NBC News
Consumers who try to buy popular weight loss drugs online without a prescription risk being scammed or receiving unsafe products, a new study has found.
About 42% of online pharmacies selling semaglutide, the active ingredient in Novo Nordisk’s anti-obesity drug Wegovy, are illegal, operating without a valid license and selling the drugs without a prescription, according to a study published Friday in JAMA Network Open.
People who buy weight-loss drugs online “face serious risks as consumers” of receiving “ineffective and dangerous products,” said Tim Mackey, author of the report, professor of global health at the University of California, San Diego, and director of the Institute for Global Health Data and Policy. Researchers from the University of Pecs in Hungary also participated in the study.
According to Dr. Christopher McGowan, founder, medical director and director of research at True You Weight Loss, a weight-loss clinic in Cary, North Carolina, shortages of the popular weight-loss drug, which belongs to a class of drugs called GLP-1, have led to “a black market for illegal knockoffs.”
“This is absolutely terrifying,” said McGowan, who was not involved in the research. Illegal pharmacies “expose patients to risks associated with unregulated, substandard and unsafe products.” potentially contaminated. The average person cannot be expected to safely navigate this minefield of drugs on the Internet, so it is best to stick to FDA-approved brand-name drugs,” he said.
Semaglutide’s popularity has increased in recent years, with more than 2.5 million prescriptions issued in the United States by December 2023, according to another study published Friday in JAMA Health Forum.
Manufacturers are struggling to keep up with demand for the drugs, which can cost as much as $1,300 a month, and many who can’t find them at local pharmacies are turning to online sellers.
Many people buy semaglutide, which is also sold under the name Ozempic to treat type 2 diabetes, online because their insurance won’t pay for the injections or their doctors won’t give them a prescription, Mackey said.
Medicare does not cover the drugs when prescribed for weight loss, and many state Medicaid plans severely restrict coverage. Most people who receive prescriptions for GLP-1 have private insurance, according to the JAMA Health Forum study.
“It’s no wonder people are looking online for alternatives,” McGowan said. “Unfortunately, this is where unscrupulous providers take advantage of the desperate.”
Illegal pharmacies pose security risks
In Mackey’s study, he and his colleagues tested samples of semaglutide ordered from six online pharmacies for quality and safety.
Two of the online pharmacies had received warning letters from the Food and Drug Administration (FDA) in the past year for illegally selling unapproved and misbranded semaglutide.
One vial of semaglutide had high levels of endotoxin, a toxin found in bacterial cells, although researchers did not find any live bacteria that could cause infection. Injecting endotoxin, which can come from environmental contamination during manufacturing, can cause discomfort.
Online purchases sampled in the study contained up to 39% more semaglutide than indicated on the label, which could lead to an overdose.
According to the FDA, an overdose of semaglutide can cause severe nausea and vomiting, as well as dangerous drops in blood sugar, which can lead to fainting.
From January to November 2023, poison control centers across the United States reported Nearly 3,000 calls related to semaglutidean increase of more than 15-fold since 2019. Most overdoses were the result of dosing errors made by consumers who injected the drug themselves.
Wegovy and Ozempic, both made by Novo Nordisk, are sold in injection devices that are relatively easy to use. Unbranded versions of semaglutide — which can come from specialty pharmacies or the online pharmacies examined in the study — typically come in liquid vials that require consumers to fill a syringe with the correct dose.
On its website, Novo Nordisk says patients can spot counterfeit drugs by looking for certain telltale signs, such as misspelled or unsealed packaging, or prices that seem too good to be true.
Online Scams
According to the study, some websites posing as pharmacies accept money from consumers but never deliver the drugs.
Although Mackey and the study’s co-authors paid for six orders, they received only three. According to the report, three of the websites they ordered from were “non-delivery scams,” which asked for additional payments of $650 to $1,200 to help their products “clear customs.”
At best, consumers who buy GLP-1 drugs from illegal online pharmacies “are simply wasting their money,” said Shabbir Safdar, executive director of the Partnership for Safe Medicines, which investigates the dangers of counterfeit drugs. “At worst, they end up with medicines that are potentially harmful.”
Some people who can’t find semaglutide at their regular pharmacy have turned to compounding pharmacies, which mix or alter drug ingredients to create medications tailored to patients’ specific needs. Legitimate pharmacies don’t dispense drugs without a prescription, according to Scott Brunner, executive director of the Alliance for Pharmacy Compounding, an industry group.
According to the FDA, compounded drugs can be manufactured and distributed with fewer restrictions when they are on the shortage list. Currently, there is a shortage of several doses of Wegovy. Still, the FDA warns that “compounded drugs should only be used in patients whose medical needs cannot be met by an available FDA-approved drug.”
In a statement on its website, Novo Nordisk said it is working to address the shortage. “While we will do everything we can to support those who want to start using Wegovy, it is important to recognize that global demand will continue to outstrip supply and some patients may still have difficulty accessing it,” the statement said.
Safdar noted that the purchase of compound semaglutide carries risks compared to branded versions.
According to an alert issued last week by the FDA, people who made dosing errors when administering semaglutide from compounding pharmacies have been harmed and even hospitalized after accidentally receiving too much.
Brunner noted that consumers should only purchase medications from pharmacists licensed by the state board of pharmacy.
Under the best of circumstances, the decision to take a GLP-1 drug is a complex medical decision and patients need regular follow-up, said McGowan of True You Weight Loss. Consumers won’t get that kind of care if they buy drugs online without seeing a health care professional.
Even when taken as directed, GLP-1 drugs can cause many side effects, including nausea, diarrhea, vomiting, constipation, stomach pain, headaches and fatigue, so many people stop taking them after two years. The FDA advises doctors to closely monitor patients for kidney disease, eye disease, depression or suicidal thoughts or behavior.
Some doctors have also noted that GLP-1 drugs can trigger eating disorders in some patients, and the Collaborative of Eating Disorders Organizations, whose members provide treatment or support to people with eating disorders, recommends that doctors screen people for conditions such as anorexia before prescribing semaglutide.
“If a pharmacy does not require a prescription, a medical consultation or any information about your health, It is not legitimate“McGowan said.
“Right now, there are no shortcuts,” he said. “Either you are lucky enough to have insurance cover GLP-1 drugs, or you are willing and able to pay hundreds, if not thousands, of dollars a month out of pocket. There is currently no proven, safe solution.”
