From 'Food Noise' to Stimulant Cravings: A New GLP-1 Trial at UMB

University of Maryland School of Medicine (UMSOM) associate professor Sarah M. Kattakuzhy, MD, joins “The UMB Pulse” this month to talk about her research exploring whether semaglutide (a GLP-1 medication widely used for diabetes and weight management) could help reduce cravings and improve outcomes for people with stimulant use disorder.

Kattakuzhy, who is also the co-director of the Kahlert Institute for Addiction Medicine at UMSOM, describes the design of the STAC Study, which is evaluating the safety and tolerability of semaglutide in people with cocaine use disorder, including participants with and without HIV, while also tracking secondary outcomes such as changes in drug use and cravings.

She also discusses why stimulant use disorders, including cocaine and methamphetamine use disorder, have been especially challenging to treat, and how her work through the University of Maryland, Baltimore community-based research partnerships aims to expand treatment options and reduce stigma around substance use disorders.

To learn more about this trial or for referrals, contact Dr. Kattakuzhy at skattakuzhy@ihv.umaryland.edu.

00:00 Introduction to Addiction and New Research
00:40 Meet Dr. Sarah Kattakuzhy
01:45 A Day in the Life of Dr. Kattakuzhy
03:57 The Journey to Addiction Research
07:40 Exploring Semaglutides for Addiction Treatment
12:34 Details of the Clinical Trial
20:29 Challenges and Hopes in Addiction Treatment
24:31 Collaborations and Future Directions
27:39 Final Thoughts and Takeaways
32:13 Post-Interview Insights

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Chapters

• 0:00 Introduction to Addiction and New Research
• 0:40 Meet Dr. Sarah Kattakuzhy
• 1:45 A Day in the Life of Dr. Kattakuzhy
• 3:57 The Journey to Addiction Research
• 7:40 Exploring Semaglutides for Addiction Treatment
• 12:34 Details of the Clinical Trial
• 20:29 Challenges and Hopes in Addiction Treatment
• 24:31 Collaborations and Future Directions
• 27:39 Final Thoughts and Takeaways
• 32:13 Post-Interview Insights

Transcript

Dana Rampolla: 0:00

Addiction is one of those issues that almost everyone touches through personal experiences or someone they love or know. And treatments for addiction haven't changed much in decades, but they could soon change thanks to some surprising research. You're probably familiar with medications used for diabetes that also have the benefits of weight loss, and you've probably heard of them as Ozempic Wegovy or Mounjaro, or even just a GLP-1, or some people call them semaglutides All of these medications help to slow digestion and quiet cravings or that food noise we hear about, and they're now being investigated to see if they can quiet cravings for cocaine and methamphetamine. That possibility has piqued the interest of Dr. Sarah Kattakuzhy at the University of Maryland Baltimore. Dr. Kattakuzhy is an associate professor at the University of Maryland School of Medicine and co-director of the Kahlert Institute for Addiction Medicine. She is overseeing a clinical trial to see if semaglutides can reduce cocaine abuse and improve drug use outcomes. Can the brain's reward response be suppressed for drugs much like it can be for food with these medications, while also reducing stigma and inducing hope? Find out that and more in our conversation with Dr. Kattakuzhy on the UMB Pulse.

Jena Frick: 1:22

You are listening to the heartbeat of the University of Maryland, Baltimore, the UMB Pulse.

Dana Rampolla: 1:35

Sarah, welcome. Thank you for joining the podcast We're looking forward to learning a lot.

Sarah Kattakuzhy: 1:41

Thank you so much. It's a pleasure to be here.

Dana Rampolla: 1:43

So let's jump right in. Start out by taking me to a Tuesday afternoon, either in your clinic or out in the community. Describe the setting. Let me know what's going on. Kind of paint a picture for us that captures what your daily work really looks like.

