GLP-1 Meds for Pain, Addiction, Obesity, Neurogenic Inflammation...

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drusso

drusso

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www.statnews.com

Top U.S. addiction researcher calls GLP-1 data for addiction 'very, very exciting'

An addiction expert says drugs like Wegovy are showing exciting results for addiction, but adds that “the pharmaceutical industry has never spontaneously embraced us and said, ‘We want to help develop treatments.’"
www.statnews.com www.statnews.com
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some people who need it for FDA approved medical treatment are not finding it available or are having insurance price it out of use.

compounding pharmacies are not a solution. remember last time people were recommending compounding injectables? NEC?
 
Nevro trial today on a woman with an A1C 7.3, who was 10.9 3 months ago until Monjouro (sp). Huge improvement.
 
These drugs are really affecting anesthesia providers. The ASA recs for holding them prior to surgery are best guesses. You should read some of the case reports of patients holding these meds and following NPO guidelines, but they are still evacuating 1+ liters of gastric contents during surgery.
 
The guideline is to hold for a week. The half life is 6-7 days. Then you have the person that has been on a high dose for months. So there levels are quite high still after one week and the patient doesn’t even miss a dose by holding a week.
 
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gaspasser127 said:
What’s Epifix ?
Click to expand...
Amniotic tissue extract sheets. A skin graft substitute to augment tissue healing. It goes in the deep wound bed to allow earlier epithelialization and reduce risk of wound infection. Used frequently in cervical cuff surgery for gynecology as well as rotator cuff surgery.
 
lobelsteve said:
Amniotic tissue extract sheets. A skin graft substitute to augment tissue healing. It goes in the deep wound bed to allow earlier epithelialization and reduce risk of wound infection. Used frequently in cervical cuff surgery for gynecology as well as rotator cuff surgery.
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Is this regen?
 
pastafan said:
In this case where are the pharmacies getting the base drugs for compounding? These are all under patent and the manufacturers aren’t sharing.
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They apparently aren’t allowed to defend their patent when there’s a shortage of the medication. Only when they’re not on the shortage list can they go after the compounding pharmacies. (That’s one of the drug reps told me at least).
 
BobBarker said:
The guideline is to hold for a week. The half life is 6-7 days. Then you have the person that has been on a high dose for months. So there levels are quite high still after one week and the patient doesn’t even miss a dose by holding a week.
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Actually ASA’s guidelines are hold for 7 days if dosed weekly, hold day of surgery if dosed daily.

www.asahq.org

American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists

www.asahq.org www.asahq.org
 
www.statnews.com

Ozempic linked to lower opioid overdose rate in those with diabetes, study shows

“The preliminary findings from this study point to the possibility that GLP-1 medications may have value in helping to prevent opioid overdoses.”
www.statnews.com www.statnews.com

"The findings add to a limited but growing body of evidence that the blockbuster medications may be more than just appetite suppressants. Recently, a small number of studies have suggested the medications can help people cut down on potentially harmful behaviors including drinking and smoking.

But the paper’s authors, including researchers at Case Western Reserve University and Nora Volkow, the director of the National Institute on Drug Abuse, cautioned that the link between GLP-1 drugs and prevention of overdose deaths is “unclear” and that more research is needed, including randomized controlled trials.

“GLP-1 medications have transformed the clinical management of type 2 diabetes and obesity by reducing associated morbidity and mortality. There is also emerging evidence of their potential in the treatment of various neurological and psychiatric disorders, including substance use disorders,” Volkow said in a statement. “The preliminary findings from this study point to the possibility that GLP-1 medications may have value in helping to prevent opioid overdoses.”
 
www.nytimes.com

Can Drugs Like Ozempic Treat the Most Common Eating Disorder?

Doctors are already using weight loss drugs to treat binge eating disorder. But some experts warn that it’s a Band-Aid, not a fix.
www.nytimes.com www.nytimes.com

"So far, the evidence that these drugs can help with binge eating disorder is largely anecdotal. But patients are already taking the medications for this purpose — and some they say they’re working."
 
some people say cupping works.

some people say deep laser works.

or green tea extract

or whole body vibration therapy

show me.GIF
 
Had a guy today who does all over random location non image guided prp which in addition to hyperbaric o2 keeps his “inflammatory arthritis” under control.

