Chapter 1: What is the main topic discussed in this episode?
The missing link between scientific journals and relationship counseling. The Last Show with David Cooper. Ozempic, it's the hottest thing right now touted for weight loss.
Chapter 2: What is the potential of Ozempic in treating alcohol use disorder?
But what if there's another revolution in the drug's path, using it to turn down alcohol cravings? The results on that use are good. I am here with someone who's done research in this area. He's a physician and scientist at the National Institutes of Health. His name is Dr. Lorenzo Leggio. Lorenzo, welcome to the program. Thank you, David. Thanks for having me.
Before we get to how many people are actually using Ozempic for alcohol use disorders, how effective is it based on the research?
Is it a good tool to treat alcohol addiction? Well, that's a great question, David. So we don't know yet. We are working on that. We have actually quite robust research.
Very promising, growing literature in animal models, mouse and rat models that they drink excessively, that show that when we give GLP-1 drugs, such as the semaglutide, which is commercially known as Ozempic, Wegovy, Rebalsius, etc., these animals will drink less alcohol.
We also know from human research, in particular looking at the big data through electronic medical records, that the people who are on these medications, they tend to drink less alcohol compared to people who are not on these medications.
Now, these studies are not what we call randomized controlled trials, which sounds like a bunch of boozy words, but it's actually the gold standard how we develop new medications in medicine. And so we do have at least one already published randomized controlled trial that shows that compared to placebo, semaglutide GLP-1 works better.
But we need more of these randomized controlled trials to make a final decision. a claim that, in fact, that's the case.
Now, I'm not a doctor, in case you're wondering, so correct me if I'm wrong, but my understanding is once a drug hits the market and it's proven safe for the general public, doctors can use it in a process called off-label prescription for things that they think it could help for.
Because Ozempic is known to be safe, and I'm sure there are people who have alcohol use disorder who talk to their doctor, when they do get prescribed it off-label, what are they saying?
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Chapter 3: How effective is Ozempic based on existing research?
Natrexone, Acamproset, Desofram. We have two more medications that are called Pyramid and Gabapentin. Sometimes the people, clinicians use off-label with the consent of the patient. These medications are endorsed by the American Psychiatric Association as a second-line treatment. And that's an example of off-label use.
I'm actually prescribed gabapentin off-label for some mental health stuff, even though it's used. Anyway, okay. I want to talk about alcohol abuse and people who have it. If I had some other illness, mental health problem, and I went to talk to a doctor, it would be likely or possible that I would get prescribed medication.
Is it the case that people who have alcohol problems very rarely get prescribed things, like at a much lower rate of other disorders, health issues? If so, why is that happening?
Yeah, you are absolutely right, David. So we actually, as a society, as a community, as a clinical community, we dramatically undertreat the people with alcohol use disorder. To give you, to make an analogy, So in the United States, 2% of people with alcohol disorder receive a prescription for an FDA-approved medication, naltrexone, acamprosate, or disulfiram.
As a comparison, 85% of people with diabetes receive the prescription for a medication approved for diabetes.
Lorenzo, if only 2% of people with diabetes got insulin, that would be like a national health problem, epidemic, scandal, that kind of thing.
It would be unacceptable. You're absolutely right. And so what are the reasons? I mean, there are many reasons. People tend to be ashamed or not even recognize that their alcohol drinking is problematic. So many people don't seek treatment. But also many clinicians are not trained to identify, screen, diagnose, and treat people with alcohol use disorder.
We don't make addiction a foundational part of a medical school and residency. And then the last but not the least, which also is part of the first two reasons, addictions are highly stigmatized, including alcohol use disorder. So if I have diabetes, I have no problem to talk about having diabetes and going to the doctor. But if I do have alcoholism disorder, I'm ashamed. I'm afraid.
I'm concerned. I'm afraid to be marginalized by the society, which is in fact what is happening. So when I talk about these issues, I'm not blaming patients or clinicians. I'm actually pointing out that we have actually still a big hole in not understanding that addictions are chronic medical disease.
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