February 6, 2026 • 36 mins
University of Maryland School of Medicine (UMSOM) associate professor Sarah M. Kattakuzhy, MD, joins “The UMB Pulse” this month to talk about her research exploring whether semaglutide (a GLP-1 medication widely used for diabetes and weight management) could help reduce cravings and improve outcomes for people with stimulant use disorder.
Kattakuzhy, who is also the co-director of the Kahlert Institute for Addiction Medicine at UMSOM, describes the design of the STAC Study, which is evaluating the safety and tolerability of semaglutide in people with cocaine use disorder, including participants with and without HIV, while also tracking secondary outcomes such as changes in drug use and cravings.
She also discusses why stimulant use disorders, including cocaine and methamphetamine use disorder, have been especially challenging to treat, and how her work through the University of Maryland, Baltimore community-based research partnerships aims to expand treatment options and reduce stigma around substance use disorders.
To learn more about this trial or for referrals, contact Dr. Kattakuzhy at skattakuzhy@ihv.umaryland.edu.
00:00 Introduction to Addiction and New Research
00:40 Meet Dr. Sarah Kattakuzhy
01:45 A Day in the Life of Dr. Kattakuzhy
03:57 The Journey to Addiction Research
07:40 Exploring Semaglutides for Addiction Treatment
12:34 Details of the Clinical Trial
20:29 Challenges and Hopes in Addiction Treatment
24:31 Collaborations and Future Directions
27:39 Final Thoughts and Takeaways
32:13 Post-Interview Insights
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dana Rampol (00:00):
Addiction is one of those issues that almost everyone
touches through personal experiencesor someone they love or know.
And treatments for addictionhaven't changed much in decades,
but they could soon change thanksto some surprising research.
You're probably familiar with medicationsused for diabetes that also have the
benefits of weight loss, and you'veprobably heard of them as Ozempic Wegovy
(00:22):
or Mounjaro, or even just a GLP-1, orsome people call them semaglutides All of
these medications help to slow digestionand quiet cravings or that food noise
we hear about, and they're now beinginvestigated to see if they can quiet
cravings for cocaine and methamphetamine.
That possibility has piqued theinterest of Dr. Sarah Kattakuzhy at
(00:44):
the University of Maryland Baltimore.
Dr. Kattakuzhy is an associate professorat the University of Maryland School of
Medicine and co-director of the KahlertInstitute for Addiction Medicine.
She is overseeing a clinical trial tosee if semaglutides can reduce cocaine
abuse and improve drug use outcomes.
Can the brain's reward response besuppressed for drugs much like it can be
(01:07):
for food with these medications, whilealso reducing stigma and inducing hope?
Find out that and more in our conversationwith Dr. Kattakuzhy on the UMB Pulse.
Jena Frick (01:22):
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (01:35):
Sarah, welcome.
Thank you for joining the podcast We'relooking forward to learning a lot.
Sarah Kattak (01:41):
Thank you so much.
It's a pleasure to be here.
Dana Ra (01:43):
So let's jump right in.
Start out by taking me to aTuesday afternoon, either in your
clinic or out in the community.
Describe the setting.
Let me know what's going on.
Kind of paint a picture forus that captures what your
daily work really looks like.
Sarah Kattakuzhy (01:58):
Wow.
Okay.
Well, how much time do we have?
I'm at a point in my career whereI have the pleasure of helping
co-lead, a large research programcalled the Research Initiative in
Infectious Disease and Substance Use.
Our goal is really to produce noveltherapeutics and approaches for people
(02:19):
disproportionately affected by substanceuse disorder and HIV epidemics.
That's really the crux of our work.
To accomplish this, wepartner with community-based
organizations, uh, that are in.
Baltimore and Washington DC toreally try and get at the patient
population, that's disproportionatelyaffected by these conditions.
(02:40):
And meet them where they are incommunity-based settings where
they feel comfortable, wherethey're receiving other services.
And then we kind of are able toalign our clinical care and research
alongside that to make thingsconvenient and culturally competent.
So, as I said, I'm, one of theco-directors along with my colleagues,
(03:01):
Dr. Elana Rosenthal and Dr. Rachel Silk.
We've been leading the program for.
over a decade.
And so on a, on a regular Tuesday,you'll see me, checking in with our
boots on the ground team, figuring outhave all the patients been seen and
what still needs to be accomplished.
We have a number of researchmeetings, that are trying to figure
(03:23):
out, who's been seen, who needsto be seen, who, lost their phone,
so how are we gonna contact them?
so it's a lot of management andcoordination, but our science, is really
focused on our active protocols, One ofour most active protocols right now, is
looking at, semaglutide or, you know,goes by a lot of names, Ozempic Wegovy
(03:45):
in people with cocaine use disorder.
Depending on the day of the week, wehave that active clinic that is seeing
those patients for that protocol,which requires a lot of management.
Dana Rampolla (03:56):
I am sure.
you just touched on everythingI'm hoping we'll talk about today,
before we, jump into the crux of it,tell me if there was a period or an
experience or maybe a patient thatchanged how you understood addiction.
Sarah (04:12):
That's a great question.
Like most people, your careeris a series of happy accidents
and right place, right time.
after I did my medical training and chiefresidency at George Washington University
Hospital in Washington DC I actuallytook a job at the National Institute
(04:33):
for Allergy and Infectious Disease.
My initial goal was really tobecome an HIV primary care provider.
I wanted to learn the guidelinesfrom the people who write them.
At that time, HIV medicine was a lotmore complicated than it is today.
While I was at the NIH is whenthey actually were doing the first
studies on what would become, today'snovel therapeutics for Hepatitis
(04:57):
C, the direct acting antivirals.
And I got to see in front of my eyesas this disease during my training
was, very poorly treated and tolerated.
I got to see people curedin front of my eyes.
So that was miraculous and what reallybrought me into clinical research,
as a way that I could approachmy medical care linking in public
(05:20):
health, which is very important to meBeing able to understand, not just how do
we get new therapies to people who needit most, but what's the missing piece?
what brought me to addiction is, isactually that the next stepping stone
is that I was doing Hepatitis C carebetween Baltimore and Washington
DC in 2013 to 2014, and that is theexact time that Fentanyl hit the
(05:46):
illicit drug supply in those regions.
And so these patients that I wastreating and curing of Hepatitis C,
more than one of them, died of a drugoverdose or was reinfected because
of their ongoing substance use.
that really lit a fire under me.
To say, if we're really looking at thisissue from a public health perspective,
(06:09):
we always think about upstream causes oreven in the field of infectious diseases.
We think of the source, what is the sourceof the infection and the source and the
upstream cause of hepatitis C in someindividuals, HIV, and complications is
really the substance use and addiction.
And that is what really caused me topivot my career to looking towards
(06:34):
the overlap and the intersection ofboth addiction and infectious disease.
And so it's more than one patient,but I can still remember them.
Especially all the patients we'velost to the ongoing, overdose death
crisis in the U.S., and these patientscontinue to reinforce the work I do.
Dana Ram (06:52):
I can definitely, feel that connection for me personally, I'm
so drawn to your story and research.
I have an adopted brother.
He was adopted at birth and dieda few years ago from an overdose.
He had been a heroin user andsomehow got fentanyl mixed into it.
I remember years ago talking tohim about his addiction and saying
(07:13):
Just take that energy, that desire,and put it into something else, like
thinking this is all mental justwork out, you know, start a workout
program or train for a marathon.
