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As an American woman living in the year 2024, I’m constantly hearing about Ozempic. For the past year, it seems like every week, someone I know says they’ve started the diabetes medication-turned-weight loss super drug — and when I’m not, I’m bombarded with the conversation on social media. Not to mention the ads — I see them on the New York City subway, on Instagram (RIP my algorithm for researching this story), and, well, everywhere else.
Since Ozempic has exploded onto the weight-loss scene, it can seem both ubiquitous and scarce, creating confusion about who can get it and how. Initially developed by Novo Nordisk to treat type 2 diabetes, its off-label usage has morphed into a phenomenon now associated with quick and extreme weight loss, leading to shortages for some diabetic patients. The company also makes a similar semaglutide drug called Wegovy, which has been approved by the Food and Drug Administration for weight loss.
You need a doctor’s prescription to get the drugs, which are extremely expensive if insurance doesn’t cover the cost — out of pocket, it’s about $935 per month for Ozempic or $1,350 for Wegovy. Generally, prescriptions are reserved for people who have diabetes or are prediabetic with other underlying conditions. Yet medical spas (nonsurgical, aesthetic medical centers that usually offer injectables, lasers, or other procedures), online pharmacies, and telehealth services are blasting social media with ads offering the hard-to-get pharmaceuticals — raising questions about what’s being offered and if it’s legit.
After I called many med spas in different states — including California, West Virginia, and Louisiana — to inquire about getting on Ozempic, the answer that emerged was: there’s no way to know what you’re getting.
Ozempic, Wegovy, and other drugs like Saxenda (liraglutide) and Mounjaro (tirzepatide) are part of a class of drugs called glucagon-like peptide 1 (GLP-1) agonists. They imitate the hormone GLP-1, which stimulates the body to produce insulin to control blood sugar. In practice, they make you feel full faster and longer, so you eat less.
Ozempic and Wegovy are listed on FDA’s Drug Shortages list, as is Saxenda. The diabetes drug Mounjaro and the obesity shot Zepbound are also facing shortages in certain dosages. Semaglutide is the active ingredient in Ozempic, Wegovy, and Rybelsus tablets, which are all under patent without a generic option. So how are some people getting it, especially when they don’t have diabetes or other conditions, including a high BMI, that doctors usually require to prescribe? And is accessing it through avenues like med spas and online pharmacies legal and safe?
The answers can be murky.
When I called med spas and weight-loss clinics, most do require an in-person consultation, unlike online pharmacies. When I asked if what they were offering was real — brand name Ozempic or Wegovy — I was told yes. But when I asked how they could offer it so cheaply (as low as $200 per month in some cases), I was told it was because they got the product from a lab or pharmacy. When I asked who would do the evaluation to see if I qualified to take it, I was told it could be a nurse or a doctor, but it was not specified. Some places said I would need to book follow-up visits to adjust the dosage. But after talking to several of these institutions, it’s clear there is no uniform protocol.
It’s likely that many of these med spas and clinics are getting their semaglutide drugs from compounding pharmacies, which make customized drugs. In times of shortages, the FDA allows these pharmacies to offer altered versions. Some versions may simply take out potential allergens or irritating ingredients, or tailor individual dosages. But some may be counterfeit drugs, or ones made from unknown or dangerous active ingredients. There is no federal oversight for compounding pharmacies; they are regulated on the state level.
“I do not know what’s in the shot, I do not know where they get it.”
“Compounded drugs pose a higher risk to patients than FDA-approved drugs because compounded drugs are not FDA-approved and do not undergo FDA premarket review for safety, effectiveness, or quality. Compounded drugs also lack an FDA finding of manufacturing quality before such drugs are marketed,” FDA spokeswoman Amanda Hills wrote in an email.
From Aug. 8, 2021, through March 31, the agency received 209 reports of adverse events and 110 complaints in association with compounded semaglutide drugs.
Although the reactions may be similar to those logged for the brand name, FDA-approved semaglutide products, the agency can’t dismiss other factors “such as differences in ingredients and formulation between FDA-approved and compounded semaglutide products,” Hills wrote, adding that the data is limited because “compounding pharmacies generally do not submit adverse event reports to the FDA.”
In addition, some facilities offering semaglutide are reportedly using something entirely different. Compounded drugs made with semaglutide sodium and semaglutide acetate, which are salt forms that are not semaglutide, the active ingredient in Ozempic, Rybelsus, and Wegovy, have been reported, prompting the agency to issue multiple warnings. As Hills wrote: “These salt forms are not the active ingredients of any FDA-approved medication, and the FDA is not aware of any basis for compounding a drug using these semaglutide salts that would meet federal requirements. In addition, it is not known whether semaglutide salts are safe or effective.”
Last year, Novo Nordisk announced it was taking action against med spas, pharmacies, and wellness and weight-loss centers that offer compounded versions of semaglutide, and has filed at least a dozen lawsuits. Eli Lilly, the maker of Mounjaro, has also launched several lawsuits against similar providers for marketing and selling compounded versions of the drug’s active ingredient, tirzepatide. Mississippi’s State Board of Medical Licensure now prohibits prescribing, dispensing, or administrating compounded semaglutide for weight loss, citing safety concerns, but laws vary from state to state. Customers can consult the FDA’s BeSafeRx campaign to navigate buying drugs safely online.
Given how much is still unregulated when it comes to compounded versions of these drugs, medical experts discourage getting the drugs outside of a licensed physician’s supervision and care. Zhaoping Li, MD, PhD, a professor of medicine and chief of the Division of Clinical Nutrition at the University of California at Los Angeles, describes weight-loss drugs coming from med spas like this: “I do not know what’s in the shot, I do not know where they get it.”
“We’re talking about prescription drugs,” she adds. “The reason it’s prescription is because it does carry significant risk and also benefits. We are now learning more and more possible side effects.”
Side effects of these drugs include nausea, vomiting, diarrhea, burping, and constipation; abdominal discomfort and pain; injection site reactions; fatigue; hair loss; gallbladder problems; low blood sugar; acute kidney damage; diabetic retinopathy (damage to the eye’s retina); and suicidal behavior or thinking, according to the FDA.
Li also emphasizes that GLP-1 agonists work differently in different people. “There are people not losing weight, and they’re also people losing a lot of weight, particularly losing muscle. That is a significant concern for elderly in particular,” she says. She urges patients taking these medications to tell their doctor if they are feeling weak.
She adds that some people “have significant depression with those shots,” noting that some patients lose weight as fast as those who undergo bariatric surgery, which can also result in increased depression, anxiety, and suicidal ideation in patients. However, she says, “we have guidelines about how to take care of patients after bariatric surgery, but we have nothing for people taking GLP-1 treatments, especially at a med spa or water therapy place.”
At UCLA’s Nutrition Clinic, the drugs are prescribed by a doctor, who also integrates a lifestyle regime that tracks diet and exercise and includes regular follow-up visits.
Li reiterated that there’s no way to know what is in the injections given out at med spas. She also warns that these places don’t offer any standardized practice of care for patients while they take the drugs.
After reading about, calling, and interviewing experts and facilities providing these weight-loss shots, I — like the FDA and the head of nutrition at UCLA — cannot tell you exactly what is in them. Hopefully, the drugs become more accessible to the people who need them. In the meantime, if something sounds too good to be true, there may be a reason for it.
Soo Youn is a journalist who covers pop culture, business, gender and technology. She has worked at Reuters and ABC News and has written for The Washington Post, The New York Times, The Guardian, NBC News, Teen Vogue and other publications.