Got mad when I wouldnt take his 1k and do an ankle prp injection for “inflammation” without an mri. -i know what works for my body- sure that will be a bad review.

Lots of weird people being given wallet biopsies but all sorts of charlatans.
 

​

This study looks at whether certain medications originally used for diabetes and weight control (GIP and GLP-1 receptor agonists, like Ozempic) might help reduce opioid overdoses and alcohol intoxication in people with opioid use disorder (OUD) or alcohol use disorder (AUD).

Key Takeaways:​

  1. Lower Risk of Overdose and Intoxication:
    • Patients with OUD and AUD who received these medications had lower rates of opioid overdose and alcohol intoxication compared to those not prescribed these drugs.
    • Specifically:
      • 40% fewer opioid overdoses in people with OUD.
      • 50% fewer alcohol intoxications in people with AUD.
  2. Why This Might Work:
    • These medications help regulate hunger and reward systems in the brain, which may also reduce cravings for substances like drugs or alcohol.
    • There’s a shared brain pathway between appetite control and addictive behaviors, which these drugs seem to influence.
  3. Works Across Different Groups:
    • The positive effects were observed even in people with other conditions like diabetes and obesity, who typically face higher health risks.
  4. Study Details:
    • It analyzed medical records from over 100 million patients across 136 health systems in the U.S., covering data from 2014 to 2022.
    • This research used a retrospective approach, meaning it looked at past medical data to find patterns rather than testing the drugs directly.

Conclusion:​

The results suggest that these diabetes medications could become part of new treatment options for substance use disorders. However, more research and clinical trials are needed to confirm these findings and explore how these drugs work to reduce substance use and related risks.

This study points to a promising future direction where medications designed for other health issues could help fight addiction, offering new hope for patients struggling with OUD and AUD.
 
nvrsumr said:
Had a guy today who does all over random location non image guided prp which in addition to hyperbaric o2 keeps his “inflammatory arthritis” under control.

Got mad when I wouldnt take his 1k and do an ankle prp injection for “inflammation” without an mri. -i know what works for my body- sure that will be a bad review.

Lots of weird people being given wallet biopsies but all sorts of charlatans.
Click to expand...
Had a patient demand that I give her a cervical epidural with 160mg of depomedrol because no other med or dose worked. She was getting it every 3 months from a university hospital pain doc who apparently also tapped her and refused to do a blood patch so the patient never went back. When I told her I wouldn’t do it, she immediately went online and gave me a 1 star review stating “lack of knowledge of steroids” 🤦🏽‍♂️
 
drusso said:

​

This study looks at whether certain medications originally used for diabetes and weight control (GIP and GLP-1 receptor agonists, like Ozempic) might help reduce opioid overdoses and alcohol intoxication in people with opioid use disorder (OUD) or alcohol use disorder (AUD).

Key Takeaways:​

  1. Lower Risk of Overdose and Intoxication:
    • Patients with OUD and AUD who received these medications had lower rates of opioid overdose and alcohol intoxication compared to those not prescribed these drugs.
    • Specifically:
      • 40% fewer opioid overdoses in people with OUD.
      • 50% fewer alcohol intoxications in people with AUD.
  2. Why This Might Work:
    • These medications help regulate hunger and reward systems in the brain, which may also reduce cravings for substances like drugs or alcohol.
    • There’s a shared brain pathway between appetite control and addictive behaviors, which these drugs seem to influence.
  3. Works Across Different Groups:
    • The positive effects were observed even in people with other conditions like diabetes and obesity, who typically face higher health risks.
  4. Study Details:
    • It analyzed medical records from over 100 million patients across 136 health systems in the U.S., covering data from 2014 to 2022.
    • This research used a retrospective approach, meaning it looked at past medical data to find patterns rather than testing the drugs directly.

Conclusion:​

The results suggest that these diabetes medications could become part of new treatment options for substance use disorders. However, more research and clinical trials are needed to confirm these findings and explore how these drugs work to reduce substance use and related risks.

This study points to a promising future direction where medications designed for other health issues could help fight addiction, offering new hope for patients struggling with OUD and AUD.
Click to expand...
more study is needed.

