A $13.3 Million Trial in Allegheny County Will Test Semaglutide Against Addiction

Allegheny County and a Pittsburgh addiction research nonprofit are preparing to launch a $13.3 million randomized trial that will give up to 1,200 county residents with alcohol or opioid use disorder a weekly injection of semaglutide — the drug sold as Ozempic and Wegovy — or a placebo, and then follow them for a year.

The Center for Addiction Science, Policy and Research (CASPR) and the Allegheny County Department of Human Services announced the trial on October 13. It is funded by a $13.3 million grant from Arnold Ventures to CASPR. UPMC Western Psychiatric Hospital's Addiction Medicine Services will serve as the lead clinical site, alongside other treatment partners in the county. Enrollment is expected to begin in early 2027, with recruitment running about two years across four sites.

Half of the participants will receive weekly semaglutide for 52 weeks. The other half will receive a placebo. Everyone continues whatever treatment they are already receiving. The medication is being tested as an addition to standard care — not as a replacement for it.

Why GLP-1 drugs, and what the evidence actually shows

Semaglutide belongs to a class of drugs called GLP-1 receptor agonists, originally developed for type 2 diabetes and later approved for weight management. Since around 2024, researchers have accumulated evidence — much of it from patients reporting unexpected side effects — that these drugs also quiet cravings for alcohol, nicotine and other substances.

The strongest published evidence so far comes from a 26-week trial in The Lancet this year. Researchers gave 108 treatment-seeking adults with moderate to severe alcohol use disorder and comorbid obesity either once-weekly semaglutide at 2.4 mg or a placebo, on top of standard cognitive behavioral therapy. Heavy drinking days fell by 41.1 percentage points from baseline in the semaglutide group, compared with 26.4 points in the placebo group — a difference of 13.7 percentage points that was statistically significant. Eighty-one percent of participants completed the full course. Side effects were mostly transient, mild-to-moderate gastrointestinal symptoms, and were more common on the drug.

The picture is not uniformly positive. A separate phase 2 trial published in the American Journal of Psychiatry this year tested an oral form of semaglutide in 50 adults with alcohol use disorder over eight weeks. It did not significantly reduce laboratory-measured alcohol craving or drinks per day compared with placebo. It did reduce heavy drinking days, drinks per drinking day, self-reported craving and alcohol-related consequences.

That split is precisely the argument for a bigger trial. As Antoine Douaihy, who leads addiction medicine at the University of Pittsburgh School of Medicine and will oversee the four clinical sites, put it, the existing studies are small and their designs "are methodologically not very strong."

The evidence for opioid use disorder is thinner still — largely craving data and clinical observation rather than large randomized results. That gap is one reason the Allegheny trial enrolls people with opioid use disorder and alcohol use disorder in the same study.

The unusual part: measuring jail, jobs and housing

Most addiction medication trials measure substance use and stop there. This one is built to answer a second question: whether a medicine that reduces craving also changes the trajectory of someone's life.

Using Allegheny County's linked administrative data — behavioral health records, criminal justice records and benefits data joined at the individual level — the researchers plan to track rearrest, reconviction and reincarceration, along with employment, housing stability, health care use, mental health, impulsivity and weight. They will also calculate fiscal and social costs.

"Most of these trials are looking just at substance use and whether people use less or not," Diana Martínez Heredia, a data scientist with the county's Department of Human Services and a co-leader of the study, told PublicSource.

Nicholas Reville, CASPR's executive director and co-founder, framed the stakes in system terms: "The crime, kids being put into foster care, employment loss, tax revenue, incarceration. If you want to really transform society, if you can solve addiction, it would change everything."

The trial grew out of an unusual partnership. Alex Jutca, director of the county's Department of Human Services, said he found CASPR through Reville's addiction medicine blog two years ago and reached out. "Local governments are often asked to respond to addiction without enough evidence about what works," Jutca said.

Why Allegheny County

The county of about 1.23 million people has both the infrastructure and the incentive.

Allegheny County spent nearly $100 million in 2025 to treat roughly 12,700 residents with substance use disorders, according to county analytics. Its Allegheny Recovery Partnership Plan, published in September, is built on three pieces: reworked residential treatment contracts, an "assertive outreach and retention" program meant to keep people engaged in care, and a single front door into treatment.

Overdose deaths in the county have been falling. Provisional 12-month-ending counts from the CDC's National Center for Health Statistics show Allegheny County at 348 deaths in the 12 months ending March 2026, down from 402 in the 12 months ending January 2025 — roughly 28 deaths per 100,000 residents. Pennsylvania statewide fell from 2,973 in the 12 months ending September 2025 to 2,554 in the 12 months ending May 2026. Both figures carry a pending-investigation caveat: about a quarter of Allegheny County's most recent records were still unresolved, meaning the true count may be somewhat higher.

Falling deaths do not mean the system is working well enough. A county still losing roughly 350 residents a year, while spending nine figures on treatment, has a clear reason to test whether an inexpensive-to-deliver medication can improve outcomes that programs alone have not.

That calculus is central to the design. "Because this is a medication, rather than a complex program, if it works in Pittsburgh, it should work almost everywhere," Reville said.

What this does not mean for patients today

Semaglutide is not approved by the FDA to treat alcohol use disorder or opioid use disorder. It is approved for type 2 diabetes, for chronic weight management, and in an oral form for diabetes. Any use for addiction is currently off-label.

The Allegheny trial has not begun enrolling. People who want to join cannot sign up yet, and nobody should expect to be prescribed semaglutide for addiction at a treatment center this year. Off-label prescribing does happen, but it is not the same thing as evidence that a drug works. Semaglutide's FDA label carries warnings for acute pancreatitis, gallbladder disease, severe gastrointestinal reactions and acute kidney injury from fluid loss, on top of the common nausea, vomiting and constipation that lead many patients to stop.

What works now for opioid use disorder is well established: buprenorphine, methadone and extended-release naltrexone, combined with behavioral treatment. For alcohol use disorder, naltrexone, acamprosate and disulfiram have decades of evidence behind them. A trial like this is a bet that something better may be coming — not a signal to wait for it.

What's next

Three things to watch. First, whether the trial registers on ClinicalTrials.gov and opens recruitment on the timeline CASPR has described. Second, how the four clinical sites handle the practical problem of retaining 1,200 people with substance use disorders for a full year — the outcome that most determines whether the results mean anything. Third, whether the county's administrative-data approach produces findings that other counties can actually reuse.

If it does, the result would be unusual in addiction medicine: not just a drug that reduces use, but evidence about whether reducing use changes what happens to people afterward.

Where to get help now

If you or someone in your family needs treatment for alcohol or opioid use disorder today, help is available and does not depend on this trial.

• SAMHSA National Helpline — 1-800-662-4357, free, confidential, 24/7, English and Spanish
• 988 Suicide and Crisis Lifeline — call or text 988
• FindTreatment.gov — searchable directory of licensed treatment facilities
• Poison Help — 1-800-222-1222

For related reading, see our guides on medication-assisted treatment, alcohol addiction treatment, and how families find and join a clinical trial.