OBJECTIVES: Research has demonstrated a positive correlation between obesity and substance use disorder (SUD)/alcohol use disorder (AUD). Recently approved anti-obesity medications (AOM), have demonstrated efficacy in mitigating obesity. Nonetheless, research on the impact of AOM treatment on the incidence of SUD and AUD is limited. To investigate the effect of AOM utilization on the incidence of SUD and AUD in US patients with obesity.

METHODS: This retrospective cohort study used Kythera Medicaid data from January 2020 to August 2023. Two groups of obesity patients were identified: those using AOM and those not using AOM. Patients in the AOM cohort had at least one pharmacy claim for Ozempic, Wegovy, or Mounjaro during the identification period (January 1, 2021-August 31, 2022), and one claim for obesity in the baseline. The index date was the treatment initiation date for the medication in the AOM group. The presence of SUD and AUD was identified utilizing diagnosis codes at outpatient and inpatient visits. We examined sociodemographic factors, clinical factors, comorbidities unique to SUD or AUD, and SUD or AUD event rates. Propensity score matching was used for risk adjustment.

RESULTS: The AOM cohort had a lower incidence of SUD (9.36% vs. 13.13%, p=.0046), AUD (0.98% vs. 2.17%, p=.0224), and either SUD or AUD outcomes (9.89% vs. 14.24%, p=.0015) after adjusting for demographic, clinical, and comorbidity variables. Additionally, the AOM cohort had a significantly higher prevalence of anxiety (31.36% vs. 21.25%, p<.0001), depression (9.92% vs. 6.56%, p<.0001), bipolar disorder (5.11% vs. 3.29%, p<.0001), post-traumatic stress disorder (4.11% vs. 2.56%, p<.0001), and any SUD/AUD-related comorbidities (38.07% vs. 27.76%, p<.0001).

CONCLUSIONS: Given that the AOM cohort had a significantly lower incidence of SUD and AUD outcomes than the non-AOM cohort, AOMs may be effective in reducing SUD and AUD events among patients with obesity.