Health & Medicine A shadowy market for weight-loss drugs has emerged online Shortages and big price tags have driven patients to unconventional sources of GLP-1 drugs Doctors are raising concerns about patients turning to unconventional sources of semaglutide and tirzepatide, the key ingredients in Ozempic and Zepbound. Eoin Ryan By Meghan Rosen 2 hours ago In late 2022, pharmacist Joseph Lambson got an unusual call from a poison control specialist. He said, “Hey Joe, I’m getting these weird calls about semaglutide.” According to the specialist’s calculations, people were giving themselves 10 times the correct dose. But that didn’t make sense. The drug is the key ingredient in the blockbuster diabetes and weight-loss medications Ozempic and Wegovy. Both come in prefilled injector pens, which typically take the guesswork out of dosing. Lambson, a board-certified toxicologist, knew right away what was going on. “This drug is probably being compounded,” he remembers thinking. He was right. After investigating, Lambson’s team at the Utah Poison Control Center in Salt Lake City reported that people were overdosing on compounded semaglutide. That means “a lot of nausea, a lot of vomiting, a lot of diarrhea,” he says. Ozempic and Wegovy, made by Novo Nordisk, had both been on the U.S. Food and Drug Administration’s drug shortage list since 2022. Across the boundless wilds of the internet, online sellers sprang up to meet demand. Some sold compounded medications. When pharmaceutical companies can’t keep up with demand for their FDA-approved drugs, compounding pharmacies can step in to fill the gap. These pharmacies measure and mix a drug’s active ingredient, creating a product that’s essentially a copy of the brand-name drug. Outside of shortages, compounding pharmacies routinely provide medicines that aren’t otherwise available or need to be tailored to a particular patient. Melanie T. shows a syringe and a vial of compounded tirzepatide, which she got with a prescription from a telehealth company.Melanie T. But even with legal, compounded forms of semaglutide, which require a prescription and usually come premixed in a vial with a syringe, patients can run into trouble, as Lambson found. People weren’t always sure how to take the drugs, so “they just went for it,” he says. Last year in Clinical Toxicology, emergency medicine doctors reported similar issues in a few cases. One man injected 20 times the correct dose of semaglutide because he misunderstood instructions. Semaglutide belongs to a class of medications known as GLP-1 receptor agonists. Even when used correctly under doctor supervision, they come with potential side effects. And when patients have to pull up the correct dose with a syringe, the risks go up. Soon, the situation could get even dicier. In February, the FDA removed semaglutide from the drug shortage list. By May, pharmacies will no longer be able to dispense compounded versions, though that depends on ongoing litigation. It’s a similar story with another GLP-1 drug, tirzepatide, the main ingredient in Mounjaro and Zepbound, Eli Lilly’s diabetes and weight-loss drugs. The FDA erased tirzepatide from the drug shortage list in October. But just because a drug is off the list doesn’t mean supply is guaranteed. And even with new discounts offered by pharmaceutical companies, the drugs’ prices keep them out of reach for many patients — especially since insurance won’t always cover them. Sign up for our newsletter We summarize the week's science breakthroughs every Thursday.