Sarah Kattakuzhy: 1:58

Wow. Okay. Well, how much time do we have? I'm at a point in my career where I have the pleasure of helping co-lead, a large research program called the Research Initiative in Infectious Disease and Substance Use. Our goal is really to produce novel therapeutics and approaches for people disproportionately affected by substance use disorder and HIV epidemics. That's really the crux of our work. To accomplish this, we partner with community-based organizations, uh, that are in. Baltimore and Washington DC to really try and get at the patient population, that's disproportionately affected by these conditions. And meet them where they are in community-based settings where they feel comfortable, where they're receiving other services. And then we kind of are able to align our clinical care and research alongside that to make things convenient and culturally competent. So, as I said, I'm, one of the co-directors along with my colleagues, Dr. Elana Rosenthal and Dr. Rachel Silk. We've been leading the program for. over a decade. And so on a, on a regular Tuesday, you'll see me, checking in with our boots on the ground team, figuring out have all the patients been seen and what still needs to be accomplished. We have a number of research meetings, that are trying to figure out, who's been seen, who needs to be seen, who, lost their phone, so how are we gonna contact them? so it's a lot of management and coordination, but our science, is really focused on our active protocols, One of our most active protocols right now, is looking at, semaglutide or, you know, goes by a lot of names, Ozempic Wegovy in people with cocaine use disorder. Depending on the day of the week, we have that active clinic that is seeing those patients for that protocol, which requires a lot of management.

Dana Rampolla: 3:56

I am sure. you just touched on everything I'm hoping we'll talk about today, before we, jump into the crux of it, tell me if there was a period or an experience or maybe a patient that changed how you understood addiction.

Sarah Kattakuzhy: 4:12

That's a great question. Like most people, your career is a series of happy accidents and right place, right time. after I did my medical training and chief residency at George Washington University Hospital in Washington DC I actually took a job at the National Institute for Allergy and Infectious Disease. My initial goal was really to become an HIV primary care provider. I wanted to learn the guidelines from the people who write them. At that time, HIV medicine was a lot more complicated than it is today. While I was at the NIH is when they actually were doing the first studies on what would become, today's novel therapeutics for Hepatitis C, the direct acting antivirals. And I got to see in front of my eyes as this disease during my training was, very poorly treated and tolerated. I got to see people cured in front of my eyes. So that was miraculous and what really brought me into clinical research, as a way that I could approach my medical care linking in public health, which is very important to me Being able to understand, not just how do we get new therapies to people who need it most, but what's the missing piece? what brought me to addiction is, is actually that the next stepping stone is that I was doing Hepatitis C care between Baltimore and Washington DC in 2013 to 2014, and that is the exact time that Fentanyl hit the illicit drug supply in those regions. And so these patients that I was treating and curing of Hepatitis C, more than one of them, died of a drug overdose or was reinfected because of their ongoing substance use. that really lit a fire under me. To say, if we're really looking at this issue from a public health perspective, we always think about upstream causes or even in the field of infectious diseases. We think of the source, what is the source of the infection and the source and the upstream cause of hepatitis C in some individuals, HIV, and complications is really the substance use and addiction. And that is what really caused me to pivot my career to looking towards the overlap and the intersection of both addiction and infectious disease. And so it's more than one patient, but I can still remember them. Especially all the patients we've lost to the ongoing, overdose death crisis in the U.S., and these patients continue to reinforce the work I do.

Dana Rampolla: 6:52

I can definitely, feel that connection for me personally, I'm so drawn to your story and research. I have an adopted brother. He was adopted at birth and died a few years ago from an overdose. He had been a heroin user and somehow got fentanyl mixed into it. I remember years ago talking to him about his addiction and saying Just take that energy, that desire, and put it into something else, like thinking this is all mental just work out, you know, start a workout program or train for a marathon. And I remember him saying it's not that easy, it's physical. I can't live without it. So when there's someone who is, using to a point that they are addicted. We look at other drugs like these semaglutides you mentioned, as a family member, I find hope in that. Talk a little bit about, you know, we've all heard of ozempic, wegovy, Is it possible this will actually be a treatment for a substance disorder like cocaine addiction?

