Semaglutide Linked to Lower Rates of Cannabis Use Disorder in Large Health Records Study

What the researchers found

In patients with obesity, semaglutide was associated with lower risk of new CUD (HR: 0.56) and recurrent CUD (HR: 0.62) versus non-GLP-1RA anti-obesity medications. Similar reductions appeared in patients with type 2 diabetes for new CUD (HR: 0.40) and recurrent CUD (HR: 0.66).

Why it matters

There are currently no FDA-approved medications for cannabis use disorder despite more than 45 million US users, one-third of whom meet criteria for CUD. If semaglutide's apparent protective effect is confirmed in randomized trials, it could represent the first pharmacological treatment option for this common condition.

The numbers in context

Obesity cohort: incident CUD HR 0.56 (95% CI: 0.42-0.75), recurrent CUD HR 0.62 (95% CI: 0.46-0.84). T2D cohort: incident CUD HR 0.40 (95% CI: 0.29-0.56), recurrent CUD HR 0.66 (95% CI: 0.42-1.03). Consistent reductions across gender, age, and race strata. Sample: 85,223 obesity patients, 596,045 T2D patients.

How the study worked

Retrospective cohort study using electronic health records from the TriNetX Analytics Network (~105.3 million patients from 61 US healthcare organizations). Compared propensity-score matched cohorts: 85,223 patients with obesity prescribed semaglutide vs non-GLP-1RA anti-obesity medications, replicated in 596,045 patients with T2D. 12-month follow-up.

What this study cannot tell us

Retrospective design with electronic health records cannot establish causation. CUD diagnosis in EHRs may undercount actual cases. Propensity score matching reduces but does not eliminate confounding. The T2D recurrent CUD result did not reach statistical significance (CI crossed 1.0).

How to read the evidence

Moderate: very large sample with propensity score matching and replication across two populations, but retrospective EHR design cannot prove causation.

When this study was published

2024 study.

The bigger picture

GLP-1 receptor agonists like semaglutide appear to affect reward circuitry beyond their metabolic targets. Preclinical studies show they reduce consumption of alcohol, nicotine, and now potentially cannabis, suggesting these drugs may broadly modulate addictive behaviors through appetite and reward pathways.

Questions still open

• What is the mechanism by which semaglutide reduces cannabis use disorder risk? Would the effect persist if semaglutide is discontinued? Are other GLP-1 receptor agonists similarly protective?

Common questions

Read the original research

Association of semaglutide with reduced incidence and relapse of cannabis use disorder in real-world populations: a retrospective cohort study.

Molecular psychiatry, 29(8), 2587-2598

Citation

Wang, William; Volkow, Nora D; Berger, Nathan A; Davis, Pamela B; Kaelber, David C; Xu, Rong. (2024). Association of semaglutide with reduced incidence and relapse of cannabis use disorder in real-world populations: a retrospective cohort study.. Molecular psychiatry, 29(8), 2587-2598. https://doi.org/10.1038/s41380-024-02498-5

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