And I remember him saying it'snot that easy, it's physical.
I can't live without it.
So when there's someone who is, usingto a point that they are addicted.
(07:34):
We look at other drugs like thesesemaglutides you mentioned, as a
family member, I find hope in that.
Talk a little bit about, you know,we've all heard of ozempic, wegovy,
Is it possible this will actuallybe a treatment for a substance
disorder like cocaine addiction?
Sarah Kattakuzhy (07:51):
thank you for your honesty and for sharing
and just wanna reinforce how,unfortunately, common your story is.
I think about, our world today andkitchen table issues what brings
us together are becoming, a smallerand smaller slice of the pie.
But unfortunately, having aloved one with substance use
disorder is one of those issues.
(08:13):
It affects so many families in America.
It does not matter your socioeconomicclass, race, religion, creed,
it has affected all of us.
I really wanna thank you for sharing that.
I see hope for the future ofsubstance use disorder, care and
treatment for a number of reasons.
before I address my research andthe field of substance use disorder
(08:37):
treatment, I will say one greatpiece of data that we have now is
that the number of overdoses for thefirst time seem to be on a decline.
And that's for a number of reasons.
I do think we've turned an importanttide in terms of the number of deaths
from drug overdose deaths does notmean that, it, it's been solved.
(09:00):
There's still an unacceptableamount of overdose death but
it has declined from its peak.
we feel good about those trends.
In terms of other things that give mehope, as a clinician and scientist,
finding new therapies for people whouse drugs, is an area of excitement
and hope because, you know, opioiduse disorder, we have excellent
(09:24):
medications, methadone, buprenorphine.
Amongst others, that have very highefficacy in terms of keeping people alive
and reducing their drug consumption.
Unfortunately that is not thecase when you apply to stimulant
use disorders, and that includescocaine and methamphetamines.
(09:46):
We do not have any FDA approved treatmentsfor those particular drugs, and there's a
lot of exciting science that's happeningaround the world and around the globe.
one of those is exploring the use ofGLP one agonists, like Semaglutide or
Tirzepatide or, their, you know, othernames, Wegovy, Ozempic, et cetera.
(10:09):
The way that we really think about it andhow this came about as an area to explore.
Is that when these drugs were beingutilized in people with diabetes or
people with obesity, individuals whowere taking it reported, Hey, you
know, I have lost a lot of weight.
(10:29):
My relationship with food has changed.
I'm making different choicesabout food, but also I don't
feel like drinking anymore.
these observations led scientists,who were, of course we have our basic
science colleagues who are lookingat things on molecular levels, in
animal models, that really tried tounderstand, you know, there are, if
(10:51):
we look at the sort of more scientificlevel, there are receptors for GLP, not
only in the stomach and the, you know.
Our GI system, but also inour central nervous system.
So we know that people change theway they're making decisions about
food when they're on GLP ones.
Could this apply to other substances?
(11:13):
Could this apply to alcohol?
Could it apply to cocaine?
And is one of the ways that the GLP oneswork, could it be around impulsivity?
Could it be around craving?
And these are all words that in thefield of addiction are really important
because they're features that arecentral to, as you mentioned, it's not
(11:38):
just an issue of willpower, it's thecentral nervous system really being
hijacked to prioritize the consumptionof drugs in order to just achieve,
a sense of normality in the brain.
And so is, it possible that the GLP oneagonist could be used to help control some
(11:58):
of that craving, to reduce the craving,to reduce the impulsivity, to keep the
brain at more of that neutral state sothat people can make healthier choices
about what they're consuming, includingeliminating or reducing their drug use.
The science right nowis that we don't know.
We definitely do not know.
There are preliminary studies, inalcohol use disorder is the main
(12:24):
place that it's been, studied.
But, we are, we're stillreally exploring that.
So I have a lot of hope, but it, itreally has to be borne out by the science.
Dana Rampolla (12:34):
tell me then a little bit about the clinical trial
that you're overseeing and howlong have you been working on it?
How long do you think something like thistakes to have data that allows you to move
forward to the, like the FDA for approval?
Sarah Kattakuzhy (12:47):
the way that, drug development typically works,
and I'm gonna super simplify it,is that you have different stages.
The first is asking the question, isthis drug safe for the patient population
that you would like to use it in?
Is it tolerable?
Can it be used safely in humans?
And so we know because these drugshave actually been around for quite
(13:10):
some time and have been, of course,approved in diabetes and obesity.
now the question is, are they safeand tolerable in people who don't have
those conditions but have a differentcondition, like a substance use disorder?
our study, is evaluating The acronymis the Stack Study, but it's really
safety and tolerability of semaglutidein people with cocaine, use disorder,
(13:34):
inclusive of people with and without.
HIV.
this study is really trying tofigure out is it safe and will
people take it, and is it tolerable?
So that means, you know, you mayhave a drug that you're like,
ah, you know, I get a little bitof upset stomach when I take it.
It doesn't stop me fromtaking the medicine.
And so I would consider it tolerable.
(13:56):
Or you could have a medicine that'slike, Hey, I know that my lab
work looks great, but I just don'tlike the way it makes me feel.
And that makes it intolerable becauseno matter what, it doesn't help anyone
if you have a medication no one willtake, in this study, our primary
outcome, the thing we're looking atmost is, is it safe and is it tolerable?
(14:18):
And then the second things we'relooking at are the secondary outcomes
is it able to reduce drug use?
Are people spending less moneyon cocaine than they used to?
Are they reporting less craving?
Does their urine show lesspositive urine drug screens for
cocaine than before they started?
And what is happening withother aspects of craving?
(14:40):
Are they still, making good choicesabout other aspects of their life?
Do they still feel, like they're ableto have pleasure in everyday life?
are we able to see if these GLP onescan be used to take away the urges and
the cravings that aren't beneficialwithout reducing everything that
(15:01):
brings pleasure from everyday life?
So these are all secondaryoutcomes that we're exploring.
Dana Ramp (15:07):
how do you explain it when you're talking to the patient
who probably doesn't, well could,but probably doesn't have your level
of education so they can kind ofunderstand what's going on with their
brain and what the hopeful outcome is?
Sarah Kattakuzh (15:20):
we have a great relationship with our patient population
because of the setup of our researchprogram, and I think because we have.
Just the best research team and thebest providers, who really offer
patient-centered care, even inthe setting of ongoing research.
the way we consent individuals is wesay, this is a study that may or may
(15:43):
not be beneficial to you as a person.
And in fact, there are somerisks that are involved.
the reason we're doing this studyis because as you know, as someone
with cocaine use disorder, there'sno treatments that are approved by
our medical system for cocaine use.
And this study is the first stepin helping us figure out, can we
(16:04):
use these new drugs that you'veprobably heard of in the news?
Can we use them in peoplewith cocaine use disorder?
And this is the first step.
And so this is a randomized controlledtrial, which means that 50% of the
people get the actual drug semaglutideand 50% get a matching placebo
I don't know which one they get,only one person on our team does.
(16:29):
And so the patient doesn'tknow and I don't know.
So I can tell them very clearly, youhave a 50% chance of being on the
medication and there is no guaranteethat this will have any benefit to you.
And I've gotta tell you, people are sowilling to participate in this 'cause
(16:51):
they want to have a contribution to movingthis field forward and they want some
hope, even if it's not for themselves.
