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When I got Sarah Zhang on the line, I

0:49

asked her to tell me the story of Victoria

0:51

Rutledge. Yeah, so Victoria

0:53

is someone who has always thought of herself

0:56

as someone with an addictive personality. Sarah

0:59

covers science and medicine for The Atlantic.

1:02

You know, the example she gave me is

1:04

that she had been addicted to alcohol

1:06

when she was younger and she had gotten sober, but

1:09

sort of had kind of replaced her addiction with to

1:11

alcohol with food and shopping. Like

1:14

she told me that she would spend something like $500 on

1:17

groceries every two weeks.

1:19

Victoria would buy so much food that

1:21

it would rot in her fridge. If

1:23

she went to Target to run an errand, she'd

1:25

find herself compulsively buying one thing

1:28

after another, unable to stop.

1:30

Just like start throwing candles or

1:32

like makeup or skin care into her cart,

1:34

even though she didn't really need it, but she just she saw

1:37

it. She just like really needed to do

1:39

that.

1:40

Then a few months ago, Victoria

1:42

started taking semaglutide for weight loss.

1:45

That's the medication sold under the brand

1:47

names Ozempic and Wegovy. There's

1:49

also Munjaro, which is slightly different

1:51

but has similar effects.

1:54

When Victoria went on semaglutide, she

1:57

lost weight, but something else

1:59

started to happen. Something she noticed

2:01

on one of those errand runs. She

2:04

just walked out of Target one day, she told me, and

2:06

she realized, oh hey, like, my

2:09

cart, like, I didn't buy anything I didn't need to. I

2:11

only got the things I wanted. Like, what's

2:13

going on? So it was almost like a switch

2:16

had flipped in her brain where she was no

2:18

longer addicted to shopping, and she realized, oh,

2:20

of course, she hadn't been buying all this food either.

2:23

But just like this kind of like addictive,

2:26

compulsive habits that she had had her entire life

2:28

had kind of gone away. Today

2:34

on the show, could Ozempic,

2:36

and the drugs like it, actually help fight

2:38

addiction? Sarah walks

2:41

us through the promise and the big unknowns. I'm

2:44

Lizzie O'Leary, and you're listening to What Next

2:46

TBD? A show about technology,

2:49

power, and how the future will be determined. Stick

2:51

around.

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4:08

If you've heard of Ozempic or semaglutide,

4:11

you may have heard about how it makes you skinny.

4:13

Hollywood predictably loves

4:16

it, celebrities are taking it, and

4:18

it's used off-label by people trying

4:20

to lose weight. You want Ozempic? Yeah.

4:21

What housewife isn't on Ozempic?

4:24

Not one. Yeah, no, not one. Half

4:27

your cast. I know. I wasn't

4:29

going to come to Reunion looking any bigger than anyone

4:31

else, so... Despite the

4:33

intense real housewife interest, Ozempic

4:36

and Munjaro are only approved by

4:38

the FDA to treat diabetes. Wigovie

4:41

is also approved for weight loss.

4:44

All these medications were initially developed

4:46

for diabetes management.

4:48

I asked Sarah to walk me through how semaglutide

4:50

works. It was originally developed

4:53

to help regulate insulin, so

4:55

we know that it acts on the pancreas so that

4:58

people who have diabetes are able to help regulate

5:00

their blood sugar. And so in those initial

5:02

trials, researchers realized, oh,

5:04

well, people with diabetes who are taking this, they're

5:07

also losing weight, which is

5:09

usually not an unwelcome side effect. So

5:11

then it kind of became repurposed as a weight loss

5:13

drug. In the past couple years, we've

5:15

seen this really explode in popularity

5:18

as a weight loss drug. In those same

5:21

trials, researchers also noticed

5:23

that people were becoming

5:25

less interested in alcohol, just

5:27

anecdotally people were reporting they become

5:29

less interested in alcohol or people

5:32

who spontaneously quit smoking. I mean,

5:34

think about how hard it is to quit smoking and kind

5:36

of just like one day out of the blue realize, oh, I

5:38

have stopped smoking. And so this anecdotal

5:40

report's kind of also really informed

5:43

a lot of the kind of early interest in

5:45

testing in animals to see whether this

5:47

could actually be something that

5:49

goes beyond just diabetes and weight loss.

