RogueRx Activity Report
Injectable Weight Loss Drugs: How Illegal Online Drug
Sellers Are Taking Advantage of Patients

No part of this publication may be reproduced in any manner without the written permission of theexecutive director/secretary of the National Association of Boards of Pharmacy.
©2024 by the National Association of Boards of Pharmacy. All rights reserved.

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INTRODUCTION
Almost 75% of Americans are clinically defined as overweight or obese.1 Therefore, it is unsurprising thatglucagon-like peptide-1 receptor agonists (GLP-1 agonists) have gone viral. This class of drugs – which
includes semaglutide, liraglutide, and tirzepatide – is well-known for its effectiveness in promoting weight loss.
Some celebrities, including Elon Musk and Tracy Morgan, have admitted to using semaglutide for weight loss –and dozens of other suddenly-slender celebrities have vehemently denied its use. These drugs are so popularthat Walmart has noted a correlated reduction in food purchases.2 Meanwhile, weight-loss chain Jenny Craig
filed for bankruptcy, and WeightWatchers acquired a telehealth platform that offers GLP-1 agonists.3, 4
GLP-1 agonists stimulate the receptor for the hormone glucagon-like peptide-1, which increases insulin
production and satiety. Approved GLP-1 agonist medications are used to treat type 2 diabetes and obesity.
Regarding the latter, semaglutide (under the brand name Wegovy®) was approved by Food and Drug
Administration (FDA) in 2021 for chronic weight management in adults with obesity or overweight with at least
one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol).5 More recently,
tirzepatide was approved by FDA (under the brand name Zepbound™) for chronic weight management in
adults with obesity or overweight with at least one weight-related condition.6 However, other GLP-1 agonists –including Ozempic®, Rybelsus®, Mounjaro®, and Saxenda® – are frequently used off-label for the same purpose.
Most of these drugs are injectable, and they must be refrigerated prior to first use. Common side effects
include nausea, vomiting, diarrhea, constipation, and abdominal pain. Currently, certain dosages of these FDAapproved drugs are on FDA’s Drug Shortage List; this means that the total supply of the commercially available
product cannot meet the current demand.7
Of course, bad actors are taking advantage of these drugs’ popularity and shortage; their unlawful actions
put patients at risk. In this report, NABP highlights the methods used by illegal actors to sell substandard or
falsified GLP-1 agonists without holding required pharmacy licensure and without requiring a valid prescription.
The Association also reports on the actions taken by government agencies around the world to preventthe illegal sale of these drugs and prosecute bad actors. Finally, NABP encourages third-party platforms tocontinue monitoring for these illegal products and recommends that pharmacists and patients report theseillegal sellers to FDA’s Office of Criminal Investigations (FDA-OCI), state boards of pharmacy, state attorneys
general, and NABP.

ILLEGAL ONLINE PHARMACIES CAPITALIZE ON GLP-1 AGONISTS’ POPULARITY
AND SHORT SUPPLYIllegal online pharmacy operators have always been opportunists, from their heavy promotion of lifestyle drugs(eg, Viagra®, Cialis®, Propecia®) to their focus on hydroxychloroquine and ivermectin during the COVID-19
pandemic. As rational economic actors, these criminals are now actively selling GLP-1 agonists – without
requiring a valid prescription and without the required pharmacy licenses – to vulnerable patients.

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Illegal online drug sellers are focusing on GLP-1 agonists for many reasons. These drugs are extremely popular,
expensive, and often not covered by insurance. This means that desperate patients will pay out of pocket
and will be highly motivated to find cheaper options online. In addition, because several FDA-approved GLP-1
agonists are not readily available in the legitimate market, patients are more likely to explore options outside of
their local retail pharmacy.
NABP has identified thousands of websites that promote the illegal sale of GLP-1 agonists. In some cases,
these websites are connected to domain names that include GLP-1 agonist brand names, including Ozempic
and Wegovy.8 An example can be found below.

FIGURE 1: Illegal online pharmacy offering Saxenda, a GLP-1 agonist, without requiring a prescription.

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Although some illegal online drug sellers, like the example in Figure 1, make it obvious that they are selling
GLP-1 agonists without requiring a prescription (a clear indicator of illegality), others try to mimic legal sellers.
One online seller has even copied the manufacturer’s website for Wegovy. See below.

FIGURE 2: Manufacturer’s website (left) versus an illegal online pharmacy (right).