So I just have so much respect forall of our patient participants,
because they do really understandthat going into the protocol.
especially 'cause it's a blinded study.
Dana (17:10):
Yeah, that's really great.
Great to understand.
Also, help me understand if someonedoesn't have diabetes or say an
issue with their weight loss.
Yeah.
How can semaglutide can work withthe brain to treat drug addiction
while not impacting their insulindigestion or food cravings.
Sarah Kattakuzhy (17:27):
Yeah.
So I have to tell you this is part ofwhat we're exploring, because we know
from previous studies of obesity thatthe data overwhelmingly suggests that
if you are someone who is of a normalor thin body habitus at baseline, you
have a much lower degree of weightloss than individuals who are obese.
(17:52):
Meaning not everyone who takessemaglutide is gonna lose 50 pounds.
It really depends on whatyour starting set point is.
And of course, the multitudereasons behind the obesity.
I think we're figuring that outas more Americans are on a GLP
one agonist, that there are superresponders who are people who are
gonna lose 40 pounds in three months.
(18:15):
And there are people who really need to goto the highest dose and beyond this for a
long time before they see some, response.
So as that relates to people with cocaineuse disorder, we have to look out for.
Weight loss in them.
This is part of our,our safety evaluation.
We have to be able to look out are theyconsuming less food because we know
(18:38):
these are effects of the medication.
So these are things that we're,we're trying to evaluate science.
Dana Rampolla (18:45):
Oh, I'm sorry.
I was just gonna ask, aren'ttypically cocaine users?
Maybe I'm generalizing, butthey're usually thinner anyway.
Sarah K (18:51):
That's exactly right is that people with cocaine use disorder in
general have a much thinner body habituscompared to your standard non, person
who does not have cocaine use disorderbecause of the action of the cocaine.
Or the methamphetamine, their stimulants.
And part of what they do in the bodyis to naturally suppress the appetite.
(19:12):
So that is a big part ofour safety considerations.
We actually have, something calledthe in-body machine, which is like
if you have a fancy gym membership,you might have it there, but it's a
machine that uses electrical impedanceto measure the difference between
water fat and muscle in the body.
And so we have every single one ofour patients, complete an in-body
(19:36):
scan at multiple time points.
And that's because I'm not justconcerned about their weight.
We know that from other studies of GLPones that about up to 30% of the weight
that people lose is actually muscle.
And so in individuals who are alreadyon the thinner side, are they going
to lose a lot of their muscle mass?
(19:59):
Are we going to put them into whatwe would medically term sarcopenia?
And would that, make any benefit thatthey get from reduced cocaine use?
Would that be imbalanced becauseof the negative side effects?
So we take safety really seriously,and that's why we're so rigorously
evaluating this, as our primary outcome.
Dana Rampoll (20:22):
Well, and you said that there is no FDA approved
medication for cocaine or otherstimulant abuse or addiction?
what does this gap mean for the peoplewho you're working with every day?
are you hopeful that this,obviously you're hopeful that it
will work, how do you see that gapexpanding or closing more quickly?
Sarah Kattak (20:41):
I think it is such a challenge because we are now in what
we consider the fourth wave of the drugoverdose death crisis, which is that,
you know, initially there was a lot ofdeath related to prescription opioids.
(21:01):
And that really shifted to deathspredominantly, related to heroin
use as prescription opioids overprescription of opioids was pulled
back and people who were dependentbecame, then developed, heroin misuse.
And then as Fentanyl hit theillicit drug supply, as I described
(21:21):
at the top of our conversation,that really became the third wave.
And so what we're in now, what'sbeen described in the literature
is this fourth wave, which is acombination of opioids and stimulants.
And we're seeing it, in a lotof specific patient populations.
But stimulant use has reallyreplaced opioids or at least
(21:42):
brought in parallel with opioids,uh, opioid use in the west coast,
and a lot of the Midwest.
So For example, in Texas, mycounterparts and colleagues in Texas,
their predominant patient populationthat they're struggling to treat are
individuals with stimulant use disorder,with methamphetamine use disorder.
Here in Maryland, you know, I treat arural patient population of individuals
(22:06):
with opioid use disorder, and that'swhere I see a lot of the co- use of
methamphetamines Here in the city.
I see a ton of cocaine use anda lot of cocaine use disorder in
individuals who already have use ofopioids and those who don't as well.
I think, this is a strong issuebecause we know that cocaine and
(22:29):
methamphetamine is also going toincrease your likelihood of overdose.
These can also becontaminated with fentanyl.
So even if you're someone whodoesn't have an opioid use disorder.
You're still at very highrisk of overdose death.
And of course the way that you usethese drugs can lead to lots of,
challenges like infectious complications.
(22:50):
And you know, for example, if you'reinjecting drugs, can lead to acquiring
HIV or Hepatitis C or other diseases.
So, I think there's a gap.
In the way that we approach stimulants,because we don't have good science to say,
yes, this is the treatment you should use.
(23:11):
We have professional guidelinesthat say, Hey, you can try these.
You know, about seven different kinds ofmedication that we can try, but none of
those have risen to the level of efficacythat's required to get an FDA label.
So how this bears out for the averagepatient is that if they make it to
a doctor, if they make it to me tosay, I really want treatment for my
(23:33):
cocaine use disorder, I can say we havereally great behavioral interventions
that we know work, like contingencymanagement, cognitive behavioral
therapy, but in terms of a medicationto help you with your withdrawals.
I don't have anything that's approved.
And so it's, really frustrating forpatients because they need help today.
(23:55):
And there's of course the corecomponent that, that is best addressed
with longitudinal behavioral therapy.
And that includes trauma, it includescoping mechanisms, developing resilience,
and those are all very, important andvital aspects of a recovery journey.
But to get someone to the pointwhere they just feel okay, where they
(24:17):
feel well enough to engage in thosetherapies, I think is the missing piece.
And that's where I really see a futureof, pharmacotherapies coming in.
Dana R (24:28):
It's all so interesting.
You mentioned your colleagues in Texas,so this study doesn't happen in isolation.
I'm sure there's manyuniversities and research centers
working on things like this.
You're doing your work throughthe Kahlert Institute For
Addiction Medicine here at UMB.
How does being part of aninstitute like Kahlert shape the
(24:49):
research you're able to do and thecommunities you're able to reach?
Sarah Kattakuzhy (24:53):
Yeah, it's a beautiful question.
I think one of the reasons that wedeveloped the Kahlert Institute for
Addiction Medicine was to potentiatethe work that we're doing because
Baltimore and Maryland, unfortunately,have a longstanding history of drug
use, especially opioid use within ourcity, were disproportionately affected.
(25:18):
Until recently we were the city that hadthe largest, highest rate of overdose
death of, of cities in the country.
And so, we have a unique responsibilityto, not only do our work individually,
but to join hands and see how wecan potentiate our work and how
we can learn from each other.
And actually, an amazing exampleof that is in the STACK study is
(25:42):
that through the Kahlert Institute,I'm collaborating with my colleagues
at the Maryland Psychiatric ResearchCenter, Dr. Daniel Roche, who's conducting
a substudy where some patients aregoing to MPRC and having MRI scans.
And they're having brain scans before andafter their, uh, peak dose of medication.
(26:05):
Dan's team at the MPRC also doesn't knowif they're getting semaglutide or what we
call the placebo, but after the study'sdone, we'll be able to look and see, hey,
this person decreased their cocaine use.