5:52

Patients say that addictive urges are

5:54

quieted when they're on these drugs. But

5:57

exactly how they work is still a

5:59

little bit. bit mysterious.

6:01

A lot of times in medicine

6:03

we see a drug has as a fact.

6:05

We don't really know how it works. But

6:08

you can sort of see why there are parallels,

6:10

right? Some people with obesity,

6:13

it's maybe because they have a compulsive

6:15

relationship with food. Some patients I've

6:17

talked to who've taken Ozempec for weight loss,

6:20

they've talked about how they just constantly have

6:22

this food noise in their head. They'll wake up

6:24

in the morning and be like, oh, what should I have for breakfast? What

6:26

should I have for dinner? What should I have for lunch? Should

6:29

it be Mexican? Should it be Chinese? And

6:31

once they've been on the drug, that kind of

6:33

chatter just totally quieted down. It's

6:36

almost like this sense of calm in their brains. And

6:38

you can imagine that might be true for someone

6:40

with addiction to drugs or alcohol

6:43

as well.

6:44

Well, what's the mechanism through which

6:46

they work? They act on the dopamine receptors?

6:48

Is that right?

6:49

So the short answer is we don't really know. But

6:51

we do have a pretty clear sense that these drugs

6:54

are acting on the brain directly. We know that

6:56

they can kind of enter the bloodstream

6:58

and then actually act on the brain. And

7:00

there are receptors that can directly

7:02

attach to the brain. And it seems to be

7:05

related to the reward

7:07

circuit in the brain, which is where dopamine

7:09

gets involved. I think dopamine sort of commonly

7:11

gets short-handed as the pleasure molecule.

7:13

Or you do something that

7:16

feels good and there's a square of dopamine in

7:18

your brain. It's definitely a little bit more complicated

7:20

than that. Another way to think about it is that

7:22

there's actually a distinction between wanting

7:25

to do something and liking

7:27

it or taking pleasure in it when you actually do it.

7:29

And, you know, nail biting may

7:31

actually be a very good example of this. You know, you might feel

7:34

like you really, really want to do it even though biting

7:36

your nails is not exactly something any

7:38

of us really thinks of as pleasurable. And

7:40

so actually it seems there's some evidence

7:43

now that's just that maybe dopamine is really more

7:46

involved in the wanting rather than the liking.

7:49

And

7:49

so maybe if you're acting on this kind

7:51

of circuit in the brain, what you're tamping down on

7:54

is the wanting to do things. You know, wanting

7:56

to keep eating, wanting to drink, wanting to bite

7:58

your nails, even

7:59

So it does not necessarily affect whether

8:02

you're able to take pleasure things or take pleasure on life.

8:04

Yeah, I was with a couple of

8:06

people on Ozempic not too long

8:08

ago and they just described

8:10

like, nah, I don't really want to eat.

8:13

Like, nah, I don't want that glass of wine.

8:15

Like it just

8:16

seemed to be switched off.

8:18

Yeah, I think it sort of really hits

8:21

at like how strange it feels that like

8:23

a chemical can alter

8:25

your behavior and your desire and your wants

8:28

and your appetite so much. I think, you know,

8:30

we sometimes think like to think we are who we are

8:32

and like, unlike a metaphysical

8:34

level. But really, we're also, you know,

8:37

we're also biology and chemistry and

8:40

this chemical could really alter just

8:42

how you act and behave.

8:44

Semaglutide as an addiction drug might

8:46

sound strange,

8:47

but there is a growing body of research on

8:50

animals that seems to show this

8:52

class of drugs can change behavior.

8:55

So semaglutide, it belongs to a class

8:57

of drugs called GLP-1. They kind of

8:59

mimic a hormone called GLP-1

9:01

in the human body. And so semaglutide

9:04

is kind of like the second generation of these drugs,

9:06

but the first generation has been around for

9:08

a while. So a lot of the early research

9:10

is the animal research has kind of been in that

9:13

first generation of drugs. One

9:15

of them is sexenda, which people may also

9:17

know is a drug that sometimes would prescribe overweight

9:19

loss and Ozumpic or semaglutide

9:23

is like a newer and improved

9:25

and possibly more effective version of that.

