Why what looks like a good deal could cause a great deal of harm.
By Carrie Dennett, MPH, RDN
The buzz around the glucagonlike peptide-1 (GLP-1) receptor agonist medications semaglutide, sold under the brand names Ozempic for diabetes management and Wegovy for weight loss, and tirzempatide, sold under the brand name Mounjaro, has contributed to a demand that exceeds supply.
These shortages, combined with spotty insurance coverage for these drugs when prescribed for weight loss, have spawned a dubious online industry, with websites illegally selling them at deep discounts and without the need for a prescription.
The National Association of Boards of Pharmacy has identified more than 35,000 websites illegally selling these drugs, with new ones popping up daily, each with the potential to do harm.
Medical Dangers
Illegally purchased GLP-1 agonists may be adulterated, contaminated, improperly stored and transported, ineffective, or unsafe. Pharmacist and diabetes educator Evan Sisson, PharmD, CDCES, a professor at the Virginia Commonwealth University School of Pharmacy in Richmond, Virginia, says it’s impossible to know what’s in these products. “When you look at the prefilled pen or syringe, it’s just a clear liquid, so you really can’t tell if it’s just saline, if there’s any active ingredient, or nothing at all.”
Some of these websites are fronts for unauthorized compound pharmacies. Drug compounding is the process of combining, mixing, or altering ingredients to create a medication tailored to the needs of an individual patient. Compounded drugs aren’t approved by the FDA, and the agency doesn’t verify the safety or efficacy of these drugs.1
In many cases, the active ingredient in illegally purchased Ozempic or Wegovy isn’t the base form of semaglutide that’s used in the approved drugs. Instead, compounders may be using salt forms of semaglutide, including semaglutide sodium and semaglutide acetate, which don’t act the same.1
Sisson says some compounding pharmacies could be buying Wegovy, which contains a higher dose of semaglutide than Ozempic, then extracting the semaglutide and dividing it into smaller doses.
“GLP-1 receptor agonists are all proteins, and proteins are not particularly stable. That’s why they come in a pen or a syringe with a small glass vial, but if you put it in a plastic pen, it’s hard to predict what will happen. It’s not the original tested product.”
Someone with type 2 diabetes taking a fraudulent form of Ozempic may have no idea it’s not working. While GLP-1 agonists can have a marked impact on A1c levels, Sisson says, the differences in daily blood glucose readings are more subtle. “They may not realize that they’re getting a product that’s diluted or inactive. They may blame themselves for their blood glucose being higher.”
“From an ethical standpoint, people who are trying to transfer even an active drug into another formulation are being dishonest,” he says. “It’s really sad that people would try to take advantage of patients who are trying to take care of themselves.”
Who’s Buying From These Websites?
Given the flood of celebrity endorsements and media coverage of GLP-1 agonists for weight loss, it’s likely that many people purchasing from illegal websites are seeking them for that purpose. But even if the online versions of the drugs were identical to the legal, authorized medications, purchasing them without a prescription carries a risk.
“Everybody on their own can decide to eat a healthier diet, but as soon as you start to add in medicine or surgery for weight loss, there’s a risk that goes with that,” Sisson says. “That risk needs to be assessed between the provider and the patient. Why would people not want to talk with someone who is expert on this?”
Some patients with type 2 diabetes who have prescriptions for Ozempic also may be turning to these websites, even if they have insurance coverage. “There’s a lot of frustration when people go to pick up their prescription, and the pharmacist says, ‘We’re out,’” Sisson says. “Then they have to call around to other pharmacies and see if they have it and if they can transfer their prescription there. Then a fake website pops up and the drug is available, and it’s less expensive and the person thinks, ‘I’ve already discussed this with my doctor, and I already have a prescription, so what’s the harm?’”
How to Identify Fraudulent Online Pharmacies
Consumers can hardly be blamed for being tricked by fraudulent websites—most are professional-looking and some have copied the appearance of the Wegovy website, giving themselves an air of legitimacy. Phrases like “cheap Ozempic” and “no prescription needed” are perhaps the biggest red flags, but both the FDA’s BeSafeRx website and the National Association of Boards of Pharmacy’s safe.pharmacy website offers advice and resources for determining whether an online pharmacy is legitimate.
When counseling his own patients, Sisson says he tells them, “When you’re looking on the internet, if anything sounds too good to be true, it probably is.”
— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Non-Diet Approach to Optimal Well-Being.
Reference
1. Medications containing semaglutide marketed for type 2 diabetes or weight loss. Food and Drug Administration website. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss. Updated October 31, 2023.