Are we seeing any changes in theirbrain that might help us explain
that in addition to understandingthey're on semaglutide or not?
(26:27):
Because that's one of the missingpieces of semaglutide is that we know
how it affects diabetes and obesity,but we don't know exactly why it
works as a potential anti cravingdrug or an anti impulsivity drug.
So through these types of collaborations,and that's not a science that I know how
to do, but through the Kahlert Instituteand through these collaborations, we
(26:49):
can take the science to the next level.
We can answer questionsthat we can't alone.
I'm part of something called theNIDA Clinical Trials Network,
which is of course sponsored by theNational Institute of Drug Abuse.
It's a consortium of academic medicalcenters who are doing this type of work
in addiction That's really geared towardsthis question, how do we get new therapies
(27:13):
for people with substance use disorders?
And UMB and the Kahlert Institutefor Addiction Medicine, um, are
actually members of that, consortium.
We just became members last year.
So I'm really excited at the opportunityfor UMB to join this fight on a
larger scale to potentiate that work.
Dana Rampolla (27:34):
That's fantastic.
So you do sound veryhopeful, which gives me hope.
What would you like our listenersto take away from this conversation?
Sarah Kattakuz (27:45):
A couple things.
I would love for everyone to understandthat substance use disorders, are a
disease and they affect people's livesdifferently in the same way that diabetes
affects people's lives differently.
But like diabetes and like manychronic relapsing remitting
(28:08):
conditions, it's treatable.
There are absolutely people who,with and without medication,
based treatment can get better.
And I think that's the missing piecefrom a lot of the stories and the
headlines that we meet there is of course.
As you know, you shared earlier a lotof people who don't make it, and those
(28:28):
are the people we continue to fight for.
I want listeners to also understandthat if people are engaged in, good
treatment, both behavioral but alsomedication based treatment, individuals
get their best chance at recovery.
I don't wanna lose that thread,that recovery's absolutely possible.
(28:49):
I also think in this era, where there'sbeen a lot of scrutiny, around science and
what benefit it can provide to society.
I think that the addiction crisis inAmerica is a prime example of where we
need to invest heavily in science becausewhat we have right now is just not enough.
(29:11):
We can't forget our boots on the ground,people who are delivering service.
That is first and foremost to prevent.
Further death, but we need toalso look to the future for
how we can curb, these trends.
And that's where science, I thinkinvestment in science really helps.
I think those are twomessages to, to really share.
(29:33):
And also, you know, if you or a loved oneknow some, an individual with substance
use disorder, just remember that substanceuse disorders really thrive in isolation.
They thrive in with, inshame and in darkness.
And so really shedding a light,offering compassion, helping
link people to services isalways something that you can do.
(29:55):
And it never, never give up hope on that.
Dana Rampol (29:58):
And my big takeaway question for you, Sarah, is if one
of our listeners has a family member,friend, loved one who has one of these
stimulant disorders, can they reach out?
How do we connect themwith you or your team?
Sarah Kattakuzh (30:13):
Not only can we help link you to this study, which I
think is important, but primarily ifanyone needs care for a substance use
disorder, we have an incredible divisionof addiction research and treatment in
the Department of Psychiatry led by Dr.
Eric Weintraub, that has incredible careAnd, that's not just here in Baltimore.
(30:34):
We have a network of telemedicineproviders throughout the state.
So, please get in touch with me.
I can make the referrals.
Hopefully I can pass oncontact information that we
can include in the show notes.
I'm the only Kattakuzhy at UMB,so it's pretty easy to find me.
but certainly for my study, uh, youknow, our, our work is really focused
on people with cocaine use disorderand there's a couple other criteria.
(30:58):
You can't be too thin, Mainly ifpeople are interested, they can contact
me again and I'll put them in touchwith our team, to get evaluated.
we would love those referrals.
Dana Ra (31:08):
That would be fabulous.
And you said there is a telehealthoption, so it's not just people right
here in the city or in the county.
How about people from other states?
So there other types of programs?
Sarah Kattakuzhy (31:20):
Absolutely.
I think we have really strongclinical connections, especially
in our neighboring states.
Pennsylvania, D.C., Virginia, et cetera.
So wherever you are, please reach out.
It's a, you know, a very small communityof addiction providers and we wanna
make sure people get linked to care.
Dana Rampolla (31:37):
thank you so much for sharing this with us.
I think it's so interesting that whenwe have medications and we know of
other examples, minoxidil and a numberof other different things, who start
out with one purpose and then wind upsolving some other dilemma or crisis.
So I'm so interested andintrigued by what you've shared.
We will definitely spread the wordand just thank you, thank you for
(32:00):
being part of the research here atUniversity of Maryland, Baltimore,
and as you said, research does matter.
We need to keep funding coming forbecause this is all so important.
So thank you Sarah,
Sarah Kattak (32:10):
thank you so much.
Charles S (32:13):
After Dana wrapped up her conversation with Dr. Sarah Kattakuzhy
we stayed on for a few minutes longerto talk about some of the biggest open
questions around GLP-1 medications, Oneof the biggest questions is what happens
after someone stops taking a GLP one?
Sarah Katta (32:29):
We actually amended our protocol to add on an optional
extension study , the study is fourmonths long and we are actually
going to follow people after theystop semaglutide versus placebo.
We'll follow them for an additionalsix months because one of the
concerns is that actually therewas a, an article published in the
(32:53):
British Medical Journal very recentlythat talked about the significant and
very rapid weight gain that people haveafter discontinuing these medications.
And so if we try to make that inparallel, we're not sure if we'll
see a reduction in cocaine use, butwill there be a rebound, for example,
(33:14):
if there's an anti craving effect?
If you stop these medications, willyou then have a rebound craving
that leads people to binge use?
Charles Schelle (33:22):
That question whether cravings return is something
researchers are actively watching.
And it ties directly into howDr. Kattakuzhy thinks about
addiction treatment more broadly.
Sarah Kattakuzhy (33:35):
These are lifelong conditions that really
require lifelong treatment.
And so in the way that I prescribemethadone or buprenorphine, and we
say there's no end date in sight, weprescribe these medications as long
as the benefits outweigh the risks.
And that's really what ourguidelines tell us to do.
And I would approach these in thesame way if there is eventually to be
(33:57):
discovered that there is an efficacyfor reduction in substance use.
I would say the first questionis not when can we stop.
It's, you know, how do we use thesemedications to gain stability in people's
lives and then try to understand,these secondary questions,
Charles Schelle (34:14):
That's also why dosing and duration are
still very much open questions
Sarah Kattakuzhy (34:19):
So we may get an anti craving effect.
At a lower dose we might nothave to go up to two or, you
know, high or higher dosing.
The effect and the dose, are reallyimportant questions that we just don't
know enough about, but it is somethingthat I am concerned about as a clinician,
as a scientist, and which is why Inever say like this is the answer.
Charles (34:41):
As GLP one medications move into pill form, those questions
expand even further, especiallyaround access and patient choice.
Sarah Kattakuz (34:51):
I think like any other patient population, being able to
provide options for individuals so thatthey can really make the best choices
for themselves is absolutely vital.
So I am really thrilled thatthere's oral options moving forward.
Charles Schelle (35:06):
Throughout all of this, Dr. Kattakuzhy is
careful to emphasize that sciencedoesn't move in straight lines.
