioid use disorder (hazard ratio 0.75)
• Reduced risk of other SUDs (hazard ratio 0.87)
• An overall reduced risk of any incident SUD (hazard ratio 0.86)

among individuals with pre-existing SUDs, GLP-1 receptor agonist initiation was linked to a decreased risk of:

• SUD-related emergency department visits (hazard ratio 0.69)
• SUD-related hospital admissions (hazard ratio 0.74)
• SUD-related mortality (hazard ratio 0.50)
• Drug overdose (hazard ratio 0.61)
• Suicidal ideation or attempt (hazard ratio 0.75)

Potential Mechanisms and Implications

The authors suggest that GLP-1 receptor agonist-related agonism may have a preventative effect on addiction phenotypes across multiple drug classes. Even as the exact mechanisms underlying this association remain unclear, the findings open avenues for further research into the potential of these medications for addiction treatment and prevention.

Expert Reaction

According to the Science Media Centre, the study was published on March 4, 2026 .

One author disclosed ties to Pfizer.