9:28

And so in these original trials, you know,

9:30

even before semaglutide came along, but with these earlier

9:33

drugs, you know, researchers

9:35

were already noticing that people were reporting that

9:37

they were less interested in drinking.

9:40

And so, yeah, that's when people that's when

9:42

they're like, hey, well, let's try taking this into

9:44

a lab and studying this isolated

9:46

behavior. And so, you know,

9:49

there are various ways you can study this.

9:51

You can sort of see, you know,

9:53

if you have basically

9:55

like rats hooked up to like a cocaine

9:58

injection like and you.

9:59

give them this drug that's that alter

10:02

their cocaine-seeking behavior that

10:04

does seem to. One

10:06

researcher I talked to, he ended up studying

10:08

these monkeys on an island

10:10

in the Caribbean. Some of these monkeys

10:12

sort of just naturally seem genetically

10:15

predisposed to really, really loving alcohol.

10:17

Originally, you might think this is rotting fruits,

10:19

but like this is being a Caribbean island, it's

10:22

like onto the point where they like they steal tourists' alcoholic

10:24

drinks. Oh, they like go swipe somebody's rum?

10:27

Yes, yes, exactly. This

10:30

is like an interesting population to study if you're

10:32

trying to study alcoholism, right? So

10:34

he studied these monkeys and said like, hey, if you give them a drug

10:37

that is similar to semiclutide, that's also

10:39

curb their drinking behavior and it seems to do that

10:41

as well. Again, these are all

10:43

in animals, so that's not humans.

10:47

But this and all of these anecdotal reports

10:49

are together now sort of point to an interesting

10:51

direction.

10:52

You were one of the first journalists to

10:54

write about this. As

10:57

you were piecing it together, were bells

11:00

going off in your head?

11:02

I think it was. And I think that's because

11:05

these anecdotes are so compelling. And a

11:07

lot of times as a journalist,

11:09

you often see people saying, oh, like,

11:11

you know, this great thing happened to me when I did this,

11:13

but like, how do you know whether it's caused like, did

11:15

it actually cause that or not? But the fact

11:18

that scientists had actually been studying this for

11:20

a long time, that made me think, well, there really

11:22

is a story here. This isn't just, you know,

11:24

people noticing things and like attributing it to

11:27

a drug that they start taking. It's like, yeah,

11:29

yeah, there's probably something going on. And

11:31

there's

11:32

a real community of researchers who are really

11:34

interested in studying whether this

11:36

drug really does have an effect as an addiction drug.

11:44

When we come back, if an injection

11:46

can fight addiction, does that change

11:49

our understanding of it?

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14:41

While research on animals and semaglutide

14:43

has been going on for years, human

14:45

trials are just starting to take off.

14:48

I know of at least two trials, one for smoking

14:50

and one for alcohol. There have been

14:53

a couple of really, really small studies

14:55

in humans, not of Ozempic

14:58

particularly, but of sort of the earlier generation

15:00

of drugs, studying that and addiction.