Sarah Kattakuzhy: 7:51

thank you for your honesty and for sharing and just wanna reinforce how, unfortunately, common your story is. I think about, our world today and kitchen table issues what brings us together are becoming, a smaller and smaller slice of the pie. But unfortunately, having a loved one with substance use disorder is one of those issues. It affects so many families in America. It does not matter your socioeconomic class, race, religion, creed, it has affected all of us. I really wanna thank you for sharing that. I see hope for the future of substance use disorder, care and treatment for a number of reasons. before I address my research and the field of substance use disorder treatment, I will say one great piece of data that we have now is that the number of overdoses for the first time seem to be on a decline. And that's for a number of reasons. I do think we've turned an important tide in terms of the number of deaths from drug overdose deaths does not mean that, it, it's been solved. There's still an unacceptable amount of overdose death but it has declined from its peak. we feel good about those trends. In terms of other things that give me hope, as a clinician and scientist, finding new therapies for people who use drugs, is an area of excitement and hope because, you know, opioid use disorder, we have excellent medications, methadone, buprenorphine. Amongst others, that have very high efficacy in terms of keeping people alive and reducing their drug consumption. Unfortunately that is not the case when you apply to stimulant use disorders, and that includes cocaine and methamphetamines. We do not have any FDA approved treatments for those particular drugs, and there's a lot of exciting science that's happening around the world and around the globe. one of those is exploring the use of GLP one agonists, like Semaglutide or Tirzepatide or, their, you know, other names, Wegovy, Ozempic, et cetera. The way that we really think about it and how this came about as an area to explore. Is that when these drugs were being utilized in people with diabetes or people with obesity, individuals who were taking it reported, Hey, you know, I have lost a lot of weight. My relationship with food has changed. I'm making different choices about food, but also I don't feel like drinking anymore. these observations led scientists, who were, of course we have our basic science colleagues who are looking at things on molecular levels, in animal models, that really tried to understand, you know, there are, if we look at the sort of more scientific level, there are receptors for GLP, not only in the stomach and the, you know. Our GI system, but also in our central nervous system. So we know that people change the way they're making decisions about food when they're on GLP ones. Could this apply to other substances? Could this apply to alcohol? Could it apply to cocaine? And is one of the ways that the GLP ones work, could it be around impulsivity? Could it be around craving? And these are all words that in the field of addiction are really important because they're features that are central to, as you mentioned, it's not just an issue of willpower, it's the central nervous system really being hijacked to prioritize the consumption of drugs in order to just achieve, a sense of normality in the brain. And so is, it possible that the GLP one agonist could be used to help control some of that craving, to reduce the craving, to reduce the impulsivity, to keep the brain at more of that neutral state so that people can make healthier choices about what they're consuming, including eliminating or reducing their drug use. The science right now is that we don't know. We definitely do not know. There are preliminary studies, in alcohol use disorder is the main place that it's been, studied. But, we are, we're still really exploring that. So I have a lot of hope, but it, it really has to be borne out by the science.

Dana Rampolla: 12:34

tell me then a little bit about the clinical trial that you're overseeing and how long have you been working on it? How long do you think something like this takes to have data that allows you to move forward to the, like the FDA for approval?

Sarah Kattakuzhy: 12:47

the way that, drug development typically works, and I'm gonna super simplify it, is that you have different stages. The first is asking the question, is this drug safe for the patient population that you would like to use it in? Is it tolerable? Can it be used safely in humans? And so we know because these drugs have actually been around for quite some time and have been, of course, approved in diabetes and obesity. now the question is, are they safe and tolerable in people who don't have those conditions but have a different condition, like a substance use disorder? our study, is evaluating The acronym is the Stack Study, but it's really safety and tolerability of semaglutide in people with cocaine, use disorder, inclusive of people with and without. HIV. this study is really trying to figure out is it safe and will people take it, and is it tolerable? So that means, you know, you may have a drug that you're like, ah, you know, I get a little bit of upset stomach when I take it. It doesn't stop me from taking the medicine. And so I would consider it tolerable. Or you could have a medicine that's like, Hey, I know that my lab work looks great, but I just don't like the way it makes me feel. And that makes it intolerable because no matter what, it doesn't help anyone if you have a medication no one will take, in this study, our primary outcome, the thing we're looking at most is, is it safe and is it tolerable? And then the second things we're looking at are the secondary outcomes is it able to reduce drug use? Are people spending less money on cocaine than they used to? Are they reporting less craving? Does their urine show less positive urine drug screens for cocaine than before they started? And what is happening with other aspects of craving? Are they still, making good choices about other aspects of their life? Do they still feel, like they're able to have pleasure in everyday life? are we able to see if these GLP ones can be used to take away the urges and the cravings that aren't beneficial without reducing everything that brings pleasure from everyday life? So these are all secondary outcomes that we're exploring.