First, the retrospective correlational nature of the data limits the ability to assume causality between GIP/GLP-1 RA prescriptions and lower rates of opioid overdose and alcohol intoxication. Additional prospective research is needed to examine if GIP/GLP-1 RA drugs have the ability to impact substance use-related behaviors and confirm our findings.
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Ducttape said:
more study is needed.
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No more munchies for you. If you told me that my cannabis cravings were in my head...I'd believe you.

This retrospective cohort study used electronic health records from over 85,000 patients with obesity and nearly 600,000 with type 2 diabetes (T2D) to explore semaglutide's effect on CUD, comparing it with non-GLP-1RA medications. Semaglutide was associated with significantly lower risks of both new and recurrent CUD diagnoses across various demographics, showing hazard ratios (HR) below 1 for both conditions. These promising results suggest semaglutide's potential to treat CUD, but further research and randomized clinical trials are needed to confirm its efficacy and mechanisms.

Mol Psychiatry. 2024 Aug;29(8):2587-2598.
doi: 10.1038/s41380-024-02498-5. Epub 2024 Mar 14.

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

William Wang 1, Nora D Volkow 2, Nathan A Berger 1, Pamela B Davis 3, David C Kaelber 4, Rong Xu 5
Affiliations Expand

Abstract​

Cannabis is the most frequently used illicit drug in the United States with more than 45 million users of whom one-third suffer from a cannabis use disorder (CUD). Despite its high prevalence, there are currently no FDA-approved medications for CUD. Patients treated with semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved for treating type 2 diabetes (T2D) and for weight management have reported reduced desire to drink and smoke. Preclinical studies have shown that semaglutide decreased nicotine and alcohol consumption. Preclinical and preliminary clinical evidence of semaglutide's potential beneficial effects on various substance use disorders led us to evaluate if it pertained to CUD. In this retrospective cohort study of electronic health records (EHRs) from the TriNetX Analytics Network, a global federated health research network of approximately 105.3 million patients from 61 large healthcare organizations in the US, we aimed to assess the associations of semaglutide with both incident and recurrent CUD diagnosis compared to non-GLP-1RA anti-obesity or anti-diabetes medications. Hazard ratio (HR) and 95% confidence intervals (CI) of incident and recurrent CUD were calculated for 12-month follow-up by comparing propensity-score matched patient cohorts. The study population included 85,223 patients with obesity who were prescribed semaglutide or non-GLP-1RA anti-obesity medications, with the findings replicated in 596,045 patients with T2D. In patients with obesity (mean age 51.3 years, 65.6% women), semaglutide compared with non-GLP-1RA anti-obesity medications was associated with lower risk for incident CUD in patients with no prior history CUD (HR: 0.56, 95% CI: 0.42-0.75), and recurrent CUD diagnosis in patients with a prior history CUD (HR: 0.62, 95% CI: 0.46-0.84). Consistent reductions were seen for patients stratified by gender, age group, race and in patients with and without T2D. Similar findings were replicated in the study population with T2D when comparing semaglutide with non-GLP-1RA anti-diabetes medications for incident CUD (HR: 0.40, 95% CI: 0.29-0.56) and recurrent CUD (HR: 0.66, 95% CI: 0.42-1.03). While these findings provide preliminary evidence of the potential benefit of semaglutide in CUD in real-world populations, further preclinical studies are warranted to understand the underlying mechanism and randomized clinical trials are needed to support its use clinically for CUD.
 
retrospective.

looks like huge group. 500,000+ charts.

when it came to looking at patients with prior cannabis use disorder who were put on semaglutide to see if there was relapse, there were 506 patients for which to base this information.

in addition, only 12 month follow up.

and, as always, you cannot make causal conclusion based on a retrospective observational study.

First, this is a retrospective observational study, so no causal inferences can be drawn.
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Second, patients in our study represented those who had medical encounters with healthcare systems contributing to the TriNetX Platform. Though both the exposure and comparison cohorts were drawn from the same platform, which should not significantly impact the relative hazard rate ratios, results from the TriNetX platform need to be validated in other populations and platforms of EHRs.
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Third, retrospective observational studies have inherent limitations, including unmeasured or uncontrolled confounders and biases.
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Fourth, in our study the follow-up time for the main analyses was 12 months.
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Fifth, the higher dose format of semaglutide as Wegovy was approved for weight management, and the lower dose format of semaglutide as Ozempic was approved for treating T2D. Since Wegovy and Ozempic were approved for different indications, we could not directly assess the dosage effect of semaglutide on CUD in the same study population.
Click to expand...