15:03

They're so small, like literally like five people,

15:06

that they're pretty inconclusive. There's

15:08

another study with alcohol, actually, which showed that

15:11

when people with alcohol use

15:13

disorder, when they were

15:16

shown pictures of alcohol and

15:18

they were on one of these drugs,

15:21

the reward centers in their brains

15:23

did not light up as much as they normally would. So

15:25

this kind of seems like maybe they were getting,

15:28

you know, kind of less wanting. Researchers

15:30

put people in an FRMI machine and showed them

15:32

pictures of alcohol. In functional MRI

15:34

machines, so they can see what's happening in

15:36

their brain. Yeah, so looking at brain activity

15:38

and saying like, what kind of brain activity do you have when

15:40

we show you a picture of a martini or

15:42

something? And people who have alcohol

15:45

use disorder, like you can imagine that part

15:47

of their brain lights up when they see

15:48

pictures of alcohol. When

15:50

they found that if you gave them, you know,

15:52

one of these drugs, that part of their

15:54

brain that is like, oh, alcohol, like

15:57

that seemed to have been quieted. What

16:00

was sort of interesting about that study though is that

16:02

once you looked at whether people actually changed their behavior,

16:05

it did not seem like on

16:07

a whole that people started drinking

16:09

less. But they found that

16:11

a subset of people who had obesity started

16:14

drinking less. They're unlikely

16:16

to be a panacea. They're unlikely to be a cure-all

16:18

that works for everyone. But it's possible

16:20

that there's a subset of people for whom it works really

16:23

well for. That might depend on,

16:25

for example, why someone needed to develop

16:27

a prediction in the first place.

16:29

I mean, one of the things I find so interesting is that

16:31

there are drugs that have

16:34

been developed and tailored toward

16:36

fighting addiction in very specific ways, whether

16:38

we're talking about nicotine or alcohol or whatever. And

16:41

this seems to be more broad-based.

16:44

And that's how you end up

16:46

with these anecdotes that you've described where

16:48

people sort of notice, oh, by the

16:50

way, I want this other thing less.

16:53

Yes, exactly, right? A lot of the addiction

16:55

treatments out there are kind of very specific to the

16:58

type of addiction that they're treating. So

17:00

like an opioid can maybe be specific

17:02

to blocking the action of opioid

17:05

receptors. What

17:07

the Zumpaq or some like Lutide seems to do

17:09

is it seems to kind of be like

17:11

a higher layer of abstraction. It just seems

17:13

to curb the wanting in

17:15

general. And that seems to generalize across

17:18

lots of different behaviors and lots of different substances,

17:21

which is really fascinating, I think, for addiction

17:23

researchers

17:23

who are like in

17:28

this space. That's also exactly what is

17:30

so promising and interesting about this

17:32

drug. Is there a similar

17:35

dulling of other wants,

17:37

desires, and loves, or

17:40

is it just for this specific

17:43

kind of craving?

17:44

Yeah, that was the sort of burning

17:47

question I had going into reporting

17:50

this. And from people I talked to,

17:52

they said, no, I can still enjoy

17:54

other things in life. I still enjoy going

17:56

out with my friends. I still enjoy interacting with

17:59

my kids. It's not like I'm sitting

18:01

around in the press and just have

18:03

to take no pleasure in life anymore. What

18:05

it really seems to do is kind of tamp

18:07

down those behaviors,

18:10

those addictions that had become compulsive

18:12

to a level that was really affecting

18:14

their lives. And so instead of having

18:16

this constant feeling of like, oh,

18:19

I need to think about that loo-loo-loo lemon

18:21

drop next week, or I need to like, what

18:24

am I going to eat for dinner? Do I want Mexican

18:26

or I want tacos? Sort

18:28

of that like, that constant

18:29

chatter, that almost distraction

18:32

really, people talk about it as a distraction. That

18:34

distraction goes away and instead they're

18:36

able to kind of be more present

18:38

in what they're actually doing and what's in

18:40

front of them.

18:42

This quote unquote noise in people's heads

18:44

has led to speculation about what else

18:47

Ozempic could potentially treat.

18:49

On TikTok, naturally, people are speculating

18:51

about using it for ADHD. When

18:54

starting Ozempic, I would say about two months

18:56

in, things really changed for me. The first two months,

18:59

I think it was like my body was getting used to it. But

19:01

after two months, I found that my

19:04

brain fog is basically non-existent.

19:06

The amount of clarity I have in my mind is unreal.

19:09

Obviously, it's not a cure for ADHD, but

19:11

it is kind of helping with some of the things that you struggle

19:14

with with ADHD. What's

19:15

really interesting is that I did

19:19

not think about ADHD when I was originally writing

19:21

this piece, but several of the people I

19:23

talked to kind of unprompted told me they had

19:25

ADHD. And then after I wrote the story,

19:28

several readers reached out to me saying, like, hey, you

19:30

know, these things you're talking about, that sounds like ADHD. I

19:32

wonder if this would work for ADHD. And

19:36

I think that's really fascinating. As far as I know,

19:38

this was not something on the radar

19:40

of ADHD researchers. But

19:42

it does seem to be that there's something, you know,

19:45

when we

19:45

want something, like there's something about

19:48

that being the focus or attention. You

19:51

can think that something that kind of takes away

19:53

your attention or shifts your attention might

19:56

also work for ADHD.