Dana Rampolla: 15:07

how do you explain it when you're talking to the patient who probably doesn't, well could, but probably doesn't have your level of education so they can kind of understand what's going on with their brain and what the hopeful outcome is?

Sarah Kattakuzhy: 15:20

we have a great relationship with our patient population because of the setup of our research program, and I think because we have. Just the best research team and the best providers, who really offer patient-centered care, even in the setting of ongoing research. the way we consent individuals is we say, this is a study that may or may not be beneficial to you as a person. And in fact, there are some risks that are involved. the reason we're doing this study is because as you know, as someone with cocaine use disorder, there's no treatments that are approved by our medical system for cocaine use. And this study is the first step in helping us figure out, can we use these new drugs that you've probably heard of in the news? Can we use them in people with cocaine use disorder? And this is the first step. And so this is a randomized controlled trial, which means that 50% of the people get the actual drug semaglutide and 50% get a matching placebo I don't know which one they get, only one person on our team does. And so the patient doesn't know and I don't know. So I can tell them very clearly, you have a 50% chance of being on the medication and there is no guarantee that this will have any benefit to you. And I've gotta tell you, people are so willing to participate in this 'cause they want to have a contribution to moving this field forward and they want some hope, even if it's not for themselves. So I just have so much respect for all of our patient participants, because they do really understand that going into the protocol. especially 'cause it's a blinded study.

Dana Rampolla: 17:10

Yeah, that's really great. Great to understand. Also, help me understand if someone doesn't have diabetes or say an issue with their weight loss. Yeah. How can semaglutide can work with the brain to treat drug addiction while not impacting their insulin digestion or food cravings.

Sarah Kattakuzhy: 17:27

Yeah. So I have to tell you this is part of what we're exploring, because we know from previous studies of obesity that the data overwhelmingly suggests that if you are someone who is of a normal or thin body habitus at baseline, you have a much lower degree of weight loss than individuals who are obese. Meaning not everyone who takes semaglutide is gonna lose 50 pounds. It really depends on what your starting set point is. And of course, the multitude reasons behind the obesity. I think we're figuring that out as more Americans are on a GLP one agonist, that there are super responders who are people who are gonna lose 40 pounds in three months. And there are people who really need to go to the highest dose and beyond this for a long time before they see some, response. So as that relates to people with cocaine use disorder, we have to look out for. Weight loss in them. This is part of our, our safety evaluation. We have to be able to look out are they consuming less food because we know these are effects of the medication. So these are things that we're, we're trying to evaluate science.

Dana Rampolla: 18:45

Oh, I'm sorry. I was just gonna ask, aren't typically cocaine users? Maybe I'm generalizing, but they're usually thinner anyway.

Sarah Kattakuzhy: 18:51

That's exactly right is that people with cocaine use disorder in general have a much thinner body habitus compared to your standard non, person who does not have cocaine use disorder because of the action of the cocaine. Or the methamphetamine, their stimulants. And part of what they do in the body is to naturally suppress the appetite. So that is a big part of our safety considerations. We actually have, something called the in-body machine, which is like if you have a fancy gym membership, you might have it there, but it's a machine that uses electrical impedance to measure the difference between water fat and muscle in the body. And so we have every single one of our patients, complete an in-body scan at multiple time points. And that's because I'm not just concerned about their weight. We know that from other studies of GLP ones that about up to 30% of the weight that people lose is actually muscle. And so in individuals who are already on the thinner side, are they going to lose a lot of their muscle mass? Are we going to put them into what we would medically term sarcopenia? And would that, make any benefit that they get from reduced cocaine use? Would that be imbalanced because of the negative side effects? So we take safety really seriously, and that's why we're so rigorously evaluating this, as our primary outcome.

