PITTSBURGH, PA — The Center for Addiction Science, Policy and Research (CASPR) and the Allegheny County Department of Human Services are preparing to launch a major $13.3 million randomized controlled trial to test whether weekly semaglutide, as an additional support to existing care, can reduce alcohol and opioid use and reduce criminal-justice involvement while improving employment, health, and housing outcomes among people at elevated risk of criminal-justice involvement.
Semaglutide (Ozempic, Wegovy) is a medication approved to treat type 2 diabetes and support weight management. Emerging evidence suggests that semaglutide reduces drinking in people with alcohol use disorder and cravings among people with opioid use disorder.
The multi-site study is expected to launch in early 2027 and will enroll up to 1,200 adults with alcohol use disorder, opioid use disorder, or both. Half of the participants will be randomly assigned to receive semaglutide weekly for 52 weeks, as an additional support, not as a replacement for traditional care.
The trial is funded through a $13.3M grant from Arnold Ventures to CASPR. University of Pittsburgh Medical Center (UPMC) Western Psychiatric Hospital, Addiction Medicine Services (AMS) will serve as the lead clinical site, along with other addiction treatment partners in Allegheny County.
“The trial is designed to be easy for other cities to adopt, if there is a positive outcome. Because this is a medication, rather than a complex program, if it works in Pittsburgh, it should work almost everywhere,” said Nicholas Reville, executive director and co-founder of CASPR.
Alex Jutca, Director of the Allegheny County Department of Human Services (DHS) said, “DHS has a longstanding commitment to using evidence to solve difficult social problems. This study is an opportunity to build on some promising early indications about the potential of GLP-1RAs while including those who might benefit most from these medications.”
“If this trial can show that we have a way to give people a better chance to recover, stay healthy, find employment, maintain stable housing, and prevent reinvolvement in the justice system (rearrest, reconviction, and reincarceration), we will have made a major advance."
“Research on GLP-1RAs and addiction show that they can often help restore personal agency. Rather than feeling dragged down by cravings, whether it’s for sugar, alcohol, or drugs, GLP-1s help quiet that noise for many people,” Reville said.
The study grew out of conversations between CASPR and Allegheny County about addiction, recidivism, and the county’s ability to connect health and criminal-justice data. The partnership combines clinical treatment, the county’s integrated data and social service partnerships, economic analysis, and addiction-policy expertise in a single randomized study.
“Despite the enormous personal and social impact of addiction, innovation in the field has not matched the scale of the problem. Local governments are often asked to respond to addiction without enough evidence about what works. This trial allows Allegheny County to help build that evidence”.
Jutca described how the collaboration began, “I was reading Nicholas’ addiction medicine blog two years ago and reached out to him. We started talking regularly about GLP-1s and addiction, recidivism, and the challenges that the County was facing. This concept for this trial emerged from those conversations.”
Reville said the partnership reflects a shared interest in practical changes that can improve outcomes across an entire system, “Alex is able to look across a complex system of operations and see opportunities for innovation that can improve results for the county while also saving money. We are natural collaborators because we’re both focused on finding solutions for addiction that have an impact at a population level.”
“The Allegheny County team and partners have shown national leadership in the push for new approaches and better evidence, which is extremely unusual for a county government,” Reville added.
The trial is structured to answer both a clinical question and a policy question. It will test whether semaglutide improves outcomes for participants, and whether those improvements are large enough to justify sustained public investment. Unlike most addiction medications trials, which primarily measure substance use, this study will use Allegheny County's linked administrative data to examine whether treatment improves real-world outcomes including employment, housing stability, health care utilization, and involvement with the criminal justice system. Because the intervention is a medicine that can be delivered through existing care, positive results could be more straightforward for other health systems and local governments to adopt than a new service program.
“This innovative trial examines the effectiveness and safety of GLP-1RAs and their impact on alcohol and opioid use disorder-related outcomes including employment, housing, health, and recidivism since drug use disorders are major drivers of criminal justice involvement and intersecting with systemic inequities and disparities. We as WPH AMS, the lead clinical site, are very much excited to partner with CASPR, Allegheny County Department of Human Services and other sites, on this trial which holds great promise to change the landscape of addiction treatment and recovery toolbox.” said Antoine Douaihy, MD Professor of Psychiatry and Medicine at the University of Pittsburgh School of Medicine, Senior Academic Director or AMS at Western Psychiatric Hospital.
