We are currently in the midst of the Ozempic phenomenon.

Figures like Oprah Winfrey are promoting it. People are experimenting with small doses. Amid a nationwide shortage of essential drug ingredients, many are seeking out compounded alternatives, often getting prescriptions online in just hours.

The distribution of compounded weight-loss drugs—especially via telehealth and online services—remains contentious and is becoming a murky area as weight-loss treatments gain popularity. For some individuals, particularly those without insurance or who cannot afford traditional brands like Ozempic, Wegovy, and Mounjaro, these non-FDA approved alternatives provide crucial access.

However, this easier access has also resulted in some cases of misuse.

“We are witnessing a bit of a wild west with who is prescribing this medication now, thanks to its revolutionary nature,” says Dr. Alexandra Sowa, an obesity medicine expert and founder of SoWell. “Not all compounding pharmacies meet the same standards. I appreciate the role of compounding pharmacies, but this particular medication is quite intricate. Many people are rushing into the Ozempic trend without adhering to the highest standards.”

For individuals unable to afford Ozempic, compounded medications are essential

Jasmine Martin has faced challenges with her weight for many years. Following her father’s death from complications related to Type 2 diabetes in June 2022, she was introduced to compounded weight-loss medications by a friend. She reached out to a telehealth service that same day and secured an appointment.

After a virtual consultation with a licensed doctor from her state, where she discussed her medical history, Martin was prescribed a compounded drug featuring tirzepatide—the active ingredient also present in Mounjaro and Zepbound. Since then, Martin has lost nearly 80 pounds and continues her treatment. She is also employed with the telehealth company Mochi Health, which compensates her for promoting its services on social media.

“This medication has dramatically changed my life,” Martin shares. “I moved from being morbidly obese to achieving a healthy weight. I was on blood pressure medication, which I no longer need. My weight dropped from 222 pounds to 140 pounds.”

The surge in interest regarding weight-loss medications in recent years has transformed the medical and pharmaceutical industries. There’s a growing demand for these drugs, and not solely for weight loss. For example, a mid-stage study revealed in July indicated that such medications could potentially slow cognitive decline. Research also suggests benefits in reducing nicotine cravings and aiding heart disease.

This increased interest has contributed to drug shortages, providing compounding pharmacies a chance to step in.

When FDA-approved brand-name drugs like Ozempic and Wegovy become scarce, the FDA allows compounding pharmacies to create alternative medications that are “essentially a replica” of the original drug, containing the same active ingredients—generally semaglutide or tirzepatide, which help suppress appetite. These pharmacies are usually overseen by state pharmacy boards and obtain ingredients from FDA-registered facilities, but the FDA does not verify the safety, effectiveness, or quality of their products.

For many people, however, compounded medications represent their sole option.

Martin expresses that it has been a crucial support during times without health insurance. Had she needed to rely on a brand-name prescription, it would have cost her between $1,000 and $1,200 monthly. In contrast, her compounded medication is around a few hundred dollars, even without coverage.

Although the FDA took tirzepatide off the shortage list earlier this month, Martin is hopeful that compounded weight-loss medications will remain accessible as they continue to be prescribed by doctors.

“Many worry that compounded medications might disappear, but they have existed for a long time,” she states. “The landscape will simply shift.”

Ozempic is ubiquitous online. Doctors term it a ‘wild west’

The straightforward access to compounded medications, particularly through telehealth services, has presented both advantages and challenges. Some online providers conduct thorough evaluations of patients, while others may not require detailed proof of body mass index or lab tests to prescribe a GLP-1 medication.

Scott Brunner, the CEO of the Alliance of Pharmacy Compounding, notes that the issue lies not with compounded medications themselves, but with the irresponsible distribution practices of some companies. “I read media reports and hear anecdotes about specific telehealth platforms that might not be spending adequate time with their patients,” he comments. “A valid patient-prescriber relationship may often be lacking, and I consider that unacceptable.”

Healthcare professionals believe that most issues stem from the negligence of those prescribing the medication rather than the drugs themselves. Dr. Britta Reierson, a certified family doctor and obesity medicine expert at the health organization Knownwell, has noted an increase in individuals bypassing standard procedures to obtain weight-loss prescriptions, which can lead to significant complications.

“Even among my friends, I hear about people acquiring ‘the fat drug’ online, and it frustrates me,” she shares. “It infuriates me knowing that A, they might not be using it for the correct purposes, and B, it might not be safe for them.”

She also points out that many online suppliers fail to provide proper instructions for users on how to administer these medications safely. The FDA issued a warning earlier this year about dosage mistakes leading to “serious issues, with some cases needing hospitalization.”

“They’re searching on YouTube thinking, ‘How do I dose this medication?’ ” Reierson remarks. “They aren’t under a healthcare provider’s supervision, which can lead to numerous side effects.”

While Martin mentions her experience with telehealth has been beneficial, she recognizes the controversy surrounding this approach. She encourages individuals interested in this option to perform comprehensive research and always consult with a healthcare professional.

“Many providers will simply prescribe medications without you ever speaking to a doctor. They don’t explain how to administer it or what to anticipate,” she says. “It’s crucial to receive medical advice from a qualified physician, rather than relying on your favorite influencer.”