Sarah Kattakuz (35:13):
Every time we've said we have a solution for something,
we know that there are new problems.
That's part of how the prescriptionopioid overdose crisis came about, is
that we said we have a cure for painand it's these prescription opioids.
We have to be cautious.
But I do think one frame shift isthat, most addictive disorders we
(35:35):
consider chronic relapsing remittingconditions in the same way we
would say diabetes or depression.
Charles Sch (35:41):
Just as we're still learning how GLP-1s work for diabetes,
heart disease, and weight loss,researchers are asking the same careful
questions about their role in addiction.
Jena (36:00):
The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB
Office of Communications and PublicAffairs production edited by Charles
Schelle, marketing by Dana Rampolla.
Addiction is one of those issues that almost everyone
touches through personal experiencesor someone they love or know.
And treatments for addictionhaven't changed much in decades,
but they could soon change thanksto some surprising research.
You're probably familiar with medicationsused for diabetes that also have the
benefits of weight loss, and you'veprobably heard of them as Ozempic Wegovy
(00:22):
or Mounjaro, or even just a GLP-1, orsome people call them semaglutides All of
these medications help to slow digestionand quiet cravings or that food noise
we hear about, and they're now beinginvestigated to see if they can quiet
cravings for cocaine and methamphetamine.
That possibility has piqued theinterest of Dr. Sarah Kattakuzhy at
(00:44):
the University of Maryland Baltimore.
Dr. Kattakuzhy is an associate professorat the University of Maryland School of
Medicine and co-director of the KahlertInstitute for Addiction Medicine.
She is overseeing a clinical trial tosee if semaglutides can reduce cocaine
abuse and improve drug use outcomes.
Can the brain's reward response besuppressed for drugs much like it can be
(01:07):
for food with these medications, whilealso reducing stigma and inducing hope?
Find out that and more in our conversationwith Dr. Kattakuzhy on the UMB Pulse.
Jena Frick (01:22):
You are listening to the heartbeat of the University of
Maryland, Baltimore, the UMB Pulse.
Dana Rampolla (01:35):
Sarah, welcome.
Thank you for joining the podcast We'relooking forward to learning a lot.
Sarah Kattak (01:41):
Thank you so much.
It's a pleasure to be here.
Dana Ra (01:43):
So let's jump right in.
Start out by taking me to aTuesday afternoon, either in your
clinic or out in the community.
Describe the setting.
Let me know what's going on.
Kind of paint a picture forus that captures what your
daily work really looks like.
Sarah Kattakuzhy (01:58):
Wow.
Okay.
Well, how much time do we have?
I'm at a point in my career whereI have the pleasure of helping
co-lead, a large research programcalled the Research Initiative in
Infectious Disease and Substance Use.
Our goal is really to produce noveltherapeutics and approaches for people
(02:19):
disproportionately affected by substanceuse disorder and HIV epidemics.
That's really the crux of our work.
To accomplish this, wepartner with community-based
organizations, uh, that are in.
Baltimore and Washington DC toreally try and get at the patient
population, that's disproportionatelyaffected by these conditions.
(02:40):
And meet them where they are incommunity-based settings where
they feel comfortable, wherethey're receiving other services.
And then we kind of are able toalign our clinical care and research
alongside that to make thingsconvenient and culturally competent.
So, as I said, I'm, one of theco-directors along with my colleagues,
(03:01):
Dr. Elana Rosenthal and Dr. Rachel Silk.
We've been leading the program for.
over a decade.
And so on a, on a regular Tuesday,you'll see me, checking in with our
boots on the ground team, figuring outhave all the patients been seen and
what still needs to be accomplished.
We have a number of researchmeetings, that are trying to figure
(03:23):
out, who's been seen, who needsto be seen, who, lost their phone,
so how are we gonna contact them?
so it's a lot of management andcoordination, but our science, is really
focused on our active protocols, One ofour most active protocols right now, is
looking at, semaglutide or, you know,goes by a lot of names, Ozempic Wegovy
(03:45):
in people with cocaine use disorder.
Depending on the day of the week, wehave that active clinic that is seeing
those patients for that protocol,which requires a lot of management.
Dana Rampolla (03:56):
I am sure.
you just touched on everythingI'm hoping we'll talk about today,
before we, jump into the crux of it,tell me if there was a period or an
experience or maybe a patient thatchanged how you understood addiction.
Sarah (04:12):
That's a great question.
Like most people, your careeris a series of happy accidents
and right place, right time.
after I did my medical training and chiefresidency at George Washington University
Hospital in Washington DC I actuallytook a job at the National Institute
(04:33):
for Allergy and Infectious Disease.
My initial goal was really tobecome an HIV primary care provider.
I wanted to learn the guidelinesfrom the people who write them.
At that time, HIV medicine was a lotmore complicated than it is today.
While I was at the NIH is whenthey actually were doing the first
studies on what would become, today'snovel therapeutics for Hepatitis
(04:57):
C, the direct acting antivirals.
And I got to see in front of my eyesas this disease during my training
was, very poorly treated and tolerated.
I got to see people curedin front of my eyes.
So that was miraculous and what reallybrought me into clinical research,
as a way that I could approachmy medical care linking in public
(05:20):
health, which is very important to meBeing able to understand, not just how do
we get new therapies to people who needit most, but what's the missing piece?
what brought me to addiction is, isactually that the next stepping stone
is that I was doing Hepatitis C carebetween Baltimore and Washington
DC in 2013 to 2014, and that is theexact time that Fentanyl hit the
(05:46):
illicit drug supply in those regions.
And so these patients that I wastreating and curing of Hepatitis C,
more than one of them, died of a drugoverdose or was reinfected because
of their ongoing substance use.
that really lit a fire under me.
To say, if we're really looking at thisissue from a public health perspective,
(06:09):
we always think about upstream causes oreven in the field of infectious diseases.
We think of the source, what is the sourceof the infection and the source and the
upstream cause of hepatitis C in someindividuals, HIV, and complications is
really the substance use and addiction.
And that is what really caused me topivot my career to looking towards
(06:34):
the overlap and the intersection ofboth addiction and infectious disease.
And so it's more than one patient,but I can still remember them.
Especially all the patients we'velost to the ongoing, overdose death
crisis in the U.S., and these patientscontinue to reinforce the work I do.
Dana Ram (06:52):
I can definitely, feel that connection for me personally, I'm
so drawn to your story and research.
I have an adopted brother.
He was adopted at birth and dieda few years ago from an overdose.
He had been a heroin user andsomehow got fentanyl mixed into it.
I remember years ago talking tohim about his addiction and saying
(07:13):
Just take that energy, that desire,and put it into something else, like
thinking this is all mental justwork out, you know, start a workout
program or train for a marathon.
And I remember him saying it'snot that easy, it's physical.
I can't live without it.
So when there's someone who is, usingto a point that they are addicted.
(07:34):
We look at other drugs like thesesemaglutides you mentioned, as a
family member, I find hope in that.
Talk a little bit about, you know,we've all heard of ozempic, wegovy,
Is it possible this will actuallybe a treatment for a substance
disorder like cocaine addiction?
Sarah Kattakuzhy (07:51):
thank you for your honesty and for sharing
and just wanna reinforce how,unfortunately, common your story is.
I think about, our world today andkitchen table issues what brings
us together are becoming, a smallerand smaller slice of the pie.
But unfortunately, having aloved one with substance use
disorder is one of those issues.
