An underground black market of GLP-1 drugs is indeed emerging. This change occurs right as demand for weight-loss drugs and diabetes treatments explodes. Semaglutide, active ingredient in household names like Ozempic and Wegovy, has taken the world by storm. Americans have a tremendous need for effective solutions that safely and sustainably manage obesity and type 2 diabetes, and millions are looking to these medications to help.
GLP-1 medications, or glucagon-like peptide-1 receptor agonists, work by imitating the hormone GLP-1. This hormone plays a key role in appetite regulation and insulin secretion. Now, a newer class of medications such as tirzepatide and retatrutide have entered the battle. Tirzepatide works by mimicking two hormones, GLP-1 and GIP, while retatrutide—which is still in clinical trials—works by mimicking GLP-1, GIP, and glucagon.
The demand for these medications is increasing, and consequently, their cost is rising. On average, the list price for GLP-1 drugs is between $1,000-$1,300 a month. Cash-paying patients are able to purchase injector pens for approximately $499 per month. In comparison, they can find compounded versions of these drugs for less than $100. Although they’re legal, compounded drugs are not approved by the FDA and pose significant risks to patients.
Rising Demand and Costs
Obesity and type 2 diabetes have been escalating epidemics in the US. As a follow-on, a growing number of people are using GLP-1 medications to lose weight and improve their health. As of early 2024, only an estimated 6 percent of U.S. adults are likely to be on a GLP-1 medication, based on the results of a recent poll. That increased demand has been noticed by all players in the pharmaceutical supply chain.
And as our own Tim Mackey explains in his piece on this topic, it’s the financial incentives behind this emerging market that are key. He states, “Everyone’s trying to make money — manufacturers, compounding pharmacies, counterfeiters, everybody.” This profit-driven environment inevitably fosters a perfect storm for an increase in the number of substandard, if not counterfeit, drugs that make it to market.
The benefits are promising, but these compounded GLP-1 medications raise red flags due to the unknown health risks. Kaitlyn Brown emphasizes that “it’s obviously more of a risk when you’re giving a patient a syringe and a vial,” underscoring the dangers linked to unregulated drug supply chains.
Safety Concerns and Regulation
Just in 2024, poison control centers in the United States fielded 8,502 cases from exposures to GLP-1 drugs. Combined with the rising abuse of these powerful drugs online, speeding up their distribution and abuse, it creates an alarming statistic. Fewer than four ED visits occur for every 1,000 patients started on semaglutide. The sheer size of cases necessitates increased scrutiny.
Pharmacists such as Tenille Davis understand that compounding plays a part in providing alternatives for drugs in shortage but emphasize safety first. “Compounding is a part of the practice of pharmacy. Pharmacists jump in and help with drug shortages all the time,” she explains. But without consistent FDA oversight of compounded drugs, patients remain at risk.
C. Michael White warns about the ease with which individuals can access these medications online. “But once you start looking, they find you,” he says, noting that patients might be unknowingly putting themselves at risk by using dangerous products.
Patient Experiences and Perspectives
For many patients, the effects of GLP-1 medications have been profound and life-changing. Melanie, a user of these medications, shares her positive experiences: “I feel so good now. I feel healthier now than I felt when I was in my 40s.” Her story is a testament to the life-changing impact that these medications can have when prescribed and utilized appropriately.
Not all experiences are positive. Mackey recounts his own challenges with online orders, revealing that “we got scammed on three of the six orders.” This mishap highlights the dangers from dodgy vendors lurking in the online marketplace.
Patients need to understand that GLP-1s are very powerful medications for weight and diabetes. They must be willing to meet unexpected challenges as they come. Melanie notes a significant behavioral shift since starting her treatment: “I eat because my brain tells me I need to eat. I don’t eat for cravings.” This official puzzlement underscores the fact that these drugs have immense effects on not only physical health but mental health as well.
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