19:58

This all sounds incredible.

19:59

promising and yet, you

20:02

know, with every

20:03

story that I have done on these drugs

20:05

or every piece that I've read,

20:08

the side effects can be pretty intense.

20:10

Vomiting, digestive upset, headaches.

20:14

That's what

20:16

we seem to know about the short term.

20:19

Is there any information

20:22

about the long term or

20:24

will we wake up in five years and

20:26

learn it then? No,

20:28

we really don't know. I mean,

20:30

as you're saying, like we know what happens in the short

20:32

term, but these drugs, they haven't been a long

20:35

round for that long. You know, these are

20:37

certainly for diabetes and weight loss, these are drugs that

20:39

we're thinking people might need to take for the rest of

20:41

their lives. So you can imagine, you know,

20:44

taking over 30, 40, 50. There's talk of giving

20:47

it to teens. So, you know, if

20:49

it works in the future, you're taking it for like decades.

20:52

And we really don't know simply because these

20:54

drugs have not been around for decades. What

20:57

we do know is that

20:58

when people take this for weight

21:00

loss, at least, once they stop

21:02

taking the drug, and of course, this is we're talking

21:05

about the scale of months or years, we're not talking about the scale

21:07

of decades, but if you've been taking this drug for like months

21:09

or years and you stop taking it, the effects

21:11

actually do go away pretty quickly, right? People,

21:13

their appetite comes back. Most

21:15

people regain the way that they lost. So,

21:18

you know, there's definitely some short

21:20

term effects that can be

21:23

reversed pretty quickly. We can even

21:25

move in what we currently know, but if we're talking about

21:27

decades, no, we don't know what's going to happen.

21:30

Is anyone prescribing this off-label

21:32

for various addiction

21:34

disorders now? That's a good

21:37

question. I have not heard of anyone doing

21:39

that specifically, but I

21:41

think it's really been in the fast, powerful

21:43

months that even the awareness of this drug being

21:45

possibly used for addiction has really gone up.

21:48

So I don't know. It's possible,

21:50

you know, there's a shortage of the drug. It's

21:52

so hard for so many people to get a hold of it, but

21:56

yeah, who knows? You know, you can prescribe anything

21:58

off-label. I think the...

21:59

the challenge is getting

22:02

hold of it or in most cases paying

22:04

for it if insurance is not covering it. Because it's

22:06

not always covered by insurance. No, in fact,

22:08

most of the times it's not. And if you're prescribing

22:10

an off-label, it's definitely not being covered by insurance.

22:13

In addition, it can be hard to

22:15

get semaglutide even if you are

22:17

prescribed it for diabetes. Because

22:19

it's so popular for off-label use, there

22:22

are nationwide shortages.

22:24

Plus, not everyone on the drug

22:26

experiences the anti-addictive effects.

22:29

It's unclear exactly what differentiates

22:31

the people who do.