(08:13):
It affects so many families in America.
It does not matter your socioeconomicclass, race, religion, creed,
it has affected all of us.
I really wanna thank you for sharing that.
I see hope for the future ofsubstance use disorder, care and
treatment for a number of reasons.
before I address my research andthe field of substance use disorder
(08:37):
treatment, I will say one greatpiece of data that we have now is
that the number of overdoses for thefirst time seem to be on a decline.
And that's for a number of reasons.
I do think we've turned an importanttide in terms of the number of deaths
from drug overdose deaths does notmean that, it, it's been solved.
(09:00):
There's still an unacceptableamount of overdose death but
it has declined from its peak.
we feel good about those trends.
In terms of other things that give mehope, as a clinician and scientist,
finding new therapies for people whouse drugs, is an area of excitement
and hope because, you know, opioiduse disorder, we have excellent
(09:24):
medications, methadone, buprenorphine.
Amongst others, that have very highefficacy in terms of keeping people alive
and reducing their drug consumption.
Unfortunately that is not thecase when you apply to stimulant
use disorders, and that includescocaine and methamphetamines.
(09:46):
We do not have any FDA approved treatmentsfor those particular drugs, and there's a
lot of exciting science that's happeningaround the world and around the globe.
one of those is exploring the use ofGLP one agonists, like Semaglutide or
Tirzepatide or, their, you know, othernames, Wegovy, Ozempic, et cetera.
(10:09):
The way that we really think about it andhow this came about as an area to explore.
Is that when these drugs were beingutilized in people with diabetes or
people with obesity, individuals whowere taking it reported, Hey, you
know, I have lost a lot of weight.
(10:29):
My relationship with food has changed.
I'm making different choicesabout food, but also I don't
feel like drinking anymore.
these observations led scientists,who were, of course we have our basic
science colleagues who are lookingat things on molecular levels, in
animal models, that really tried tounderstand, you know, there are, if
(10:51):
we look at the sort of more scientificlevel, there are receptors for GLP, not
only in the stomach and the, you know.
Our GI system, but also inour central nervous system.
So we know that people change theway they're making decisions about
food when they're on GLP ones.
Could this apply to other substances?
(11:13):
Could this apply to alcohol?
Could it apply to cocaine?
And is one of the ways that the GLP oneswork, could it be around impulsivity?
Could it be around craving?
And these are all words that in thefield of addiction are really important
because they're features that arecentral to, as you mentioned, it's not
(11:38):
just an issue of willpower, it's thecentral nervous system really being
hijacked to prioritize the consumptionof drugs in order to just achieve,
a sense of normality in the brain.
And so is, it possible that the GLP oneagonist could be used to help control some
(11:58):
of that craving, to reduce the craving,to reduce the impulsivity, to keep the
brain at more of that neutral state sothat people can make healthier choices
about what they're consuming, includingeliminating or reducing their drug use.
The science right nowis that we don't know.
We definitely do not know.
There are preliminary studies, inalcohol use disorder is the main
(12:24):
place that it's been, studied.
But, we are, we're stillreally exploring that.
So I have a lot of hope, but it, itreally has to be borne out by the science.
Dana Rampolla (12:34):
tell me then a little bit about the clinical trial
that you're overseeing and howlong have you been working on it?
How long do you think something like thistakes to have data that allows you to move
forward to the, like the FDA for approval?
Sarah Kattakuzhy (12:47):
the way that, drug development typically works,
and I'm gonna super simplify it,is that you have different stages.
The first is asking the question, isthis drug safe for the patient population
that you would like to use it in?
Is it tolerable?
Can it be used safely in humans?
And so we know because these drugshave actually been around for quite
(13:10):
some time and have been, of course,approved in diabetes and obesity.
now the question is, are they safeand tolerable in people who don't have
those conditions but have a differentcondition, like a substance use disorder?
our study, is evaluating The acronymis the Stack Study, but it's really
safety and tolerability of semaglutidein people with cocaine, use disorder,
(13:34):
inclusive of people with and without.
HIV.
this study is really trying tofigure out is it safe and will
people take it, and is it tolerable?
So that means, you know, you mayhave a drug that you're like,
ah, you know, I get a little bitof upset stomach when I take it.
It doesn't stop me fromtaking the medicine.
And so I would consider it tolerable.
(13:56):
Or you could have a medicine that'slike, Hey, I know that my lab
work looks great, but I just don'tlike the way it makes me feel.
And that makes it intolerable becauseno matter what, it doesn't help anyone
if you have a medication no one willtake, in this study, our primary
outcome, the thing we're looking atmost is, is it safe and is it tolerable?
(14:18):
And then the second things we'relooking at are the secondary outcomes
is it able to reduce drug use?
Are people spending less moneyon cocaine than they used to?
Are they reporting less craving?
Does their urine show lesspositive urine drug screens for
cocaine than before they started?
And what is happening withother aspects of craving?
(14:40):
Are they still, making good choicesabout other aspects of their life?
Do they still feel, like they're ableto have pleasure in everyday life?
are we able to see if these GLP onescan be used to take away the urges and
the cravings that aren't beneficialwithout reducing everything that
(15:01):
brings pleasure from everyday life?
So these are all secondaryoutcomes that we're exploring.
Dana Ramp (15:07):
how do you explain it when you're talking to the patient
who probably doesn't, well could,but probably doesn't have your level
of education so they can kind ofunderstand what's going on with their
brain and what the hopeful outcome is?
Sarah Kattakuzh (15:20):
we have a great relationship with our patient population
because of the setup of our researchprogram, and I think because we have.
Just the best research team and thebest providers, who really offer
patient-centered care, even inthe setting of ongoing research.
the way we consent individuals is wesay, this is a study that may or may
(15:43):
not be beneficial to you as a person.
And in fact, there are somerisks that are involved.
the reason we're doing this studyis because as you know, as someone
with cocaine use disorder, there'sno treatments that are approved by
our medical system for cocaine use.
And this study is the first stepin helping us figure out, can we
(16:04):
use these new drugs that you'veprobably heard of in the news?
Can we use them in peoplewith cocaine use disorder?
And this is the first step.
And so this is a randomized controlledtrial, which means that 50% of the
people get the actual drug semaglutideand 50% get a matching placebo
I don't know which one they get,only one person on our team does.
(16:29):
And so the patient doesn'tknow and I don't know.
So I can tell them very clearly, youhave a 50% chance of being on the
medication and there is no guaranteethat this will have any benefit to you.
And I've gotta tell you, people are sowilling to participate in this 'cause
(16:51):
they want to have a contribution to movingthis field forward and they want some
hope, even if it's not for themselves.
So I just have so much respect forall of our patient participants,
because they do really understandthat going into the protocol.
especially 'cause it's a blinded study.
Dana (17:10):
Yeah, that's really great.
Great to understand.
Also, help me understand if someonedoesn't have diabetes or say an
issue with their weight loss.
Yeah.
How can semaglutide can work withthe brain to treat drug addiction
while not impacting their insulindigestion or food cravings.
Sarah Kattakuzhy (17:27):
Yeah.
So I have to tell you this is part ofwhat we're exploring, because we know
from previous studies of obesity thatthe data overwhelmingly suggests that
if you are someone who is of a normalor thin body habitus at baseline, you
have a much lower degree of weightloss than individuals who are obese.
(17:52):
Meaning not everyone who takessemaglutide is gonna lose 50 pounds.
