Addiction
GLP-1 Agonists for Seniors With Addiction
The role of the primary care provider in GLP-1 prescribing for seniors with addiction.
Posted July 7, 2026 Reviewed by Michelle Quirk
Key points
- Medicare expanded coverage of GLP-1 agonist medications for weight loss and other indications.
- While not specifically approved for this purpose, GLP-1 agonists show promise for addiction.
- Special considerations include risks of loss of bone density or muscle mass, as well as pancreatitis.
On July 1, 2026, Medicare launched the GLP-1 Bridge Program for Foundayo (orforglipron), Wegovy (semaglutide), and Zepbound (tirzepatide). For the next 18 months, the program flattens the price of these medications, which are commonly prescribed in primary care settings for weight loss, from an upward range of more than $1000 per month to just $50 per month. To be eligible, beneficiaries must have a body mass index (BMI) of at least 35, or 27-30 if they have another qualifying medical condition like diabetes or a history of heart attack or stroke. Nearly 4 million people are expected to meet criteria.
Absent from the list of qualifying conditions is addiction. But evidence for the use of GLP-1 agonist medications to treat substance use disorders is growing. Primary care providers should take note of the benefits as well as risks particular to patients 65 and older.
GLP-1 agonists, addiction, and seniors
The receptors for GLP-1 agonist medications are found in the brain as well as the gastrointestinal tract. In addition to promoting feelings of satiety in the gut, they also quiet food noise, or intrusive thoughts of food. This latter effect is mediated by modulation of dopamine reward pathways in the brain. That same mechanism seems to allow the medications to attenuate cravings for alcohol and other drugs.
Adults 65 and older are using substances at alarming rates, with alcohol use disorder, cannabis use disorder, and opioid use disorder on the rise in this population. Meanwhile, smoking, which is on the downslope for the general population, is stagnating in seniors.
Loneliness, the COVID-19 pandemic, chronic pain, and generational attitudes toward substance use have all been cited as risk factors for substance use among older adults.
Seniors may be more vulnerable to adverse effects of GLP-1s
As all primary care providers know, body composition changes with aging. Total body water decreases, as do muscle mass and bone density. GLP-1 agonists can suppress thirst as well as appetite, and the drive to hydrate tends to diminish in the elderly even without these medications on board. GLP-1s can thus set the stage for dehydration and acute kidney injury. Many of the studies on GLP-1 agonists excluded elderly patients with impaired kidney function. Seniors should be counseled on the importance of hydration before starting these medications.
Loss of muscle alongside fat has been commonly observed with GLP-1 agonists. Dietary counseling for seniors should emphasize maintaining a daily protein intake of 1.2-1.6 grams of protein per kilogram of body weight. Tailored resistance exercise is also recommended. Primary care providers should ensure patients are up to date on their bone density (DEXA) scans and treat osteoporosis or osteopenia with a high estimated fracture risk (FRAX score). Review recommendations for calcium, vitamin D, and weight-bearing exercise. Also consider titrating the dose of the GLP-1 more slowly than with younger patients, as rapid weight loss may pose a greater risk.
Cholesterol also tends to increase with aging, as metabolism slows. Primary care providers routinely perform lipid screenings and should pay special attention to triglyceride levels, especially when anticipating starting a GLP-1 agonist for a patient with alcohol use disorder. While the GLP-1 may decrease the patient's desire to drink, this class of medications also carries a warning for pancreatitis. Significantly elevated triglyceride levels, too, increase pancreatitis risk. Consider checking pancreatic enzymes before starting a GLP-1 in a patient with high triglycerides, and monitor lipid panels closely while prescribing appropriate cholesterol-lowering medications.
Weighing additional considerations
It is important to note that GLP-1 agonists are not approved by the U.S. Food and Drug Administration (FDA) for addiction treatment. Numerous on-label options exist, such as naltrexone for alcohol use disorder, buprenorphine products for opioid use disorder, and varenicline for smoking cessation.
At the same time, minimizing polypharmacy is a priority in the elderly population. If an older patient meets criteria for a GLP-1 agent based on their BMI, heart disease history, diabetes, or another condition, plus they are experiencing addiction, the primary care provider may wisely choose to prescribe the GLP-1 rather than two separate drugs.
Moreover, cannabis use disorder lacks an FDA-approved pharmacotherapy. While gabapentin has off-label evidence, it poses risks of sedation and falls in seniors. A GLP-1 agonist may be the safer option.
As with any medication that treats a chronic condition associated with aging, older people may both be more likely to meet criteria for GLP-1 agonists and more susceptible to their potential adverse effects. Primary care providers, who know their patients’ history and collect regular screening and diagnostic studies, play a vital role in weighing the risks and benefits of these medications.
