Allegheny County to Test Semaglutide in 1,200-Person Addiction Trial

A Pittsburgh addiction research nonprofit and Allegheny County's human services department are preparing to launch a $13.3 million randomized controlled trial that will give weekly semaglutide to as many as 1,200 adults with alcohol use disorder, opioid use disorder, or both. The study is expected to begin enrolling in early 2027, with UPMC Western Psychiatric Hospital's Addiction Medicine Services serving as the lead clinical site alongside other treatment partners in the county.

The announcement, made Tuesday by the Center for Addiction Science, Policy and Research, extends a research push that has moved quickly over the past two years from retrospective claims analyses toward large randomized designs. Semaglutide, sold as Ozempic for type 2 diabetes and Wegovy for weight management, is not approved for any substance use disorder.

Half the participants get a weekly injection for a year

The trial is registered with the AEA RCT Registry as a 1,200-participant study in Allegheny County. Half of those enrolled will receive semaglutide injections weekly for 52 weeks; the other half will serve as the comparison group. Investigators describe the drug as an addition to standard care rather than a substitute for it — participants in both arms continue whatever treatment they are already receiving, including medication-assisted treatment where clinically indicated.

The registry entry frames the primary question as whether semaglutide reduces substance use among people with alcohol or opioid use disorders who are at elevated risk of criminal justice involvement. Enrollment will span multiple sites rather than a single clinic, a design choice intended to make the protocol reproducible if the results are positive.

Measuring jobs, housing and jail time, not just drug use

The outcome set is the study's most unusual feature. Alongside standard measures of drinking and drug use, the trial will draw on Allegheny County's linked administrative data to track employment, housing stability, health care use and rearrest, reconviction and reincarceration.

"We as WPH AMS, the lead clinical site, are very much excited to partner with CASPR, Allegheny County Department of Human Services and other sites, on this trial which holds great promise to change the landscape of addiction treatment and recovery toolbox," said Antoine Douaihy, a professor of psychiatry and medicine at the University of Pittsburgh.

Nicholas Reville, CASPR's executive director and co-founder, said the design reflects a judgment that addiction trials have historically measured too narrow a set of outcomes to guide public spending. "Despite the enormous personal and social impact of addiction, innovation in the field has not matched the scale of the problem," Reville said.

Alex Jutca, director of the Allegheny County Department of Human Services, described the study's origins as a conversation between a county administrator and a researcher over shared frustration with the evidence base. "DHS has a longstanding commitment to using evidence to solve difficult social problems," Jutca said.

Why semaglutide, and why the caution

Glucagon-like peptide-1 receptor agonists have drawn intense interest from addiction researchers after a series of observational studies associated their use with lower rates of overdose, craving and heavy drinking. Those findings come from claims and cohort data, not randomized assignment, and they cannot rule out that people who receive a GLP-1 prescription differ in ways that also protect them.

CASPR itself has published retrospective work on the question, including analyses of patients with opioid use disorder who took semaglutide. The Pittsburgh trial is designed to test the signal directly — and, importantly, to test whether any benefit is large enough to justify paying for the drug at scale, an argument a single-institution trial of a few hundred people could not settle.

The potential side effects matter too. Semaglutide carries gastrointestinal risks and labeling cautions, and any expansion into a population with high rates of untreated infection, unstable housing and inconsistent follow-up would need to weigh tolerability alongside efficacy.

Arnold Ventures puts up the money, and other cities are the audience

The trial is funded through a $13.3 million grant from Arnold Ventures to CASPR. The philanthropy has backed GLP-1 addiction research for several years, including planning work that led to the coalition behind the Pittsburgh study.

Investigators have been explicit that adoptability is part of the design. Unlike a new counseling program, a medication can be delivered through existing clinical infrastructure — which means a positive result would be easier to replicate in other counties than a service model would be. People seeking treatment for opioid addiction today still rely on a small set of approved medications, and evidence that a widely prescribed diabetes drug could reduce relapse would be a substantial addition to that toolbox.

The trial is also a test of a broader claim: that county governments, which run most of the country's jails and much of its behavioral health system, can generate the kind of evidence their own budgets need rather than waiting on it.