The research team includes leading researchers from MIT, the University of Pittsburgh, the University of California San Diego, and UPMC Western Psychiatric Hospital (AMS), bringing together economists, addiction psychiatry specialists, and policy researchers to study the trial from every angle: clinical, economic, and behavioral.
“If the results of the trial are positive, we will consider this approach on an ongoing basis for individuals with substance use disorders and will work with other cities and counties across the country to disseminate our findings. This reflects the broader direction of our Allegheny Recovery Partnership, which aims to build a coordinated system of care that keeps people engaged in treatment over time. We believe new medications will become more valuable if we integrate them into systems that consistently support recovery,” said Jutca.
The research team will also examine health-care use and costs, housing instability, mental health, self-control and impulsivity, weight, and total fiscal and social costs. Allegheny County’s nation-leading administrative data infrastructure will allow the study to follow outcomes across systems and test whether any clinical benefit translates into greater stability for participants and lower costs for the public.
To participate in the trial, individuals must have alcohol or opioid use disorder and be clinically appropriate for GLP-1 medications. Additionally, trial recruitment will focus on individuals at risk of criminal justice-system involvement, reflecting DHS’s focus on targeting new innovations toward those with the greatest needs and commitment to reintegration and community safety. Once enrolled, participants will be randomly selected for once-weekly semaglutide in addition to standard addiction treatment. Participants will continue to be eligible for other behavioral health supports.
“We are working closely with community leaders and our partners so that trial participants are treated with respect throughout this process,” Jutca said. “We know addiction is widespread, but the costs are unequally distributed. We want to demonstrate that widening inclusion in medical research is important and possible while upholding high clinical and safety standards.”
The Allegheny County trial builds on international efforts to understand whether GLP-1 medications reduce drug and alcohol use among individuals with substance use disorders. This work includes phase 2 trials indicating decreased heavy drinking and opioid craving. [1]
The trial also supplements CASPR’s broader work to test GLP-1 medications for addiction and understand how reductions in craving affect recovery, employment, health, housing, and justice-system involvement.
“In our program with OpenDoors in RI, we provide semaglutide to women in a post-incarceration sober housing program. We’ve seen remarkable outcomes, with women describing drug dreams vanishing and a feeling better than they’ve ever felt in their life. Once that noise quiets down, they can rebuild their careers and their relationships with their families,” said Reville. The pilot program at OpenDoors has been covered by the New York Times , Washington Post , and other outlets.
Reville said GLP-1 medications may be especially impactful because many patients are already familiar with the drug class and are interested in receiving it, “GLP-1 medicines have the potential to be the most significant advancement in addiction medicine in decades, largely because they are so appealing to patients. This is a drug class that people with substance use disorders are eager and excited to take. That makes a sustainable population-level impact possible”.
The trial brings together the Allegheny County Department of Human Services, the Center for Addiction Science, Policy and Research (CASPR), UPMC Western Psychiatric Hospital, AMS and other addiction treatment partners in Allegheny County. The research team includes experts in addiction medicine, economics, and public policy from the Allegheny County Department of Human Services (Diana Martínez Heredia), MIT (Frank Schilbach and Dhruv Gaur), University of Pittsburgh (J. Travis Donahoe), University of California San Diego (Gordon Dahl), and UPMC Western Psychiatric Hospital, AMS (Antoine Douaihy).
The trial is funded through a $13.3M grant from Arnold Ventures to CASPR. CASPR is a research and policy organization focused on advancing breakthrough innovations in addiction medicine. CASPR has developed and published research with the VA, created and funded the first-ever pilot programs giving GLP-1RAs to patients receiving addiction treatment, and advances policy to enable faster medication development. CASPR’s programs have been covered in the New York Times , Washington Post , and many other publications . CASPR is funded by individuals and foundations and does not accept direct or indirect funding from pharmaceutical companies.
[1] See prior research: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00305-3/fulltext ; https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2829811 ;
https://www.statnews.com/2024/02/17/opioid-cravings-glp1-weight-loss-liraglutide-penn-state/.