Believe it or not, good news still exists! In fact, marvelous news concerning cravings that lead to, or are part of, addiction. I learned about new research that points to the possibility of reducing cravings for alcohol, smoking, food, stimulants and drugs all the way to gambling behavior – everything we associate with potential addiction and often catastrophic health effects, up to reduced life expectancy. Never mind societal disruption due to loss of productivity and increased crime (60% of all crimes are related to drugs or alcohol) to finance addiction.

My cravings need no further explanation….

There is this strange incongruity between the damage done to both individuals and society at large from addiction on the one side, and the lack of treatment(s) available or drug development aiming at fighting addiction, on the other side.

On the damage side of the ledger we have over 100.000 drug overdose deaths a year from addiction, and many, many more when you think about lung cancer from smoking, car accidents from drunk driving and obesity related heart and diabetes deaths that often involve cravings for too much or the wrong food. In fact the number of addiction-related deaths outweigh every other single cause of death. As a country we spend over 1.3 trillion dollars on the opioid crisis alone.

On the research side of the ledger, we have just a 0.5% investment of the pharmaceutical industry in the development of new anti-addiction drugs. Academic research into addiction is getting some support, but academia is not in the business of directly developing drugs, actual medicine that people can take. It seems odd that there is so much willingness to put money into drugs for cancer or diabetes, but not into fighting addiction, when so many more people suffer the consequences from their unquenchable cravings. Why would that be?

The answer is somewhat complicated, with many parts. For one, people all agree that many different causes can start the cravings: poverty, depression, anxiety, genetic susceptibility, traumatic life events. They can all lead to the use of cigarettes, alcohol or stronger drugs. Could there really be a happy pill that deals with all of these different root triggers? Likely not, is the popular assumption.

Secondly, there is still this somewhat puritan assumption that people lack will power and discipline. If they just put their minds to it and work hard, they could overcome the addiction. That is certainly true for some, benefitting from AA programs that foster this approach. But it is not realistic for a lot of people, particularly with synthetic drugs creating ever stronger physiological effects.

Third, don’t we have the war on drugs? Should that not be sufficient effort to curb overdoses for addicts? Well, it hasn’t worked for all of the programs’ existence and it is increasingly clear that you cannot stop drugs that are so small that they can be smuggled without detection no matter what: a single golf ball holds 8000 doses of fentanyl. You read that right. A sesame seed-sized dose of fentanyl will kill you. Also: don’t we have addiction treatments for users of hard drugs? Methadone, for example, and naloxone? The problem with methadone is the fact that it is hard to obtain and expensive, needs to be taken regularly at a particular site under observation, difficult to do if you are poor, have no transportation, can’t get off work. It also only works against the cravings while you are on it, and has terrible side effects.

Fourth, the pharma industry has been very reluctant to get engaged in addiction drug development for a number of reasons, not the least of it a worry about their reputation. Ever since it became clear that part of the industry created addiction with their pain medications, others in the industry do not want to seem like profiting off of addiction. More importantly, though, it is hard to run clinical trials with a population (of people living with addiction) that is unstable, prone to high drop-out rates and high suicide rates that could potentially (if falsely) be ascribed to the test drugs. It is also the case that the FDA has stringent criteria for green lighting new drugs which include demands for erasing a particular addiction completely (abstinence) rather than accepting modified behavior (less drinking, for example.)

All this against the backdrop of the fact that scientists have chanced on a weight loss drug’s craving-reducing effects, a drug that was developed to help with obesity and diabetes. You have by now heard of the brand Ozempic (Semiglutide) or Wegovy, which run under the tag of GLP-1 medications. People who were prescribed these drugs not only lost weight. They also experienced reduced cravings for other substances than food, and when researchers looked, for example, at a group of veterans who had been taking the drug and a comparison group that had not, the health differentials and life expectancy statistics were stunning. It reduced the rate of death by overdose by over 50% alone.

Importantly, the drug has almost no side effects, and a weekly injection works like a vaccine against cravings – of all kinds. So before you hit rock bottom or get sucked into the full cycle of addiction, this could be an intervention that would reduce your risk manifold.

By next year, it will reach generic status and can be sold internationally, helping hundreds of millions of people. People in the U.S. have become aware of the benefits of this drug to the point where they lie about their weight just to get hands on it, not for weight loss, but for curbing cravings that make their life miserable, given how much mental energy is spent (or wasted, more likely) in fighting substance abuse. Just think of all the lung cancer avoided if you quit smoking. Or the liver diseases disappearing if you can enjoy alcohol only in moderation. Or the family closeness restored when people do not turn their backs at members who are addicts, kids no longer losing their parents with alarming frequency to alcoholism or ODs.

The challenge is to find new molecules that target cravings specifically, and maintain the incidental benefits of the modern weight loss drugs: reducing inflammation of the brain and combating depression and anxiety. Approval policies will have to be adapted to the fact that we are talking about behavior modulation here, not a complete disappearance of consumption. People at the Center for Addiction Science, Policy, and Research (CASPR) are pursuing this project with palpable urgency. If you go to their website, you can see a cool summary of the main points promoting and challenging this project, in more detail.

There is even the suggestion that GLP-1 s can interfere with the development of Alzheimer’s Disease. Now there is good news. Says the person for whom losing her brain is one of the scariest scenarios, ever.

Music today is titled “On an overgrown Path” and “In the Mists”- two beautiful cycles of piano pieces by Leos Janáček that bring light into this week’s darkness, since there was not much good news overall with the inauguration of the coalition of creeps.

Bakery in Mexico City. Those were real cakes!