Semaglutide for Helping Opioid Recovery

Inclusion Criteria * English-speaking adults aged 18 or older * DSM-5 diagnosis of severe opioid use disorder (OUD) * Receiving buprenorphine ≥16 mg/day or methadone ≥70 mg/day for at least 30 days prior to enrollment * Planning to continue buprenorphine or methadone treatment throughout the study * Willing to bring buprenorphine prescriptions to visits for dose counts (if applicable) * Willing to authorize communication between the study team and their MOUD prescriber via a 42 CFR release Exclusion Criteria * Active psychosis, suicidality, homicidality, or psychiatric conditions impairing capacity to consent * Current or lifetime history of an eating disorder * BMI \<21 kg/m² * Current or lifetime diagnosis of Type 1 or Type 2 diabetes * Personal or family history of medullary thyroid carcinoma or MEN2 * GLP-1 receptor agonist use within the past 3 months or anticipated use during the study * Myocardial infarction, stroke, unstable angina, or congestive heart failure within the past 90 days * Persistently elevated BP (\>160 mmHg systolic or \>100 mmHg diastolic) during screening * History of inflammatory bowel disease, bariatric surgery, idiopathic pancreatitis, or diabetic gastroparesis * Liver function tests \>3x the upper limit of normal or eGFR \<30 * History of hypersensitivity or allergy to semaglutide * Pregnancy or breastfeeding * Anticipated participation in another investigational drug trial * Any other condition that investigators determine may interfere with participation or pose a safety concern