Episode Transcript
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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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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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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
is vice president of audio for Slate. And
30:52
TBD is part of the larger What Next
30:55
family. We are also a part of Future
30:57
Tense, a partnership of Slate, Arizona State
30:59
University, and New America.
31:00
And if you like
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31:12
right, we'll be back next week with more episodes. I'm
31:14
Lizzie O'Leary.
31:15
Thanks for listening.
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