Dana Rampolla: 20:22

Well, and you said that there is no FDA approved medication for cocaine or other stimulant abuse or addiction? what does this gap mean for the people who you're working with every day? are you hopeful that this, obviously you're hopeful that it will work, how do you see that gap expanding or closing more quickly?

Sarah Kattakuzhy: 20:41

I think it is such a challenge because we are now in what we consider the fourth wave of the drug overdose death crisis, which is that, you know, initially there was a lot of death related to prescription opioids. And that really shifted to deaths predominantly, related to heroin use as prescription opioids over prescription of opioids was pulled back and people who were dependent became, then developed, heroin misuse. And then as Fentanyl hit the illicit drug supply, as I described at the top of our conversation, that really became the third wave. And so what we're in now, what's been described in the literature is this fourth wave, which is a combination of opioids and stimulants. And we're seeing it, in a lot of specific patient populations. But stimulant use has really replaced opioids or at least brought in parallel with opioids, uh, opioid use in the west coast, and a lot of the Midwest. So For example, in Texas, my counterparts and colleagues in Texas, their predominant patient population that they're struggling to treat are individuals with stimulant use disorder, with methamphetamine use disorder. Here in Maryland, you know, I treat a rural patient population of individuals with opioid use disorder, and that's where I see a lot of the co- use of methamphetamines Here in the city. I see a ton of cocaine use and a lot of cocaine use disorder in individuals who already have use of opioids and those who don't as well. I think, this is a strong issue because we know that cocaine and methamphetamine is also going to increase your likelihood of overdose. These can also be contaminated with fentanyl. So even if you're someone who doesn't have an opioid use disorder. You're still at very high risk of overdose death. And of course the way that you use these drugs can lead to lots of, challenges like infectious complications. And you know, for example, if you're injecting drugs, can lead to acquiring HIV or Hepatitis C or other diseases. So, I think there's a gap. In the way that we approach stimulants, because we don't have good science to say, yes, this is the treatment you should use. We have professional guidelines that say, Hey, you can try these. You know, about seven different kinds of medication that we can try, but none of those have risen to the level of efficacy that's required to get an FDA label. So how this bears out for the average patient is that if they make it to a doctor, if they make it to me to say, I really want treatment for my cocaine use disorder, I can say we have really great behavioral interventions that we know work, like contingency management, cognitive behavioral therapy, but in terms of a medication to help you with your withdrawals. I don't have anything that's approved. And so it's, really frustrating for patients because they need help today. And there's of course the core component that, that is best addressed with longitudinal behavioral therapy. And that includes trauma, it includes coping mechanisms, developing resilience, and those are all very, important and vital aspects of a recovery journey. But to get someone to the point where they just feel okay, where they feel well enough to engage in those therapies, I think is the missing piece. And that's where I really see a future of, pharmacotherapies coming in.

Dana Rampolla: 24:28

It's all so interesting. You mentioned your colleagues in Texas, so this study doesn't happen in isolation. I'm sure there's many universities and research centers working on things like this. You're doing your work through the Kahlert Institute For Addiction Medicine here at UMB. How does being part of an institute like Kahlert shape the research you're able to do and the communities you're able to reach?