Sixth, we could not directly control for patient adherence to medications due to limited medical adherence information captured in patient EHRs.
Click to expand...
 
Ducttape said:
retrospective.

looks like huge group. 500,000+ charts.

when it came to looking at patients with prior cannabis use disorder who were put on semaglutide to see if there was relapse, there were 506 patients for which to base this information.

in addition, only 12 month follow up.

and, as always, you cannot make causal conclusion based on a retrospective observational study.
Click to expand...

You should be ashamed of trying to "explain away" the utility of a life-transforming therapy for obese/metabolically challenged, opioid-addicted, chronic pain patients. They are fat, their feet hurt, and they want drugs, and you want to get in their way.

www.nytimes.com

Opinion | Why We May Soon Use Ozempic to Treat Addiction

Early data suggests GLP-1 drugs, renowned for their ability to assist in weight loss, may have a powerful effect on treating addiction.
www.nytimes.com www.nytimes.com

"Unfortunately, despite the drugs’ promise, drug manufacturers seem reluctant to pay for the larger trials that would be needed to seek Food and Drug Administration approval for use for addiction. Historically, pharmaceutical companies have avoided developing anti-addiction medications, in part because of the stigma that frames addiction as a moral problem, not a medical one. Paul Kenny, chair of neuroscience at Mount Sinai Hospital in New York, suggests drug companies may also worry that testing these drugs in people with addiction, who often have multiple medical problems, could reveal or falsely connect the drugs to previously unknown side effects. That might threaten their highly profitable approval for diabetes and obesity."
 
no.

i dont want to be the one to tell them that their GLP-1 induced gastroparesis is permanent and yes, that i knew there was not great evidence that it would stop them from abusing cannabinoids but we gave it to them anyways.
 
www.theatlantic.com

Understanding Desire in the Age of Ozempic

Many people who take GLP-1 drugs find that their cravings disappear. I went to a Buddhist monastery to try to understand why that doesn’t feel like enlightenment.
www.theatlantic.com www.theatlantic.com

"Desire, or wanting, is a discrete mental phenomenon that is driven by the neurotransmitter dopamine. In the 1980s, Kent Berridge, a neuroscientist at the University of Michigan, led a study demonstrating that the neurobiology of wanting was separate from liking. Wanting is the motivation to pursue a reward, whereas liking is the enjoyment we get from that reward. This wanting is different from a cognitive plan, like wanting to stop by the library later; it’s an urge to act. Berridge and others have shown that wanting involves different chemicals and areas of the brain than liking does. This means we can want what we don’t like, and enjoy what we don’t crave; for example, Berridge has argued that addiction stems from the triumph of desire over enjoyment. Anhedonia, the loss of pleasure in activities that used to be meaningful, is commonly understood to be a symptom of psychological conditions such as depression. A better term for what’s happening to some GLP-1 users, Berridge said, would be avolition—a loss of motivation and wanting."
 
Got me wondering if there are receptors for GLP-1 everywhere in the body, like opioid receptors. Another implication is that since ingesting more fiber in one's diet indirectly also stimulates GLP-1 actions, perhaps the reason for the obesity epidemic and drug related deaths in the USA is simply not enough fiber in the USA diet. Sort of related to the backlash against easily digested carbs.
 
Last edited:
GLP-1 receptor agonists can lead to tachyphylaxis, particularly concerning their effect on gastric emptying. Tachyphylaxis refers to a rapid decrease in the response to a drug after its initial administration.

Mechanism of Tachyphylaxis with GLP-1 Agonists:
• Gastric Emptying: GLP-1 agonists are known to slow gastric emptying, which helps in controlling postprandial blood glucose levels. However, studies have shown that this effect diminishes with prolonged use due to tachyphylaxis. This reduction is likely through rapid tachyphylaxis at the level of vagal nerve activation. 
• Clinical Implications: The diminished effect on gastric emptying over time means that the initial benefits of GLP-1 agonists in controlling postprandial glucose may decrease with long-term use. This phenomenon has been observed in both short-acting and long-acting GLP-1 receptor agonists. 
 
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