When Lucy, a psychiatrist practicing in the Northeast, saw one of her patients after she started using Ozempic, a drug that has exploded in popularity in recent months, she could tell that something was off. Lucy’s patient was getting her medication from a medical spa, and it was clear there were other additives in the medicine making her jittery and agitated. And it wasn't cheap. On top of the negative side effects, she was also paying $2,000 a month for her prescription, Lucy said.
“I think it was effective for her, but the additives they put in it were not great for her,” Lucy, who asked to be referred to by her first name, told Salon in a phone interview. “There were, I think, a little bit of various supplements that help with weight loss, and a lot of those are pretty psychoactive and make people anxious.”
Lucy takes Ozempic (which has the generic name semaglutide) herself and is a part of many Ozempic public forum groups on social media. Originally approved by the Food and Drug Administration (FDA) in 2017 to treat type 2 diabetes, many forms of semaglutide are increasingly being prescribed off-label for weight loss, including Wegovy, which has a different dosage that is FDA-approved for weight loss. However, Lucy had to leave several online groups because moderators were trying to sell various shady forms of the drug, she said.
“It’s an alarming trend out there of these predatory people being involved with this medication,” Lucy said. “A lot of people will go to pill mills online and get various people ‘prescribing’ [weight loss drugs for them] when they haven’t even talked to a physician.”
Ozempic is in a class of drugs called a glucagon-like peptide-1 (GLP-1) receptor agonists. They work by mimicking hormones in the gastrointestinal tract the body naturally produces to reduce blood sugar and control appetite. Though these drugs have been around for a few years, their popularity rose significantly in 2023 after celebrities like Oprah Winfrey and Elon Musk began attributing their weight loss to semaglutide. Between 2020 and the end of last year, the number of prescriptions for Ozempic and similar weight loss drugs — such as Rybelsus tablets, which were FDA-approved to lower blood sugar in adults with type 2 diabetes — increased 300 percent.
Kelli Coviello, a principal's assistant at an elementary school in Massachusetts, said Ozempic was life-changing for her. The medication made her eat less and also took away some of her joint pain and other things associated with her weight that made it more difficult to stay motivated to exercise. Yet pretty soon after she started taking it, she could no longer find it due to the shortage and hasn’t taken a dose since late November 2023.
“I felt like the way I used to, and it felt really good,” Coviello told Salon in a phone interview. “It gave me this motivation that this is really going to work, I'm feeling myself and I can start exercising again.”
A skyrocketing demand along with high prices for these weight loss drugs led to a global shortage that made them inaccessible for many. Pharmaceutical companies also hyped up demand with an aggressive marketing strategy more than they ramped up supply, said Margaret Steele, a postdoctoral researcher who studies obesity and the philosophy and ethics of medicine at the School of Public Health at University College Cork.
In particular, Novo Nordisk was banned from the industry body of pharmaceutical companies in the U.K., the Association of the British Pharmaceutical Industry (ABPI), for "bribing health professionals with an inducement to prescribe," according to a 2022 ABPI complaint. (Such behavior is more or less excused in the U.S.)
“When even your own industry body is telling you that you've crossed the line, it's safe to say that you're marketing your product very hard,” Steele told Salon in a video call. “Of course, the result is that people are going to want the product, and when there isn't enough of it out there in the legitimate supply chain, they're going to look elsewhere.”
A representative from Novo Nordisk, the pharmaceutical company that manufacturers Ozempic, said in response that the company "will remain committed to following the ABPI Code of Practice and maintaining the highest possible ethical standards required by the pharmaceutical industry." They also said they are working to expand production sites in Denmark and France to ease the shortage.
Meanwhile, many illegitimate sources online are selling “generic” or counterfeit weight loss drugs and capitalizing on millions of U.S. patients eager to access a drug that helped them stabilize their insulin and appetite — with serious consequences. According to the American Association of Poison Control Centers, the number of calls related to injectable weight loss drugs increased 15-fold between 2019 and 2023. One study published in October in the Journal of the American Pharmacists Association reported two cases in which people took 10 times the recommended dose of drugs like Ozempic. In Austria, several patients were hospitalized after taking counterfeit Ozempic that contained insulin instead of semaglutide while a man in Chicago slipped into a coma after supplying the drug from an unregulated source.
According to a study published this week in JAMA Network Open, one in 10 teens have also used laxatives and supplements labeled as “nature’s Ozempic” or “budget Ozempic” in their lifetimes. These substances are not recommended for children and have been linked to an increased risk of being diagnosed with eating disorders and mental health conditions.