Sarah Kattakuzhy: 24:53

Yeah, it's a beautiful question. I think one of the reasons that we developed the Kahlert Institute for Addiction Medicine was to potentiate the work that we're doing because Baltimore and Maryland, unfortunately, have a longstanding history of drug use, especially opioid use within our city, were disproportionately affected. Until recently we were the city that had the largest, highest rate of overdose death of, of cities in the country. And so, we have a unique responsibility to, not only do our work individually, but to join hands and see how we can potentiate our work and how we can learn from each other. And actually, an amazing example of that is in the STACK study is that through the Kahlert Institute, I'm collaborating with my colleagues at the Maryland Psychiatric Research Center, Dr. Daniel Roche, who's conducting a substudy where some patients are going to MPRC and having MRI scans. And they're having brain scans before and after their, uh, peak dose of medication. Dan's team at the MPRC also doesn't know if they're getting semaglutide or what we call the placebo, but after the study's done, we'll be able to look and see, hey, this person decreased their cocaine use. Are we seeing any changes in their brain that might help us explain that in addition to understanding they're on semaglutide or not? Because that's one of the missing pieces of semaglutide is that we know how it affects diabetes and obesity, but we don't know exactly why it works as a potential anti craving drug or an anti impulsivity drug. So through these types of collaborations, and that's not a science that I know how to do, but through the Kahlert Institute and through these collaborations, we can take the science to the next level. We can answer questions that we can't alone. I'm part of something called the NIDA Clinical Trials Network, which is of course sponsored by the National Institute of Drug Abuse. It's a consortium of academic medical centers who are doing this type of work in addiction That's really geared towards this question, how do we get new therapies for people with substance use disorders? And UMB and the Kahlert Institute for Addiction Medicine, um, are actually members of that, consortium. We just became members last year. So I'm really excited at the opportunity for UMB to join this fight on a larger scale to potentiate that work.

Dana Rampolla: 27:34

That's fantastic. So you do sound very hopeful, which gives me hope. What would you like our listeners to take away from this conversation?

Sarah Kattakuzhy: 27:45

A couple things. I would love for everyone to understand that substance use disorders, are a disease and they affect people's lives differently in the same way that diabetes affects people's lives differently. But like diabetes and like many chronic relapsing remitting conditions, it's treatable. There are absolutely people who, with and without medication, based treatment can get better. And I think that's the missing piece from a lot of the stories and the headlines that we meet there is of course. As you know, you shared earlier a lot of people who don't make it, and those are the people we continue to fight for. I want listeners to also understand that if people are engaged in, good treatment, both behavioral but also medication based treatment, individuals get their best chance at recovery. I don't wanna lose that thread, that recovery's absolutely possible. I also think in this era, where there's been a lot of scrutiny, around science and what benefit it can provide to society. I think that the addiction crisis in America is a prime example of where we need to invest heavily in science because what we have right now is just not enough. We can't forget our boots on the ground, people who are delivering service. That is first and foremost to prevent. Further death, but we need to also look to the future for how we can curb, these trends. And that's where science, I think investment in science really helps. I think those are two messages to, to really share. And also, you know, if you or a loved one know some, an individual with substance use disorder, just remember that substance use disorders really thrive in isolation. They thrive in with, in shame and in darkness. And so really shedding a light, offering compassion, helping link people to services is always something that you can do. And it never, never give up hope on that.

Dana Rampolla: 29:58

And my big takeaway question for you, Sarah, is if one of our listeners has a family member, friend, loved one who has one of these stimulant disorders, can they reach out? How do we connect them with you or your team?

Sarah Kattakuzhy: 30:13

Not only can we help link you to this study, which I think is important, but primarily if anyone needs care for a substance use disorder, we have an incredible division of addiction research and treatment in the Department of Psychiatry led by Dr. Eric Weintraub, that has incredible care And, that's not just here in Baltimore. We have a network of telemedicine providers throughout the state. So, please get in touch with me. I can make the referrals. Hopefully I can pass on contact information that we can include in the show notes. I'm the only Kattakuzhy at UMB, so it's pretty easy to find me. but certainly for my study, uh, you know, our, our work is really focused on people with cocaine use disorder and there's a couple other criteria. You can't be too thin, Mainly if people are interested, they can contact me again and I'll put them in touch with our team, to get evaluated. we would love those referrals.

