Telehealth Is Selling GLP-1s for Alcohol Use. The FDA Hasn't Said Yes, and the Patient Is Holding the Risk.

A person worried about their drinking can now click through an online intake form and be offered a weight-loss-class shot for their craving. The platform is not lying, exactly. It is doing something that is legal and unproven at the same time.

Selling a craving drug before it has been approved for cravings makes the patient the clinical trial.

STAT reported on October 22 that online addiction-treatment platforms have started marketing GLP-1 prescriptions, both brand-name and compounded, for alcohol use disorder and other addictions, ahead of any FDA decision. Two terms worth unpacking. “Off-label” means a doctor can legally prescribe a drug approved for one thing, here diabetes and weight, for something else. “Compounded” means a pharmacy mixed its own version, which the FDA doesn’t review the way it reviews the branded product. Experts told STAT the setup shifts the work of vetting an unapproved treatment onto the person buying it.

The science is moving, which is why the temptation is real. Caron Treatment Centers in Wernersville, Pennsylvania has prescribed GLP-1s to more than 650 patients with substance use disorders, per STAT. Eli Lilly, Altimmune and Baseline Therapeutics all have programs aimed at alcohol, and addiction specialists hope the FDA approves the first new alcohol use disorder medication in about two decades. Our earlier look at the cross-substance research lays out why the interest is serious. Interest is not approval. STAT’s visible reporting does not claim an efficacy result, and neither will we.

For providers, the move this week is simple. Ask every new patient with an alcohol problem whether they are already on a GLP-1, who prescribed it, and whether it came from a branded or compounded source. Write it in the chart. Then make sure the three FDA-approved alcohol medications, naltrexone, acamprosate and disulfiram, were on the table, because a patient who got a GLP-1 from a phone intake may never have heard of them.

If you are the one considering it: wanting a pill that quiets the craving is not a weakness, it is a reasonable thing to want. Ask whoever prescribes it what the evidence is for alcohol specifically, and where the pharmacy gets it. A good clinician will not be offended by either question.

The person at the keyboard at 2 a.m. should not have to be the one who knows the difference between hope and approval.