And it’s not just teens increasingly ordering drugs like this online. In a 2023 survey conducted by the Alliance for Safe Online Pharmacies (ASOP), 59 percent of respondents said they’d be comfortable ordering controlled substances from an online pharmacy if the drugs weren’t available at their local pharmacy. Another 44 percent said a prescription was not necessary on these sites — even though that is false.
Any drug received from an illegitimate source comes with inherent risk, including getting sugar pills and wasting money, getting a substance that has been contaminated with something that shouldn’t be consumed, or not having a prescriber to issue instructions on how to administer it, said Dr. John Hertig, a pharmacist and ASOP member. However, illegitimate weight loss drugs posing as Ozempic carry specific risks because they are injectables.
“They're not only counterfeiting the actual pharmaceutical product, they're also counterfeiting the needles that go with it,” Hertig told Salon in a phone interview. “Think about counterfeit needles in the risk that that might have is you're literally injecting yourself with something you don't know where that needle came from either.”
These weight loss drugs are only available with a prescription and authorized to be sold by FDA-approved vendors. In recent months, the FDA issued warning letters to various websites for selling unapproved or misbranded semaglutide products.
“Although we understand certain drugs are in short supply and patients are having difficulty obtaining their medication, the FDA urges patients to obtain prescription drugs only from state-licensed pharmacies that are located in the U.S., where the FDA and state authorities can assure the quality of drug manufacturing, packaging, distribution and labeling,” an FDA spokesperson told Salon in an email. “FDA’s BeSafeRx campaign helps consumers learn about how to safely buy prescription medicines online.”
Certain sellers are pushing semaglutide salt forms online, but these formulations have different active ingredients and may not be safe or effective in humans, according to the FDA. Some sites based in the U.K. demonstrate how to mix raw ingredients for weight loss medications at home before injecting, despite the dangers associated with doing this. Buyers should also be aware that there is no FDA-approved “generic” version of semaglutide, so any product marketed as such could pose risks.
“Even with drugs that have gone through all the phase three clinical trials and are used in humans, you’ll still hear doctors and scientists say things like, ‘We don’t fully know why this works,’” Steele said. “If you're taking something that hasn't even gone through those hoops, we really don't know what it's doing.”
Some companies offer compounded versions of Ozempic or other semaglutide-based weight loss drugs. While Novo Nordisk says it doesn’t sell semaglutide to compounding pharmacies, certain compound pharmacies are licensed by the FDA or state boards of pharmacy to make their own version of a drug with raw materials provided by the original manufacturers, particularly when that drug is in shortage, according to a statement issued by the Alliance for Pharmacy Compounding (APC).
The FDA confirmed Ozempic and Wegovy were both listed on the FDA’s drug shortage list as of May 2023, but noted that compounded drugs may pose a higher risk because they haven’t been tested and approved by the agency.
“The FDA’s compounding program aims to protect patients from poor quality compounded drugs while preserving access to lawfully marketed compounded drugs for patients who have a medical need for them,” the FDA spokesperson said.
Still, last summer, Novo Nordisk pushed ahead with 12 legal actions against medical spas and certain compound pharmacies for selling semaglutide products. Eli Lilly, which manufactures Mounjaro, a drug similar to semaglutide, also recently sued various providers for “passing off as ‘Moujaro’ their own unapproved compounded drugs.”
"Novo Nordisk does not directly or indirectly provide or sell bulk semaglutide to compounding pharmacies or any other entity for the purposes of compounding semaglutide products," the company spokesperson said. "Medical spas, weight loss or medical clinics, and compounding pharmacies that are claiming to offer or sell compounded products claiming to contain 'semaglutide' are sourcing their ingredients from entities other than Novo Nordisk."
However, the APC said in its statement that Novo Nordisk does not have total control over the supply chain and that other FDA-registered manufacturers can produce semaglutide and provide it to compounding pharmacies.
“Compounding is authorized in federal law and in all 50 states — as is compounding ‘essentially a copy’ of an FDA-approved drug when that drug appears as ‘currently in shortage’ on FDA’s drug shortage list,” according to the statement.
It remains to be seen what comes out of the litigation regarding compound pharmacies. Regardless, it will likely keep the spotlight on these weight loss drugs even longer. Meanwhile, intermittent Ozempic shortages are expected to continue throughout 2024, potentially leading more patients to turn to illegitimate sources to buy what some are calling "Faux-zempic."
In the meantime, the demand is clearly there: Close to 40% of Americans meet the criteria for obesity and more than half of Americans want to lose weight. Now that there are therapeutics designed for both of those things, people are scooping them up more quickly than they can be produced.
"The question is: Why are people so desperate that they're willing to buy weight loss drugs from seedy online sources?" Steele said. "That kind of takes you into weight stigma and fatphobia and the cultural drive for thinness, which I think is also very much the elephant in the room for all of this."
