Whatever your stance is on using the diabetes drug Ozempic to assist with weight loss, there’s no denying that its popularity is at an all-time high. In fact, a survey by independent information organization KFF found that one in eight adults in the US has taken a GLP-1 at least once in their life. Makes sense that we had a GLP-1 shortage last year—intertwining with a new means of getting the drug for those who previously may not have been prescribed: KFF also reported that 11% of people are getting their GLP-1 drug from an online provider or website. Experts say that lower costs and easy access seem to be the driving factors.

Holly Lofton, MD, director of the medical weight management program at NYU Langone Health, explains that GLP-1s and other similar medications can cost well over $1,000 per month without insurance. Dr. Lofton adds that many prescribers may not feel comfortable prescribing these medications (“They have not been properly trained or don’t understand the complexity of overweight and obesity as chronic medical conditions,” she says), making it difficult for patients to get the drug from their primary care physicians.

These online platforms make it convenient for consumers looking to avoid having to go back and forth with their insurance and doctors, with a catch: They can be unregulated. “This convergence of unmet demand and commercial supply has driven individuals toward alternative channels,” says Peter Goulden, MD, FRCP, division chief of the division of endocrinology, diabetes, and bone diseases at Mount Sinai. “Often without full appreciation of the clinical risks involved.”

The Risks

Dr. Goulden says unregulated sources and the absence of clinical screenings of these drugs may lead to incorrect dosages, counterfeit products, or ineffective or contaminated products that can cause serious adverse effects such as dehydration, hypoglycaemia, and infection. You also risk not having access to regular monitoring with a licensed professional. Without a doctor or medical professional coaching you through long-term treatment, he says you risk possible negative interactions with medications you’re already taking or worsening renal function, gallbladder disease, or pancreatitis. “Circumventing the standard medical framework in favor of online acquisition undermines the safeguards designed to ensure appropriate, evidence-based use of these potent agents,” he says.

The Compound Issue

Compounded options also continue to grow in popularity online—causing great concern. Compounded medication, as Dr. Goulden explains it, is a drug that has been custom-made by a pharmacy onsite. It typically involves combining, mixing, or altering ingredients to meet the specific needs of a patient. It is only permitted when there is a genuine shortage of a commercial drug or when a patient has a specific need for it (e.g., an allergy to a preservative in the original medication) that the standard drug cannot provide.

When it comes to compounded Ozempic and other semaglutides, Dr. Goulden adds that they are not identical to their FDA-approved counterparts and are not subjected to the same rigorous testing or quality control. The FDA recently reported its concerns on fraudulent compounded GLP-1s in the market, where some don’t even contain semaglutide at all.