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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. We're going to talk again now about Ozempic, the diabetes medication being touted as a miraculous weight loss drug by some and an injectable eating disorder by others. Apart from obesity, some patients are reporting that Ozempic has been able to treat another stubborn affliction, addiction. If true, Ozempic could be more miraculous than even originally hoped for. With us now to discuss Ozempic's potential future as an anti-addiction drug and more is Sarah Zhang, staff writer for The Atlantic. I'll point out that The Atlantic has put out four different pieces on the topic of Ozempic in the last month. Seems like a lot of coverage for a diabetes drug. Sarah's article is called Scientists Accidentally Invent an Anti-Addiction Drug. Sarah, thank you so much for joining us. Welcome to WNYC today. Do we have Sarah's line connected?

Sarah Zhang: Yes, I'm here.

Brian Lehrer: Oh, you're there. Sorry about that. Thought we had a problem there for a second. How would Ozempic function as an anti-addiction drug? How is it different for more specialized anti-addiction drugs that may already be on the market? All right, so I guess we do have a problem with Sarah's line. In the meantime, listeners, we'll open up the phones for you to start getting in here. Are you on Ozempic or another semaglutide treatment? What has been your experience on the medication? Have you experienced a lessening of what you might call your other addictive or compulsive behaviors? 212-433-WNYC is our phone number. Also, we would love to hear from doctors in this segment. Doctors, have you prescribed Ozempic in your practice? What do you make of the discovery of the-- Of course, Ozempic is the brand name. What do you make of the discovery of the drug itself, which is known as semaglutide? Is it really the miracle everyone is making it out to be? Call in at 212-433-WNYC. Doctors, we would love to hear from you on the upsides and the downsides, 212-433-9692. As well as anybody who's been using Ozempic maybe for weight loss related to diabetes, or diabetes prevention purposes but then perhaps finding that it's also helping you curb other behaviors that might be classified as addiction, 212-433-9692. Sarah, I think we have you back now. You there?

Sarah Zhang: Yes, I'm here. Good to be here.

Brian Lehrer: Good. Sorry about that. How would Ozempic function as an anti-addiction drug?

Sarah Zhang: [chuckles] The true answer is we don't really know, but the [unintelligible 00:03:16] long answer is we have some hypotheses. Ozempic seems to somehow just annihilate or eliminate the desire to do things. Not everything, but things that are-- For example, smoking or drinking, people who just have gotten on the drug and spontaneously quit smoking. What we think seems to happen is that it does seem to interact directly with the brain. There are receptors in the brain that this drug can bind to, and we don't know-- It probably does many things, but one of the things it seems to do is it probably interacts with the dopamine circuit in the brain, and if we've heard of dopamine, that's sometimes called the pleasured chemical. Basically, it seems to maybe reduce the amount of dopamine in a certain part of your brain when you're doing something such as drinking or smoking or maybe even nail biting. That makes that behavior just a little bit less pleasurable or less rewarding, or maybe the anticipation of that less rewarding so that you decide you don't want to do it again.

Brian Lehrer: Right. You just used a few words from the subhead of your article, which I'm going to read to the listeners because it's so intriguing. It says people taking Ozempic for weight loss say they have also stopped drinking, smoking, shopping, and even nail biting. Does that mean, in general, stopped [chuckles] doing these things even at healthy levels because they lose their desire to have experiences, or is it they're stopping doing these things at problem levels?

Sarah Zhang: It really seems to be at problem levels. I'm glad you asked that question though, because when I was going into writing this story, I was wondering, "Hey, does this drug just make you lose your desire to do things, period? Are you just sitting around not drinking, not eating because you just don't want to do anything?" Then, I actually talked to people taking this drug, and what they told me is that what it really does is it curbs their behaviors that have become obsessive to the point of really negatively impacting their lives. These are people who might have been spending $500 on groceries every two weeks, buying way more food they could actually eat, or getting into credit card debt because they keep buying so many clothes, or smoking or drinking, and suddenly, they just no longer have the desire to do these things that they were really going way overboard in. On the other hand, other parts in their lives, that they're still enjoying going out with their friends, they're still enjoying eating a bite of food. They're just not enjoying eating two entrees. What it really seems to do is seems to be specifically shifting perhaps attention away from those things that you might have been obsessing over or really ruminating over. What people say is that they feel so much more peace in their brains actually. Instead of having this constant food noise where they wake up in the morning and are thinking about, "What am I eating this morning? What am I eating for lunch? When am I eating for dinner?" They're just more present. That chatter in your brain is gone and they can actually focus more on the things that are actually in front of them.

Brian Lehrer: How far are we away from doctors prescribing Ozempic to those experiencing whatever kind of addiction if it has this effect?

