GLP-1R Agonist Treatment for Opioid Use Disorder

Exclusion Criteria

• •Age \< 18 or \> 75 years.
• •BMI \<18.
• •Individuals who are pregnant, planning pregnancy, breastfeeding, or unwilling to use adequate contraceptive measures.
• •Current use of glucagon-like peptide 1 receptor (GLP-1R) agonist.
• •History of angioedema, serious hypersensitivity reaction, or anaphylactic reaction to semaglutide or another GLP-1R agonist.
• •Personal or family history of medullary thyroid carcinoma (MTC) or patients with multiple endocrine neoplasia syndrome Type 2 (MEN 2) or thyroid nodule.
• •Type 1 diabetes or history of diabetic ketoacidosis.
• •Type 2 diabetes mellitus or current use of a dipeptidyl peptidase-4 (DPP-4) inhibitor.
• •Past 30-day use of Sincalide, Sulfonylureas, insulin and insulin products or other medications that may interact with semaglutide.
• •Hypoglycemia on intake visit (blood glucose \< 60 mg/dL).
• •End-stage renal failure, on dialysis, or glomerular filtration rate (GFR) \<30 mL/min per 1.73 square meters or previous renal transplant.
• •End stage liver disease or previous liver transplant.
• •Current or past diagnosis of pancreatitis, gastroparesis, or other severe gastrointestinal (GI) disease.
• •Current or past diagnosis of gallbladder disease or gallstones.
• •Serious cardiovascular disease within the past 6 months (e.g. uncontrolled hypertension, heart failure, significant cardiac arrhythmias, myocardial infarction, presence of angina pectoris, symptomatic coronary artery disease, deep vein thrombosis, pulmonary embolism, second- or third-degree heart block, mitral valve or aortic stenosis, hypertrophic cardiomyopathy, stroke).
• •Severe co-occurring psychiatric disorder (e.g., bipolar disorder, psychotic disorder, schizophrenia), and/or history or evidence of organic brain disease or dementia that would compromise safety or compliance with the study protocol in the opinion of the site principal investigator (PI) and/or physician. As there is no specific scale that determines this, this will include the Site PI/physician determining if the potential participant shows consistency in decision making and if they are alert and oriented to time, date, day and location.
• •Significant risk of suicide requiring a different/higher level of care, according to the clinical judgment of the study physician or site principal investigator, or history of suicide attempts within the past 1 year, unless participation is cleared by clinician assessment and/or judgment. A Columbia-Suicide Severity Rating Scale (C-SSRS) indicating a history of suicide attempts within the past year, or active suicidal ideation within the past 1 month, will qualify as significant risk of suicide.
• •Treatment with any investigational drug in the one month preceding the study.
• •Any contraindication to both methadone and BUP.
• •Any contraindication to a GLP-1R agonist.
• •Previous randomization for participation in this trial.
• •Any other condition at screening that precludes safe participation in the trial in the judgment of the site PI or study physician.
• •Plans for travel outside of the local area over the 19 weeks (1 week of baseline, 12 weeks of medication, 1 week wash-out, and follow-up after a further 28 days) that would interfere with visits during the study period or other logistic factors that would make it difficult to commit to the entire duration of study.
• •Currently a prisoner.