As NABP has discussed in previous reports,
many illegal online pharmacies belong to large,
rogue online pharmacy networks. At this time,these large networks appear to be selling only
oral semaglutide, marketed as Rybelsus; they
do not sell the injectable versions, which require
refrigeration prior to first use. For example,
see Figure 3 below. However, many smaller
networks and isolated actors do sell injectable
GLP-1 agonists without requiring a prescription.
That said, pharmaceutical manufacturers areactively developing new oral GLP-1s intended
for weight loss, which experts predict will becheaper to produce and will be better tolerated
by patients; as such, NABP predicts that thelarge criminal networks will soon be promoting
oral GLP-1s as actively as they currently
promote erectile dysfunction drugs.9

WHAT IS A ROGUE INTERNET PHARMACY NETWORK?
Most illegal internet pharmacies belong to organizedcriminal networks, many of which have been therecipients of FDA warning letters. These networks areoften complex, global operations that include hundreds– or even thousands – of related websites. The network
operators create website templates and run back-end
services (eg, payment processing and pharmaceuticalshipping). They offer these templates and services
to “affiliate marketers” who: (1) operate websites onbehalf of the network; (2) drive traffic to those websites;and (3) take a small cut of the profits. Illegal pharmacy
networks typically sell prescription-only drugs without
requiring a prescription, sell unapproved drugs, and do
not hold proper licensure in the jurisdictions where they
offer shipping.

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FIGURE 3: Website belonging to a large rogue internet pharmacy network that sells oral semaglutide.

Some illegal websites offer GLP-1 agonists as part of “non-delivery schemes.”10 A non-delivery scheme is afinancial crime where a buyer pays for goods or services online, but never receives them. NABP has received
reports directly from patients regarding this issue. For example, one patient reported that a website “took mymoney out from my bank account and no contact. Missing $640.” Another stated, “[l]ong story short, via aseries of text messages and naiveté on my part, they stole $700 from me.”ILLICIT PEPTIDE DEALERS ADD GLP-1 AGONISTS TO THEIR PRODUCT CATALOGS
To avoid enforcement, some illegal online drug sellers advertise drug products as “peptides.” Although thesebad actors knowingly sell their products for consumer use, they claim that these products are for “research
purposes only” and “not for human consumption.” The “peptides” are typically delivered as lyophilized (freezedried) powder, and users are required to reconstitute the product with bacteriostatic water.
Illegal peptide sellers have been around long before Ozempic. They typically offer a limited product catalog ofinvestigational new drugs, unapproved drugs, and prescription-only drugs that are popular among bodybuilders(eg, melanotan 2, CJC-1295, clomiphene). The United States Department of Justice, in collaboration with FDAOCI, has prosecuted several of these illegal peptide sellers.11

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In response to consumer demand, these bad actors have recently added GLP-1 agonists – including
semaglutide and tirzepatide – to their product catalogs. Because they are claiming the products are forresearch purposes, they do not use brand names. Instead, NABP has seen peptide websites label their productswith the following names: GLP-1 analogue, GLP-1, Tirz, and Sema GLP-1. One such example can be foundbelow.

FIGURE 4: “Sema GLP-1” is advertised on a peptide website.

In an article focusing on peptide websites selling GLP-1 agonists, the Wall Street Journal identified more than
50 websites selling semaglutide and tirzepatide. Nearly all of them included disclaimers that the substanceswere “not for human consumption.”12 These sellers likely offer, at best, research-grade versions of these drugs,
which do not eliminate impurities at the same level as pharmaceutical-grade versions.13
In recent months, illicit peptide websites have begun offering retatrutide, a GLP-1 agonist that is currently
classified as an investigational new drug.14 For example, in Figure 5 below, the seller notes, “[a]ll products
purchased are for laboratory & research use ONLY, this means we cannot provide any further instructions onreconstitution and/or dosing.”

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According to George Karavetsos, former director of FDA-OCI, “[i]t’s unprecedented to see a drug that is in latestage clinical trials being so flagrantly advertised for sale online.”13

FIGURE 5: A peptide website is marketing retatrutide, an investigational new drug.

CRIMINAL ACTORS TAKE ADVANTAGE OF ONLINE MARKETPLACES AND AD PLATFORMS
Illegal online drug sellers are also taking advantage of online marketplaces to sell substandard or falsified GLP1 agonists.
In some cases, bad actors intentionally misspell or nickname the product to avoid detection by the platform’s
automated compliance tools. For example, on one platform, an illicit seller described tirzepatide as “Tirz”(see Figure 6). In another example, an illegal seller intentionally placed spaces between the letters in thewords “semaglutide,” “Ozempic,” and “Wegovy” (see Figure 7). In a third example, the word “semaglutide” ismisspelled (see Figure 8).