Sarah Zhang: Right. We're still in the middle of clinical trials, very small trials to determine whether this actually has an effect on smoking or alcohol, but it really right now is in the realm of anecdote where people are reporting really compelling personal stories. Again, it's not universal that everyone is necessarily having the exact same effects, but enough people are that we think there is. What's interesting is even before all of this, scientists were already interested in drugs similar to Ozempic. They've been studying them in the lab in lab animals and finding that they could get mice or monkeys to drink less alcohol or do less cocaine. We have these two parallel ends of evidence, all these really interesting anecdotes, and also stuff that's been going in the lab for several years now. Together, that's pretty promising. For addiction, researchers Ozempic is particularly interesting just because it's already a drug on the market. We wouldn't have to go through the whole rigmarole of like, "Is this drug even safe in patients? Can people take it?" We know that it is safe, at least for diabetes and obesity. If this were proven to be effective, it would probably be a lot more quickly used for addiction than a drug that you were developing from scratch.

Brian Lehrer: All those cokehead mice running around, we have to do something about that. Seriously, how do they do an experiment like that? They get a mouse hooked on cocaine and then they would give it Ozempic to see if it curbs the addictive response?

Sarah Zhang: Yes, that's basically the idea. A lot of the research in animals so far has not necessarily been on Ozempic itself but on earlier generations of this class of drugs that are called GLP-1s. Basically, you just see when you give this mouse a choice, do they keep going back to the water with cocaine in it or do they not? It does seem like when you've given rats or mice or even monkeys this drug, they're just less interested. One interesting fact of studies is that there are monkeys on an island in the Caribbean that have naturally a subset of them really love alcohol to the point where they'll actually steal drinks from tourists. One scientist who studies alcohol addiction studied Ozempic drugs in these monkeys and found that they became less interested in alcohol when they were on these drugs.

Brian Lehrer: Very interesting and pretty hilarious too. Sherry in Montclair, you're on WNYC. Hi, Sherry.

Sherry: Hi. How are you? I just wanted to tell you, I'm an educator and I'm on my lunch break, and I heard what you were talking about like I do every day. I just want to tell you one of the most incredible things that have changed my life is the semaglutide Mounjaro. My sister was living with us for six months before she returned to live back in Switzerland, and during that time, she's an avid reader We come from a family-- I'll just preface this. We come from a family that always believed in doing things naturally. The second thing is I always hated needles. My sister, I watched her lose 45 pounds while she lived with us, and she said, "Sherry, you have to do this. This is the most incredible thing," and we both have addictions to food. I would tell you, once we started, we're quite tall, no one ever thought that we were the weight we were. We could carry it very well, but I will tell you that this has been the easiest weight loss method I've ever experienced than during my teens, I'm in my late 50s. I can tell you this has been the easiest and best weight loss method ever. I don't look for food. I do the intermittent fasting, so I'm able to eat my dinner at five, six o'clock. Then, in the morning, I'm drinking lots, and then what I've noticed is I'm not looking for food. I'm going through empty nest syndrome, which is a really big stressor, and I'm fine. I'm absolutely fine.

I can eat normal meals and the vegetables and the fruits without looking for the carbs, without looking for the sweets, which is my downfall. It's wonderful, and I don't have, like my sister, no side effects. It's been incredible.

Brian Lehrer: For you, Sherry, I'm curious. Is this a good thing because you're concerned about disease from your previous eating habits, or is it more because of you like how you look?

Sherry: Excellent question. As I said, I'm in my late 50s, so my daughter just got married, and I have a young son. As my mother has said, "You better take care of yourself. You have a long road ahead with these kids." I want to be there. I want to see grandchildren. I want to live to a good old age. I don't want to die young because of cholesterol issues. I think that's what's been happening to a lot of us. Eating on the run, short lunch breaks, stress at work. All of this has created a way of eating poorly. I would say health is the number one. Number two, I've got a husband who's in great shape and who looks fantastic. I don't want to look like a mope. That's the second issue. The first is health.

Brian Lehrer: Sherry, thank you. Thank you for disclosing so much about yourself. It probably wasn't easy, but I think it shows how strongly you feel you're being helped by this drug. Our guest is Sarah Zhang from The Atlantic. Her article, Did Scientists Accidentally Invent an Anti-Addiction Drug? It's about Ozempic. Who else has a story? 212-433-WNYC. I think, Sarah, that the call we just heard goes to the push and pull socially and in the press, as well as medically and personally around this drug. The last segment that we did on Ozempic was focused more on the negative implications of Ozempic's popularity off-label for people who are using it to get really thin.

It was all tied up with the traditional body image stereotypes of the thinner, the better, being reinforced by Ozempic. Maybe there's a complicated relationship between the body positivity movement where fat shaming should not be okay, discriminating against people based on size in employment or housing or anything else should not be okay. At the same time, obesity is a real medical problem and potential medical problem for a lot of people. Then, the conversation about Ozempic gets caught between those two poles.

Sarah Zhang: Yes, I think you're absolutely right. It's both true that the availability of these drugs, especially off-label, has a lot of people who just want to be 10 pounds skinnier and look good in a bikini to do that. It's also really helped people, as Sherry was talking about, really deal-- Obesity is a medical problem, and doctors who prescribe this drug for obesity, it's clear that this drug is as medically indicated for obesity as it is for diabetes. I don't want to set up that duality where some patients might be more deserving of this drug than others. This is a really powerful drug. As we've been talking about, it may have all these other implications for other types of addictive or compulsive behaviors too. I think it is complicated. This is a drug that truly does improve the lives of people whose conditions are to a point where it's really affecting their lives or they have obsessive behaviors, but this widespread availability of it, it does open up, as you said, all of these questions about body positivity and the move to become skinnier and skinnier.