It really depends on whatyour starting set point is.
And of course, the multitudereasons behind the obesity.
I think we're figuring that outas more Americans are on a GLP
one agonist, that there are superresponders who are people who are
gonna lose 40 pounds in three months.
(18:15):
And there are people who really need to goto the highest dose and beyond this for a
long time before they see some, response.
So as that relates to people with cocaineuse disorder, we have to look out for.
Weight loss in them.
This is part of our,our safety evaluation.
We have to be able to look out are theyconsuming less food because we know
(18:38):
these are effects of the medication.
So these are things that we're,we're trying to evaluate science.
Dana Rampolla (18:45):
Oh, I'm sorry.
I was just gonna ask, aren'ttypically cocaine users?
Maybe I'm generalizing, butthey're usually thinner anyway.
Sarah K (18:51):
That's exactly right is that people with cocaine use disorder in
general have a much thinner body habituscompared to your standard non, person
who does not have cocaine use disorderbecause of the action of the cocaine.
Or the methamphetamine, their stimulants.
And part of what they do in the bodyis to naturally suppress the appetite.
(19:12):
So that is a big part ofour safety considerations.
We actually have, something calledthe in-body machine, which is like
if you have a fancy gym membership,you might have it there, but it's a
machine that uses electrical impedanceto measure the difference between
water fat and muscle in the body.
And so we have every single one ofour patients, complete an in-body
(19:36):
scan at multiple time points.
And that's because I'm not justconcerned about their weight.
We know that from other studies of GLPones that about up to 30% of the weight
that people lose is actually muscle.
And so in individuals who are alreadyon the thinner side, are they going
to lose a lot of their muscle mass?
(19:59):
Are we going to put them into whatwe would medically term sarcopenia?
And would that, make any benefit thatthey get from reduced cocaine use?
Would that be imbalanced becauseof the negative side effects?
So we take safety really seriously,and that's why we're so rigorously
evaluating this, as our primary outcome.
Dana Rampoll (20:22):
Well, and you said that there is no FDA approved
medication for cocaine or otherstimulant abuse or addiction?
what does this gap mean for the peoplewho you're working with every day?
are you hopeful that this,obviously you're hopeful that it
will work, how do you see that gapexpanding or closing more quickly?
Sarah Kattak (20:41):
I think it is such a challenge because we are now in what
we consider the fourth wave of the drugoverdose death crisis, which is that,
you know, initially there was a lot ofdeath related to prescription opioids.
(21:01):
And that really shifted to deathspredominantly, related to heroin
use as prescription opioids overprescription of opioids was pulled
back and people who were dependentbecame, then developed, heroin misuse.
And then as Fentanyl hit theillicit drug supply, as I described
(21:21):
at the top of our conversation,that really became the third wave.
And so what we're in now, what'sbeen described in the literature
is this fourth wave, which is acombination of opioids and stimulants.
And we're seeing it, in a lotof specific patient populations.
But stimulant use has reallyreplaced opioids or at least
(21:42):
brought in parallel with opioids,uh, opioid use in the west coast,
and a lot of the Midwest.
So For example, in Texas, mycounterparts and colleagues in Texas,
their predominant patient populationthat they're struggling to treat are
individuals with stimulant use disorder,with methamphetamine use disorder.
Here in Maryland, you know, I treat arural patient population of individuals
(22:06):
with opioid use disorder, and that'swhere I see a lot of the co- use of
methamphetamines Here in the city.
I see a ton of cocaine use anda lot of cocaine use disorder in
individuals who already have use ofopioids and those who don't as well.
I think, this is a strong issuebecause we know that cocaine and
(22:29):
methamphetamine is also going toincrease your likelihood of overdose.
These can also becontaminated with fentanyl.
So even if you're someone whodoesn't have an opioid use disorder.
You're still at very highrisk of overdose death.
And of course the way that you usethese drugs can lead to lots of,
challenges like infectious complications.
(22:50):
And you know, for example, if you'reinjecting drugs, can lead to acquiring
HIV or Hepatitis C or other diseases.
So, I think there's a gap.
In the way that we approach stimulants,because we don't have good science to say,
yes, this is the treatment you should use.
(23:11):
We have professional guidelinesthat say, Hey, you can try these.
You know, about seven different kinds ofmedication that we can try, but none of
those have risen to the level of efficacythat's required to get an FDA label.
So how this bears out for the averagepatient is that if they make it to
a doctor, if they make it to me tosay, I really want treatment for my
(23:33):
cocaine use disorder, I can say we havereally great behavioral interventions
that we know work, like contingencymanagement, cognitive behavioral
therapy, but in terms of a medicationto help you with your withdrawals.
I don't have anything that's approved.
And so it's, really frustrating forpatients because they need help today.
(23:55):
And there's of course the corecomponent that, that is best addressed
with longitudinal behavioral therapy.
And that includes trauma, it includescoping mechanisms, developing resilience,
and those are all very, important andvital aspects of a recovery journey.
But to get someone to the pointwhere they just feel okay, where they
(24:17):
feel well enough to engage in thosetherapies, I think is the missing piece.
And that's where I really see a futureof, pharmacotherapies coming in.
Dana R (24:28):
It's all so interesting.
You mentioned your colleagues in Texas,so this study doesn't happen in isolation.
I'm sure there's manyuniversities and research centers
working on things like this.
You're doing your work throughthe Kahlert Institute For
Addiction Medicine here at UMB.
How does being part of aninstitute like Kahlert shape the
(24:49):
research you're able to do and thecommunities you're able to reach?
Sarah Kattakuzhy (24:53):
Yeah, it's a beautiful question.
I think one of the reasons that wedeveloped the Kahlert Institute for
Addiction Medicine was to potentiatethe work that we're doing because
Baltimore and Maryland, unfortunately,have a longstanding history of drug
use, especially opioid use within ourcity, were disproportionately affected.
(25:18):
Until recently we were the city that hadthe largest, highest rate of overdose
death of, of cities in the country.
And so, we have a unique responsibilityto, not only do our work individually,
but to join hands and see how wecan potentiate our work and how
we can learn from each other.
And actually, an amazing exampleof that is in the STACK study is
(25:42):
that through the Kahlert Institute,I'm collaborating with my colleagues
at the Maryland Psychiatric ResearchCenter, Dr. Daniel Roche, who's conducting
a substudy where some patients aregoing to MPRC and having MRI scans.
And they're having brain scans before andafter their, uh, peak dose of medication.
(26:05):
Dan's team at the MPRC also doesn't knowif they're getting semaglutide or what we
call the placebo, but after the study'sdone, we'll be able to look and see, hey,
this person decreased their cocaine use.
Are we seeing any changes in theirbrain that might help us explain
that in addition to understandingthey're on semaglutide or not?
(26:27):
Because that's one of the missingpieces of semaglutide is that we know
how it affects diabetes and obesity,but we don't know exactly why it
works as a potential anti cravingdrug or an anti impulsivity drug.
So through these types of collaborations,and that's not a science that I know how
to do, but through the Kahlert Instituteand through these collaborations, we
(26:49):
can take the science to the next level.
We can answer questionsthat we can't alone.
I'm part of something called theNIDA Clinical Trials Network,
which is of course sponsored by theNational Institute of Drug Abuse.
It's a consortium of academic medicalcenters who are doing this type of work
in addiction That's really geared towardsthis question, how do we get new therapies
(27:13):
for people with substance use disorders?