Dana Rampolla: 31:08

That would be fabulous. And you said there is a telehealth option, so it's not just people right here in the city or in the county. How about people from other states? So there other types of programs?

Sarah Kattakuzhy: 31:20

Absolutely. I think we have really strong clinical connections, especially in our neighboring states. Pennsylvania, D.C., Virginia, et cetera. So wherever you are, please reach out. It's a, you know, a very small community of addiction providers and we wanna make sure people get linked to care.

Dana Rampolla: 31:37

thank you so much for sharing this with us. I think it's so interesting that when we have medications and we know of other examples, minoxidil and a number of other different things, who start out with one purpose and then wind up solving some other dilemma or crisis. So I'm so interested and intrigued by what you've shared. We will definitely spread the word and just thank you, thank you for being part of the research here at University of Maryland, Baltimore, and as you said, research does matter. We need to keep funding coming for because this is all so important. So thank you Sarah,

Sarah Kattakuzhy: 32:10

thank you so much.

Charles Schelle: 32:13

After Dana wrapped up her conversation with Dr. Sarah Kattakuzhy we stayed on for a few minutes longer to talk about some of the biggest open questions around GLP-1 medications, One of the biggest questions is what happens after someone stops taking a GLP one?

Sarah Kattakuzhy: 32:29

We actually amended our protocol to add on an optional extension study , the study is four months long and we are actually going to follow people after they stop semaglutide versus placebo. We'll follow them for an additional six months because one of the concerns is that actually there was a, an article published in the British Medical Journal very recently that talked about the significant and very rapid weight gain that people have after discontinuing these medications. And so if we try to make that in parallel, we're not sure if we'll see a reduction in cocaine use, but will there be a rebound, for example, if there's an anti craving effect? If you stop these medications, will you then have a rebound craving that leads people to binge use?

Charles Schelle: 33:22

That question whether cravings return is something researchers are actively watching. And it ties directly into how Dr. Kattakuzhy thinks about addiction treatment more broadly.

Sarah Kattakuzhy: 33:35

These are lifelong conditions that really require lifelong treatment. And so in the way that I prescribe methadone or buprenorphine, and we say there's no end date in sight, we prescribe these medications as long as the benefits outweigh the risks. And that's really what our guidelines tell us to do. And I would approach these in the same way if there is eventually to be discovered that there is an efficacy for reduction in substance use. I would say the first question is not when can we stop. It's, you know, how do we use these medications to gain stability in people's lives and then try to understand, these secondary questions,

Charles Schelle: 34:14

That's also why dosing and duration are still very much open questions

Sarah Kattakuzhy: 34:19

So we may get an anti craving effect. At a lower dose we might not have to go up to two or, you know, high or higher dosing. The effect and the dose, are really important questions that we just don't know enough about, but it is something that I am concerned about as a clinician, as a scientist, and which is why I never say like this is the answer.

Charles Schelle: 34:41

As GLP one medications move into pill form, those questions expand even further, especially around access and patient choice.

Sarah Kattakuzhy: 34:51

I think like any other patient population, being able to provide options for individuals so that they can really make the best choices for themselves is absolutely vital. So I am really thrilled that there's oral options moving forward.

Charles Schelle: 35:06

Throughout all of this, Dr. Kattakuzhy is careful to emphasize that science doesn't move in straight lines.

Sarah Kattakuzhy: 35:13

Every time we've said we have a solution for something, we know that there are new problems. That's part of how the prescription opioid overdose crisis came about, is that we said we have a cure for pain and it's these prescription opioids. We have to be cautious. But I do think one frame shift is that, most addictive disorders we consider chronic relapsing remitting conditions in the same way we would say diabetes or depression.

Charles Schelle: 35:41

Just as we're still learning how GLP-1s work for diabetes, heart disease, and weight loss, researchers are asking the same careful questions about their role in addiction.

Jena Frick: 36:00

The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB Office of Communications and Public Affairs production edited by Charles Schelle, marketing by Dana Rampolla.