BMJ

GLP-1 drugs tied to lower risk of substance use disorders in U.S. veterans

March 6, 2026

A large cohort study of more than 600,000 U.S. veterans with T2DM found that initiating a GLP‑1 receptor agonist was associated with reduced risk of developing multiple substance use disorders (SUDs)—including alcohol, nicotine, cannabis, cocaine, and opioids—compared with starting an SGLT‑2 inhibitor. Risk reductions ranged from 14% to 25%, translating to roughly 1 to 6 fewer SUD cases per 1,000 people over three years. Among veterans with pre‑existing SUDs, GLP‑1 therapy was also associated with fewer SUD‑related emergency visits, hospitalizations, overdoses, and deaths.

In an accompanying editorial, Dr. Fares Qeadan of Loyola University Chicago says that although this target trial emulation strengthens the case that GLP-1s may influence substance-related outcomes in real-world practice, the challenge is to translate the signal into trials and equitable care pathways while continuing to scale proven treatments for SUDs.

Sources:

Cai M, et al. (2026, March 4). BMJ. Glucagon-like peptide-1 receptor agonists and risk of substance use disorders among US veterans with type 2 diabetes: cohort study. https://pubmed.ncbi.nlm.nih.gov/41781010/

Qeadan F. (2026, March 4). BMJ. Metabolic medicines and addiction: what GLP-1 receptor agonists might add to substance use care. https://pubmed.ncbi.nlm.nih.gov/41781016/