22:33

Yeah, we don't know the answer. But

22:35

I asked one of the researchers I talked to to kind of

22:37

speculate a little bit about like, oh, who might

22:39

this work for? Who might? It doesn't. And he sort

22:41

of gave the example that, think

22:43

about alcohol. Maybe some people are drinking

22:46

alcohol because they're self-medicating

22:48

for something else. Maybe it's really they have social anxiety

22:50

and that's why they're drinking alcohol. Maybe

22:52

some people are drinking alcohol because they

22:55

are genetically predisposed to kind

22:57

of take a lot of pleasure

22:59

from alcohol. Their brains are just wired that

23:01

way. You could imagine that this drug

23:03

might work better for that second group who'd kind

23:05

of have this predisposition to really want

23:07

alcohol. Their

23:10

brains are just wired to want alcohol. You

23:13

might imagine this drug might work better than for people

23:15

who are drinking for reasons such

23:17

as masking social anxiety. But the

23:20

bottom line is we don't really know. And

23:22

maybe in a few years' time, we'll have a better answer. It

23:25

could be that if you're someone who has

23:28

a lot of different kind of compulsive behaviors that

23:30

underlies many things in life, that this

23:33

might be

23:33

something that might be more effective for you than

23:35

someone who just has only alcohol

23:38

because for various reasons, that's

23:40

the addiction that you happen to develop. Kaitlin Luna

23:42

One of the things I find so fascinating, just

23:45

like spitting out to the slightly more

23:47

theoretical realm here, is like both the

23:49

potential for addiction treatment, but also

23:51

like

23:52

what that means. I mean, I feel

23:54

like in the past 30 years or so, society

23:58

has made big.

24:00

leaps and bounds in our understanding of various

24:03

addictions or thinking about them as

24:06

chronic health issues and

24:08

disease. What

24:11

happens and what meaning does it impart

24:13

if a shot can just make that go

24:16

away?

24:17

Yeah, I think it's really similar

24:20

with obesity as well, right? The idea that

24:22

these conditions that

24:25

there's often like a moral valence to them. It's

24:27

like it's a matter of willpower. Yes. A

24:30

matter of being able to morality.

24:32

But we're finding that really it's also

24:34

just a matter of brain chemistry. I think

24:37

for addiction researchers who've been studying this for a long

24:39

time, they really hope that the fact that this

24:41

drug can have such

24:43

a remarkable effect on behavior kind of takes

24:46

away a little bit of the stigma of addiction

24:47

because it really is a biochemical

24:50

condition and not just a matter of

24:52

willpower. You know, people I

24:55

talk to who've been on the

24:57

drug and have just seen not only has

24:59

it changed their weight loss but also their other

25:01

habits such as picking their skin or

25:04

addictions to drugs. They've told me that it has

25:07

helped them give them a little bit more grace

25:09

for themselves because they kind of had beat

25:11

themselves up their whole lives about these

25:14

things that they couldn't really control and they realized,

25:16

oh, actually it was just out of my control.

25:17

Now I'm taking this drug and it

25:19

has just completely changed my

25:22

life.

25:23

I was talking after I read your

25:25

piece to someone in my life

25:27

from close to who has a substance

25:29

use disorder and is sober now

25:32

and he basically said, like, yes, sign me up. Like,

25:34

if I could do this, that would be amazing.

25:37

And then said, on the one hand,

25:39

it feels like a shortcut to, you

25:41

know, sort of skipping the work.

25:43

But also, you know, if it

25:45

gets you there and it gets you safer,

25:48

then great. You know, it's so interesting.

25:50

I feel like a lot of people I've talked to not only with this

25:54

sort of starting it is a shortcut, but often

25:56

talk about even though doctors say this is

25:58

a lifelong drug, there's often

25:59

quite of a resistance about really

26:02

thinking about it as a lifelong drug. Quite

26:04

a few people I talked to say, hey, I want to use

26:07

this drug to help me build better habits, but then I

26:09

just want to get off of it and kind of keep

26:11

those habits. Not unlike antidepressants.

26:13

Yes, yes. Like, right, thinking

26:15

of this drug as like a bridge rather

26:17

than something you might have to take lifelong. Whereas,

26:19

you know, I think a lot of doctors would say, no, this

26:22

is probably a drug you're going to have to take, at least when it

26:24

comes to weight loss of a drug you're going to have to take for

26:26

the rest of your lives. Yeah, and I think there is

26:28

a lot of still, you know, as you say, a

26:29

kind of resistance to this idea that, oh,

26:32

a drug can like make you skip

26:34

all of that hard work. But I think we're

26:36

all we're also finding, and certainly I really

26:39

felt this when I started talking to people, is that

26:42

our brains are all really different. It's like hard

26:44

for us to know what it's like to live inside

26:47

the mind of someone else. And

26:49

sure, it's like, you know, if for

26:51

an ordinary person. So,

26:53

you know, one thing that I've heard a lot is people will

26:55

say, oh, man, like, I've gotten a

26:58

zen bag and like I used to be someone who thought about food

27:00

all the time. I could not stop thinking about food.

