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Among people with pre-existing SUDs, initiation of GLP-1 receptor agonists was associated with reduced risk of SUD related emergency department visits (0.69 (0.61 to 0.78), NRD 8.92 (11.59 to 6.25)), SUD related hospital admissions (0.74 (0.65 to 0.85), NRD 6.23 (8.73 to 3.74)), and SUD related mortality (0.50 (0.32 to 0.79), NRD 1.52 (2.32 to 0.72)), and drug overdose (0.61 (0.42 to 0.88), NRD 1.49 (2.43 to 0.55)) and suicidal ideation or attempt (0.75 (0.67 to 0.83), NRD 9.95 (13.14 to 6.77))