Naltrexone Is the Ozempic for Alcoholism

Naloxone (Narcan), naltrexone (Trexan; ReVia), and Vivitrol (long-acting injectable naltrexone) changed addiction medicine into a profession with FDA-approved treatments for opioid overdose reversal, opioid use disorder (OUD), and alcohol use disorder (AUD). Yet few patients received prescriptions, and fewer took their medications. Yet so many need treatment: The CDC reports that 29.5 million met AUD criteria in the past year. It is generally assumed that the shockingly low treatment rate is due to stigma, physicians' fears about treating addictions, and ignorance. Yet maybe something else is at work. The stunning recent successes of GLP-1 medications like Ozempic for type 2 diabetes argue that other underlying factors may be responsible.

Here's what I think: Obesity was stigmatized for decades, and most physicians didn’t treat this disorder, other than telling patients to diet, until GLP-1 drugs like Ozempic arrived on the scene. Similarly, online health services are providing naltrexone to people wishing to manage alcohol issues.

NIDA and NIAAA Experts Blame M.D.s and Treatment Programs

Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA), and Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), have expressed concern over the underutilization of FDA-approved medications, like naltrexone, for treating AUD. They argue, despite the clear efficacy of these medications, most physicians and treatment programs don’t incorporate them into patient care.

Koob emphasized that < 2% of individuals with AUD receive pharmacological treatment, despite the availability of effective medications. Attributing this gap partly to stigma and also to a lack of physician engagement, he has pointed out that many doctors hesitate to screen for and treat AUD, leading to patients being unaware of effective medication options. Koob challenged focusing on abstinence, promoted by programs like Alcoholics Anonymous (AA), and suggested new treatment goals, including drinking less, reducing binge drinking, and overall harm reduction, could enhance patient engagement and outcomes.

In a 2022 blog post, Volkow emphasized the need for a pragmatic approach to addiction treatment, stating, “the perfect should not be the enemy of the good.” She highlighted that only 13% of individuals with drug use disorders receive any treatment, advocating for reduced substance use, not just complete abstinence.

The problem is that we have been trying to do this since I first gave naltrexone at Yale in 1975. (See my blog post.)

Rather than blaming physicians, treatment programs, or patients themselves, those advocating for naltrexone might consider the recent online successes of drugs like Ozempic for diabetes and weight loss or Viagra for erectile dysfunction: capturing the public’s interest in the benefits of these drugs. When the public learned Ozempic often resulted in significant weight loss, they clamored for access.

Patient Access to Naltrexone

Some companies provide online access to naltrexone. For example, Oar Health supports abstinence and moderation goals, allowing individuals to choose their preferred path. They advertise, “Drink less or stop drinking entirely with medication delivered directly to your door.”

Oar Health was launched in January 2021 by former health care executive Jonathan Hunt-Glassman after his 15-year struggle with alcohol misuse was changed by naltrexone. This medication helped him reduce alcohol consumption. He founded Oar Health to increase access to effective, medication-assisted treatment. The company adopted successful models used to treat other diseases characterized by shame and stigma, using direct-to-consumer advertising.

Oar Health launched a national television advertising campaign in July 2024. This initiative led to a 150% increase in monthly growth. Oar Health was incubated by NewCo, a startup incubator backed by IAC/InterActiveCorp. In 2021, IAC investment was not disclosed but was likely < $10 million, facilitating its growth and development.

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IAC has a history of incubating and scaling companies across various sectors, including media, technology, and consumer services. Notable ventures that emerged from IAC include Match Group (which owns Tinder and Match.com), Vimeo, and Angi Inc. (formerly Angie’s List).

Oar Health operates a direct-to-consumer program that is heavily advertised to consumers. This telehealth model closely resembles business structures used by companies offering medications like Viagra (sildenafil) for erectile dysfunction and semaglutides like Ozempic for weight loss. Like these companies, Oar Health provides an online platform allowing patients to receive medical evaluations and prescriptions without visiting a physical clinic or pharmacy.

Patients complete an intake assessment and are connected with licensed clinicians. If they are prescribed naltrexone, it is discreetly shipped to their homes. The company policy is to only prescribe naltrexone to patients who meet AUD criteria through this subscription-based service that includes medication delivery, ongoing clinical support, and coaching for managing drinking goals. This mirrors the approach used by Hims/Hers and Ro (for ED treatments) and Calibrate, Found, and Sequence (for GLP-1 weight-loss therapies), providing streamlined, convenient, and stigma-sensitive health care.

Stigma Reduction

One of the most distinctive traits these companies delivering very different medications share is their reframing of stigma and behavioral goals. For example, Oar Health targets individuals who meet clinical criteria for alcohol use disorder and believe alcohol is interfering with their health, productivity, or happiness. The company’s core message is that you don’t need to hit “rock bottom” to seek help.

Oar emphasizes empowerment and destigmatization, framing alcohol reduction as a personal health choice rather than emphasizing alcohol use disorder as a sign of dependency or failure. Similarly, ED platforms focus on younger men dealing with performance concerns, reframing erectile dysfunction as a quality-of-life issue rather than just an older man’s treatment for an ordinary men’s health problem. GLP-1 telehealth weight-loss platforms using semaglutide promote their services as health-optimization tools, emphasizing the health benefits of weight loss, such as diabetes prevention and cardiovascular health, more than appearance, rather than vanity solutions. These companies heavily invest in digital marketing—SEO, social media, influencer partnerships—to acquire customers and normalize treatment for previously stigmatized conditions.

In all cases, the tele-platform’s success depends on removing shame associated with seeking help and offering a fast track toward lifestyle improvement that feels accessible and affirming. Jonathan Hunt-Glassman's LinkedIn post states, "We recently eclipsed 50,000 members served, but we're not stopping until everyone who needs it has access to safe, effective medication that can help them drink less or quit. "

Concerns About Telehealth Platforms

Telehealth platforms face similar scrutiny, such as concerns about overprescribing or inadequate screening. Some AUD experts worry about psychiatric and medical comorbidities present in online patients and continuity of care, especially for chronic conditions. Others fear drinking less is a "pyrrhic victory," increasing risks and delaying the inevitable. As with most digital health prescribers, there are regulatory questions from government agencies like the FDA, FTC, and state medical boards about marketing practices and clinical rigor.

Naltrexone or GLP-1s for AUD?

GLP-1s have also been studied as a possible treatment medication for AUD. Very recent research findings are encouraging. In a randomized clinical trial, low-dose semaglutide injected once a week reduced the amount of alcohol consumed. Over nine weeks, semaglutide led to reductions in some measures of weekly alcohol consumption and significantly reduced weekly alcohol craving relative to placebo.

Summary

Naltrexone has long been a wonder drug in search of physicians willing to prescribe it and patients willing to take it. So few patients took it daily that a 30-day injectable form was invented. AUD stigma is often ignored, leading to patients' denial and waiting too long to ask for help. Naltrexone might have been a wonder drug for researchers, but patients themselves have never heard about it at all.

Telehealth platforms following a playbook for financial success must educate consumers and make it relatively easy to obtain the medication without shame and stigma at the doctor's office or pharmacy. If they can also retain patients and encourage continued compliance, this approach may mean new hope for naltrexone and changing the AUD treatment paradigm. More studies are necessary in AUD, but GLP-1 medications might have better patient adherence than naltrexone.