27:02

And now I go to a party and like, I

27:04

don't I no longer like thinking

27:06

about the cookie tray all the time. Is this what everyone

27:09

else's brain is like? So

27:11

I think it's, you know, for some people, especially

27:13

for whom these drugs might be working, it really could be

27:15

that their brains are actually a little bit different. And

27:18

it's not necessarily a matter of like how hard

27:20

you're working. We don't know what it's like to be

27:22

in mind as someone else. And I think the

27:24

fact that you can this drug can

27:27

kind of shift you between states. It's

27:29

like a really

27:29

powerful example of like

27:32

how behavior is has this biological

27:34

and chemical basis. What

27:37

happens now? Like, does

27:39

does the FDA start thinking about

27:42

the different use cases

27:44

here or sort of do we continue

27:46

in this nether world where people

27:49

are talking about it on the Internet

27:51

and trying to get a hold of it in all

27:53

sorts of maybe slightly dodgy

27:55

ways? Yeah, I think we might be

27:57

in this kind of nether world gray area.

27:59

for a while. You know, we're pretty far

28:02

out from any clinical trials that can kind of definitively

28:04

prove that these drugs can

28:06

really have an effect on addiction. So we're kind

28:08

of in the world of anecdote and animal

28:12

studies. To really get FDA approval

28:14

just requires years of follow-up

28:16

and we're nowhere close to that point. So,

28:20

you know, using these drugs off-label

28:22

is pretty common, or it's

28:24

not uncommon in other cases with other drugs.

28:27

But you are also in a world where

28:30

there's a shortage, but there's also this way

28:33

to get it from compounding pharmacies that are not

28:35

from the actual manufacturer. So I

28:37

think we unfortunately might be in this kind of compelling

28:40

but like not definitive world

28:42

for a while.

28:44

What does that mean if you are

28:46

someone who, say, read your story or listens

28:48

to this conversation and says, oh my God, like

28:51

this could change my life? Like

28:55

are you going down a path

28:58

that

28:59

you don't have any support

29:01

kind of while you're doing that or like what

29:03

happens?

29:05

That's such a good question. You know, when

29:07

I was writing about this, I wasn't really thinking

29:09

about people who are deliberately seeking out the drug

29:11

for addiction. It was more like people noticing

29:13

this after they were taking it for

29:15

diabetes or taking it for weight loss. Yeah,

29:18

unfortunately, we just don't know enough to

29:20

definitively say what will happen to you if you

29:22

take this drug. And to be clear, this

29:25

doesn't necessarily happen to everyone. It seems to

29:28

have a more drastic effect on this kind

29:30

of compulsive behavior for some people than for others.

29:32

Like there were also people who said, no, it didn't help me

29:35

with like pipping my skin or pulling

29:37

on my hair at all. And it's

29:39

hard to predict who for whom it will

29:41

work for, for whom it doesn't. You

29:44

know, at this point, like access to the drug is

29:47

both so gated and also so like double

29:50

tiered, right? Like if you can get

29:52

prescribed for it and you choose to cover

29:54

it, that's so different than if you are going online

29:56

and ordering from a compounding pharmacy, which

29:59

the FDA has.

29:59

is now warning against. So

30:03

yeah, it's sort of a really unsatisfying

30:06

space where your doctor is

30:08

probably not going to have that much to tell you about it

30:10

just because scientists don't have

30:12

that much data about it. Yet

30:15

people are kind of talking about it

30:17

in the media and we're all

30:19

kind of speculating about what's happening.

30:27

Sarah Zhang, thank you so much

30:29

for your reporting and for talking to me about

30:31

it. Yeah, thank you for such an interesting conversation.

30:39

Sarah Zhang is a staff writer

30:41

at The Atlantic. And that is it

30:43

for our show today. What Next TBD

30:45

is produced by Eben Campbell. Our show is edited

30:48

by Shannon Paulus. Alicia Montgomery

30:50

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Lizzie O'Leary.

31:15

Thanks for listening.