Brian Lehrer: Toshana in the Bronx, you're on WNYC. Hi, Toshana. Thanks for calling.

Toshana: Hi. I just wanted to say that I was on the Ozempic for five months and I had such a great experience with it. At the beginning, it was a little rough because like all medications, when you're trying something out, you may have some side effects. It was more things like dizziness, and if you didn't have enough water, you definitely had to drink more water. Those are things that I had to learn. The biggest thing that I want to share is that on Ozempic, I found it really helpful because it was, for the first time taking the drug, and it happened so quickly, I was able to experience food as others may, closer to "normal". My experience with food has always been one of obsession. What I mean by that is like I'm thinking about my next meal trying to figure out, making sure that I don't overeat or making sure that I ate the right things, all of those kinds of things. When I was using the drug, that's not something that I ever really had to consider. That was very exciting for me. It was like a whole new world. You don't know what you don't know.

Brian Lehrer: Toshana, thank you very much. Another story that reinforces the angle of your article, which again is headlined, Did Scientists Accidentally Invent an Anti-Addiction Drug? I will say that, after our last conversation on this, which was focusing more on the negative implications of Ozempic's popularity off-label to be really, really thin, I got a phone call from a doctor to say, you're missing the point, this is a revolutionary drug in terms of its ability to cure the kinds of eating disorders that our two callers have been describing, over-eating disorders, compulsively over-eating disorders, and to fight the health effects of obesity, which are real for so many people. It's incredibly polarizing. We also had a lot of callers last time who talked about how they had to stop using the drug due to side effects, including nausea and other gastro side effects. We have callers like that who want to tell that story this time too. I'll just acknowledge that they're there. It's really complicated, isn't it?

Sarah Zhang: Yes, it is really complicated. I think what I heard in the last caller and what I actually heard from a lot of patients I talked to you is that they were suddenly like, "Wow, is this what it's like to be living in someone else's brain? Is this what it's like for everyone else to not be obsessing over food all the time?" What the drug really does, it's not even on a conscious level, it just almost works on this unconscious level where the desire or the need to think about food or maybe alcohol or smoking isn't there anymore. One of the stories I heard is one person I talked to said that she had picked the skin on her back for basically her entire life to the point where she would wake up with blood in her sheets, that she wouldn't even wear white because she was afraid of bleeding through her shirt. Then, one day, she just woke up and realized her back had completely healed. She had stopped picking her back weeks ago to the point where it completely healed, and this is not something she was thinking about. It was not something she was consciously trying to stop. It just happened when she started taking Ozempic.

Brian Lehrer: Listener asks via a text message, "What happens when people go off Ozempic? Do they regain the weight, and what about dangerous side effects?"

Sarah Zhang: Yes, so it does seem that the effects of these drugs that we know go away pretty fast once they're out of your system. From the studies that have been done, the cravings come back, the eating comes back, and people do regain most if not all of the weight that they lost. In terms of side effects, I think this is also similar. It seems like if you stop the drug, the side effects probably will also stop. I think it was, as the caller talked about earlier, the side effects such as vomiting, nausea, constipation. Those tend to go away after your body is acclimated to it. There are other possible side effects that can happen, serious ones like pancreatitis, gallbladder issues that are less common. There's also this other question of if this is a drug that you're taking for the rest of your life, right, this is not a drug that you take for a few months or a year, yhis might be a drug that you take for 30 years or 40 years, well, what does that do? The answer is we don't really know because this drug just hasn't been available for 30 or 40 years yet.

Brian Lehrer: To wrap this up, I noticed that you had another article on The Atlantic called, Can You Have a Fun Vacation on Ozempic? Why did you write an article like that?

Sarah Zhang: I actually realized as I was reporting this article that there's a certain phenomenon on people who decide to skip a dose while they're on vacation. The drug actually doesn't go away completely in a week. It's a weekly injection. What they say is they can just enjoy food a little bit more. They want to just enjoy a cocktail at dinner. It's still they're not going overboard, they're not going to a 12-course tasting menu. There's some interesting claims into l what happens when you skip a dose, which is what some people have decided to do on vacation.

Brian Lehrer: Right. Which again suggests that you can't have a normal enjoyment of food if you're on this drug. Is that what you mean to imply?

Sarah Zhang: Well, when we talk about enjoying food, are we talking about enjoying the food itself or it's the whole social experience of food, right? If what you love is going out to dinner with your husband and having this long, 11-course tasting menu, that's something you can't do on Ozempic. You can still go to a restaurant and order an appetizer. Yes, it's the whole social thing-- I think what the drug really brings up is that there's a lot of eating that's not just for nourishment. It's also this social event, and that probably does have to change if you're on the drug.

Brian Lehrer: Sarah Zhang, staff writer for The Atlantic. Thank you so much for joining us.

Sarah Zhang: Thanks. Great to be here.

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