- Weight-loss drugs are expensive, so many people are buying cheaper versions online.
- A researcher at UCSD bought weight-loss drugs online and tested them.
- His results underscore why people are at higher risk of dangerous side effects from gray market drugs.
Ever since the FDA approved the prescription of GLP-1 weight-loss drugs, it's been hard to get hold of the real thing.
Demand is so high for semaglutide, a GLP-1 sold under the brand names Ozempic and Wegovy, that it almost immediately went into shortage after it was FDA-approved for weight control in 2021.
Plus, at over $1,000 for a month's supply, it's a tough medication to afford even if you can access it.
Naturally, that spawned wave after wave of cheaper copycat drugs.
Researchers have watched nervously as the resulting gray market of trendy injections like so-called generic semaglutide has ballooned. Pharmacies are technically allowed to make their own versions of brand-name drugs under specific circumstances, and with a prescription. But some websites are offering the drugs without a prescription, no questions asked.
It begs the question: what is in online versions of semaglutide, and how can the consumer know what they're getting, or if it's safe.
Cue Timothy Mackey, a professor at the University of California, San Diego, who has been studying the online market for counterfeit drugs for decades. He decided to buy some of these cheaper, more accessible weight-loss drugs himself and study them in a lab with a team of researchers.
Their results, published August 2 in JAMA Network Open, provide some of the clearest information we have to date on what is — and isn't — in knock-off versions of Ozempic.
Some sites were scamming people out of money
Not all off-brands of semaglutide are illegal, or necessarily dangerous. Popular telehealth companies typically provide compounded semaglutide, cheaper than brand name versions, and make it easier for customers to obtain a prescription via online consultation.
There are risks involved in this process, Mackey said. There's less supervision than seeing a doctor in person, plus compounded medications are not FDA-approved and can have unpredictable additives. However, the pharmacies that fill these prescriptions are regulated and have some level of quality control.
Mackey's team was specifically interested in what he called the highest-risk form of semaglutide — weight-loss drugs sold online without a prescription. They gathered samples of these products to test.
All of the websites the researchers used to purchase and test the products appeared in the top results on mainstream search engines and have millions of visitors, according to an analysis of the site traffic, Mackey told Business Insider.
They found that half of the sites were advertising brand-name Ozempic, costing between $190 to $360 for two pens, plus delivery fees. That is huge because Ozempic was in shortage when they conducted this study, and even doctors were struggling to get hold of the real drug via official means. Predictably, brand-name products never arrived. When the researchers followed up, they were asked to pay extra money — between $650 to $1,200 — to "clear customs," but it was a fraud, the researchers found after contacting customs agencies.
Dangerous ingredients and concentrations
The other sites advertised generic semaglutide. They did deliver the product, albeit in a dubious form with inconsistent dosage.
For one thing, all of the samples arrived in powdered form, requiring users to reconstitute using a special sterilized water before injection. (This practice is common for online sales of peptides, a common category of fitness and anti-aging supplements.) Only one of the products provided instructions on how to do this, and doing it wrong is a serious contamination risk, according to Mackey.
All of the samples were advertised as 99% pure semaglutide. Testing revealed they were between 7% and 14% pure. They also provided higher doses of semaglutide than the label suggested — up to 39% more per batch — increasing the risk of overdose. Too much semaglutide can cause serious gastrointestinal side effects like vomiting, as well dehydration, and acute pancreatitis, according to the FDA.
Mackey's team also found that the products were likely research-grade semaglutide, never intended for human use. The websites used creative marketing language and imagery to imply their wares are intended for people, without saying it directly.
One of the products also contained high levels of a substance called endotoxin, a harmful substance found in bacterial cells,(although no live bacteria were seen).
Poison control centers saw a massive spike in semaglutide overdoses last year, CNN reported. Based on his team's results, Mackey is not surprised. "That's a clear sign of a product not intended for human use," Mackey said. "The bottom line there is that there are discrepancies in their manufacturing process."
Counterfeit Ozempic isn't going away, so buyer beware
Mackey said a wave of telehealth services and online providers have made it easier than ever to get prescriptions and medications online. But it's also harder to spot a scam now than when everything came from brick-and-mortar pharmacy after a face-to-face with a doctor.
"The average user is more confused about how to get this legitimately," he said.
Illicit websites can be convincing, but if they emphasize their weight loss medications don't require a prescription, that's a major red flag, according to Mackey.
Another warning sign is cost. Brand name semaglutide can set you back more than $1,000 per month. If a product is listed online for significantly cheaper, that's because you're likely to get what you paid for — an inferior or counterfeit product.
"If providers are advertising at $200, that's because they're not real, but still they're advertising at a lower price point and that's going to be attractive to consumers," Mackey said.
Despite the risks, and FDA efforts to crack down on scammers and shady products, the market for weight loss drugs is just too big, too new, and too messy to expect counterfeiters will stop anytime soon.
"It's going to be something endemic in our supply chain because of how popular the market is," Mackey said. "It's kind of an arms race here."