Today, I review, link to, and excerpt from Addiction Medicine’s “#536 Q&Apalooza: Your Addiction Questions Answered!”*
*Kryzhanovskaya E, Morford K, Cohen S, Huxley-Reicher Z, Chan CA “#Q&Apalooza: Your Addiction Questions Answered!” The Curbsiders Addiction Medicine Podcast. https://thecurbsiders.com/addiction August 17th, 2026.
All that follows is from the above resource.
Link To YouTube Video when available.
Transcript available via YouTube
This episode explores complex questions around addiction treatment from our audience, including the off-label use of GLPs for SUDs, the nuances of naloxone, and managing high-dose methadone in hospital settings. Experts Drs. Shawn Cohen and Zina Huxley-Reicher, in addition to the co-hosts Drs. Carolyn Chan and Era Kryzhanovskaya share insights, resources, and practical tips for clinicians navigating these challenging scenarios.
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Production Partner: ACAAM
The Curbsiders Addiction Medicine Podcast are proud to partner with The American College of Addiction Medicine (ACAAM) to bring you this mini-series. ACAAM’s membership has grown to include a strong and expanding community of addiction medicine specialists, fellows, and trainees dedicated to advancing the field. Membership provides access to a wide range of educational resources, professional development, and a national network of colleagues. Learn more about ACAAM Membership here.
Show Segments
- Intro, disclaimer
- Picks of the Week
- Off-Label GLP use
- Naloxone review
- Acute pain in patients with opioid use disorder (OUD)
- Care Coordination with opioid treatment programs (OTPs)
- New medications for pain; suzetrigine
- Perioperative pain management for patients with OUD
- Outro
Q&A Pearls
- GLP-1 receptor agonists are not FDA-approved for alcohol use disorder (AUD), but emerging RCT data (particularly with semaglutide) suggest they may reduce drinks per drinking day, heavy drinking, and cravings—though they do not appear to promote abstinence. Consider them when overlapping indications exist (e.g., obesity or type 2 diabetes), and don’t forget first-line AUD medications (naltrexone, acamprosate, disulfiram) remain underutilized.
- The naloxone that works is the naloxone that’s available to treat an opioid overdose. Standard IM (0.4 mg) and intranasal (4 mg) formulations remain effective for opioid overdose reversal. Higher-dose formulations (8 mg, 10 mg intranasal) are FDA-approved but may be associated with more severe precipitated withdrawal without demonstrated superiority.
- Don’t stop medications for opioid use disorder (MOUD) when managing acute pain. Continue methadone and buprenorphine at stable doses during acute pain episodes and perioperatively. Stopping or tapering these medications creates an “opioid deficit” that can increase opioid requirements and risk of opioid withdrawal and return to opioid use. Use multimodal analgesia and add short-acting opioids as needed, recognizing patients with opioid tolerance will need higher doses.
- Avoid flumazenil for suspected benzodiazepine overdose. It increases the risk of seizures, arrhythmias, and other serious adverse events compared to placebo, particularly in patients with unknown history or benzodiazepine dependence. Supportive care (airway management, monitoring, oxygenation) is the mainstay.
- Suzetrigine is a first-in-class NaV1.8 inhibitor approved only for moderate to severe acute pain in adults, studied for up to 14 days in abdominoplasty and bunionectomy. There is no data for its use in patients with OUD, no data for chronic pain, and potential CYP3A4-mediated drug interactions with buprenorphine and methadone.
*Clinical Opiate Withdrawal Scale (COWS) is an 11-item tool used by clinicians to measure the severity of opioid withdrawal. [1, 2].
Q&Apalooza: Your Addiction Questions Answered! – Notes
GLP-1 Receptor Agonists for Alcohol Use Disorder
GLP-1 receptor agonists (GLP-1 RAs) act on the GI tract, pancreas, and brain. At higher doses used for obesity, they affect satiety and reward pathways, which may underlie their potential effects on alcohol consumption. Observational data from a Swedish national registry showed that semaglutide and liraglutide use were associated with reduced AUD hospitalizations (aHR 0.64 and 0.72, respectively) (Lähteenvuo 2024). VA data similarly demonstrated greater reductions in AUDIT-C scores among patients taking GLP-1 RAs compared to unexposed individuals and those taking DPP-4 inhibitors (Farokhnia 2025).
The first RCT of semaglutide for AUD (Hendershot 2025) tested low-dose semaglutide (up to 1 mg/week) in 48 non-treatment-seeking adults and found reduced laboratory alcohol self-administration, drinks per drinking day, heavy drinking, and weekly cravings—but did not reduce total drinking days. This suggests GLP-1 RAs may reduce consumption per occasion rather than promote abstinence. A subsequent larger RCT (Klausen 2026) of semaglutide 2.4 mg/week in 108 treatment-seeking patients with AUD and comorbid obesity showed significant reductions in heavy drinking days (the primary endpoint) and multiple secondary alcohol consumption measures.
RCT data for other SUDs (tobacco, opioid, cocaine use disorders) remain limited or unpublished. Multiple ongoing trials on clinicaltrials.gov are investigating semaglutide and tirzepatide across various SUDs.