And UMB and the Kahlert Institutefor Addiction Medicine, um, are
actually members of that, consortium.
We just became members last year.
So I'm really excited at the opportunityfor UMB to join this fight on a
larger scale to potentiate that work.
Dana Rampolla (27:34):
That's fantastic.
So you do sound veryhopeful, which gives me hope.
What would you like our listenersto take away from this conversation?
Sarah Kattakuz (27:45):
A couple things.
I would love for everyone to understandthat substance use disorders, are a
disease and they affect people's livesdifferently in the same way that diabetes
affects people's lives differently.
But like diabetes and like manychronic relapsing remitting
(28:08):
conditions, it's treatable.
There are absolutely people who,with and without medication,
based treatment can get better.
And I think that's the missing piecefrom a lot of the stories and the
headlines that we meet there is of course.
As you know, you shared earlier a lotof people who don't make it, and those
(28:28):
are the people we continue to fight for.
I want listeners to also understandthat if people are engaged in, good
treatment, both behavioral but alsomedication based treatment, individuals
get their best chance at recovery.
I don't wanna lose that thread,that recovery's absolutely possible.
(28:49):
I also think in this era, where there'sbeen a lot of scrutiny, around science and
what benefit it can provide to society.
I think that the addiction crisis inAmerica is a prime example of where we
need to invest heavily in science becausewhat we have right now is just not enough.
(29:11):
We can't forget our boots on the ground,people who are delivering service.
That is first and foremost to prevent.
Further death, but we need toalso look to the future for
how we can curb, these trends.
And that's where science, I thinkinvestment in science really helps.
I think those are twomessages to, to really share.
(29:33):
And also, you know, if you or a loved oneknow some, an individual with substance
use disorder, just remember that substanceuse disorders really thrive in isolation.
They thrive in with, inshame and in darkness.
And so really shedding a light,offering compassion, helping
link people to services isalways something that you can do.
(29:55):
And it never, never give up hope on that.
Dana Rampol (29:58):
And my big takeaway question for you, Sarah, is if one
of our listeners has a family member,friend, loved one who has one of these
stimulant disorders, can they reach out?
How do we connect themwith you or your team?
Sarah Kattakuzh (30:13):
Not only can we help link you to this study, which I
think is important, but primarily ifanyone needs care for a substance use
disorder, we have an incredible divisionof addiction research and treatment in
the Department of Psychiatry led by Dr.
Eric Weintraub, that has incredible careAnd, that's not just here in Baltimore.
(30:34):
We have a network of telemedicineproviders throughout the state.
So, please get in touch with me.
I can make the referrals.
Hopefully I can pass oncontact information that we
can include in the show notes.
I'm the only Kattakuzhy at UMB,so it's pretty easy to find me.
but certainly for my study, uh, youknow, our, our work is really focused
on people with cocaine use disorderand there's a couple other criteria.
(30:58):
You can't be too thin, Mainly ifpeople are interested, they can contact
me again and I'll put them in touchwith our team, to get evaluated.
we would love those referrals.
Dana Ra (31:08):
That would be fabulous.
And you said there is a telehealthoption, so it's not just people right
here in the city or in the county.
How about people from other states?
So there other types of programs?
Sarah Kattakuzhy (31:20):
Absolutely.
I think we have really strongclinical connections, especially
in our neighboring states.
Pennsylvania, D.C., Virginia, et cetera.
So wherever you are, please reach out.
It's a, you know, a very small communityof addiction providers and we wanna
make sure people get linked to care.
Dana Rampolla (31:37):
thank you so much for sharing this with us.
I think it's so interesting that whenwe have medications and we know of
other examples, minoxidil and a numberof other different things, who start
out with one purpose and then wind upsolving some other dilemma or crisis.
So I'm so interested andintrigued by what you've shared.
We will definitely spread the wordand just thank you, thank you for
(32:00):
being part of the research here atUniversity of Maryland, Baltimore,
and as you said, research does matter.
We need to keep funding coming forbecause this is all so important.
So thank you Sarah,
Sarah Kattak (32:10):
thank you so much.
Charles S (32:13):
After Dana wrapped up her conversation with Dr. Sarah Kattakuzhy
we stayed on for a few minutes longerto talk about some of the biggest open
questions around GLP-1 medications, Oneof the biggest questions is what happens
after someone stops taking a GLP one?
Sarah Katta (32:29):
We actually amended our protocol to add on an optional
extension study , the study is fourmonths long and we are actually
going to follow people after theystop semaglutide versus placebo.
We'll follow them for an additionalsix months because one of the
concerns is that actually therewas a, an article published in the
(32:53):
British Medical Journal very recentlythat talked about the significant and
very rapid weight gain that people haveafter discontinuing these medications.
And so if we try to make that inparallel, we're not sure if we'll
see a reduction in cocaine use, butwill there be a rebound, for example,
(33:14):
if there's an anti craving effect?
If you stop these medications, willyou then have a rebound craving
that leads people to binge use?
Charles Schelle (33:22):
That question whether cravings return is something
researchers are actively watching.
And it ties directly into howDr. Kattakuzhy thinks about
addiction treatment more broadly.
Sarah Kattakuzhy (33:35):
These are lifelong conditions that really
require lifelong treatment.
And so in the way that I prescribemethadone or buprenorphine, and we
say there's no end date in sight, weprescribe these medications as long
as the benefits outweigh the risks.
And that's really what ourguidelines tell us to do.
And I would approach these in thesame way if there is eventually to be
(33:57):
discovered that there is an efficacyfor reduction in substance use.
I would say the first questionis not when can we stop.
It's, you know, how do we use thesemedications to gain stability in people's
lives and then try to understand,these secondary questions,
Charles Schelle (34:14):
That's also why dosing and duration are
still very much open questions
Sarah Kattakuzhy (34:19):
So we may get an anti craving effect.
At a lower dose we might nothave to go up to two or, you
know, high or higher dosing.
The effect and the dose, are reallyimportant questions that we just don't
know enough about, but it is somethingthat I am concerned about as a clinician,
as a scientist, and which is why Inever say like this is the answer.
Charles (34:41):
As GLP one medications move into pill form, those questions
expand even further, especiallyaround access and patient choice.
Sarah Kattakuz (34:51):
I think like any other patient population, being able to
provide options for individuals so thatthey can really make the best choices
for themselves is absolutely vital.
So I am really thrilled thatthere's oral options moving forward.
Charles Schelle (35:06):
Throughout all of this, Dr. Kattakuzhy is
careful to emphasize that sciencedoesn't move in straight lines.
Sarah Kattakuz (35:13):
Every time we've said we have a solution for something,
we know that there are new problems.
That's part of how the prescriptionopioid overdose crisis came about, is
that we said we have a cure for painand it's these prescription opioids.
We have to be cautious.
But I do think one frame shift isthat, most addictive disorders we
(35:35):
consider chronic relapsing remittingconditions in the same way we
would say diabetes or depression.
Charles Sch (35:41):
Just as we're still learning how GLP-1s work for diabetes,
heart disease, and weight loss,researchers are asking the same careful
questions about their role in addiction.
Jena (36:00):
The UMB Pulse with Charles Schelle and Dana Rampolla is a UMB
Office of Communications and PublicAffairs production edited by Charles
Schelle, marketing by Dana Rampolla.
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