Commentary on Qeadan et al.: Leveraging opportunities to expand the substance use disorder treatment arsenal

Many efficacious behavioral and medication treatments exist for substance use disorders (SUDs), but these treatments often have important limitations. Behavioral options that include cognitive–behavioral therapy and contingency management can effectively treat a variety of SUDs [1, 2], but these interventions are limited by their expense, availability of trained clinicians and the motivation and time commitment required of those seeking treatment [3, 4]. SUD medications are similarly impacted by access, cost and motivational barriers [3], with further structural barriers in some countries [5, 6] resulting from unique concerns about the potential for misuse or diversion of highly effective opioid agonist treatments [7]. Along with these limitations, many individuals with SUD may not benefit from a specific treatment, highlighting the need for ongoing medication and behavioral therapy development.

Qeadan et al. [8] provide intriguing evidence that glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonists are linked to reduced incidence of alcohol intoxication and opioid overdose in individuals with alcohol use disorder or opioid use disorder, respectively. Using electronic health record (EHR) data from a US sample, they found a 50% reduction in the incidence of medical visits for alcohol intoxication and a 40% reduction in the incidence of opioid overdose. When combined with animal evidence [9] and emerging but more mixed evidence from human experimental and observational studies [10-12], Qeadan et al.’s [8] methodological perspective strengthens the case for double-blind, randomized controlled trials (RCTs) to evaluate the effectiveness of these medications for SUD. Indeed, the diverse sets of methodologies and samples that support effectiveness of GIP and GLP-1 receptor agonists further increase the case for RCTs, and addictions research needs these diverse methodological perspectives to truly understand the causes and develop treatments for SUD.

Ty S. Schepis: Conceptualization; funding acquisition; writing - original draft.

T.S.S. receives research support from the US National Institute on Drug Abuse, the US Substance Abuse and Mental Health Services Administration and the US Food and Drug Administration.