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FIGURE 6: Tirzepatide is marketed on an online marketplace as “Tirz.”

FIGURE 7: Semaglutide is promoted for sale with spaces between the letters in the words “semaglutide,” “Ozempic,” and “Wegovy.”
Wegovy is also misspelled.

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FIGURE 8: Semaglutide is misspelled,
possibly to avoid detection byautomated compliance solutions.

Illegal sellers have also advertised on major online ad platforms and social media.15, 12, 13 Often, these sellers
are peptide websites that are marketing GLP-1 agonists as research chemicals.

GOVERNMENT AGENCIES IDENTIFY SUBSTANDARD AND FALSIFIED GLP-1 AGONISTS AND
TAKE ACTION AGAINST ILLEGAL SELLERS
Medicine regulators around the world have identified substandard and falsified GLP-1 agonists in the supply
chain. In the US, FDA has seized thousands of units of fake Ozempic.16, 17 In the UK, the Medicines and
Healthcare products Regulatory Agency (MHRA) announced that, since January 2023, they had seized 369
potentially fake Ozempic pens. MHRA also stated that they had “received reports of fake Saxenda pensthat have been obtained by members of the public in the UK through non-legitimate routes (any route that
does not require a prescription from a qualified prescribing healthcare professional).”18, 19 Germany’s Federal
Institute for Drugs and Medical Devices identified wholesale batches of counterfeit Ozempic 1 mg in German
packaging.20 Australia’s Therapeutic Goods Administration also detected fake semaglutide being illegallyimported into Australia.21 Ireland’s Health Products Regulatory Authority detained 254 units of products
claiming to contain semaglutide between January and September 2023, compared to just 32 units in 2022.22
According to the Partnership for Safe Medicines, substandard and falsified Ozempic has been found in at least
16 countries to date.23
These fake medicines have resulted in patient harm. For example, in October 2023, Austria’s drug regulatory
authority reported that several people suffered hypoglycemia and seizures after using what was suspected to
be a falsified version of Ozempic.24 “Due to the untested quality of the counterfeit drug, possible impurities andunknown ingredients, these counterfeits can also be life-threatening,” the Austrian agency said. In Lebanon, 11
people suffered bouts of dangerously low blood sugar, one of whom required hospitalization, after injecting
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suspected fake versions of Ozempic.25 According to information gained from FDA’s Adverse Event Reporting
System, 42 people around the world were hospitalized after being injected with substandard or falsified
semaglutide. Of the reports, 28 are classified as “serious” with outcomes that include death. Three of these
hospitalizations happened in the US.26
Regulators are taking action to stop the unlawful sale of GLP-1 agonists. In addition to seizing fake Ozempic
and alerting pharmacists and patients about fake lot numbers,16 FDA is regularly issuing warning lettersto peptide website operators and illegal online pharmacy operators who engage in the illicit sale of GLP-1
agonists.27, 28, 29 Likewise, the European Medicines Agency is assisting European Union member states in theirinvestigations of falsified versions of Ozempic.30
Meanwhile, Canada has taken a different approach. To ensure availability for Canadian patients and toprotect the legitimate supply chain, the Canadian province of British Columbia passed legislation to restrict
the shipment of semaglutide to US patients.31 After enacting the regulation, the number of dispenses to US
residents dropped by more than 99%.32
Regulators are also collaborating internationally to take down sellers of substandard and falsified GLP-1
agonists. According to Jim Mancuso, director of the US Department of Homeland Security’s Intellectual
Property Rights Coordination Center (IPR Center), “[t]hese weight loss drugs are a hot topic right now because
they’re on TV and getting a lot of media attention. If I’m a criminal organization, that’s the next opportunity I
go ahead and exploit.” According to Reuters, the IPR Center is “working with Europol, INTERPOL, and around23 other law enforcement agencies on tracking weight-loss drugs to quell what they believe could become theworst tide of counterfeit lifestyle medicines since erectile dysfunction drugs like Viagra.”33

CONCLUSION
In 2023, the American Association for the Advancement of Science declared that GLP-1 drugs were the“Breakthrough of the Year.”34 By all accounts, these medications are critical for public health. Unfortunately,illegal actors are taking advantage of high demand and short supply in order to sell substandard and falsified
versions of these products to patients around the world.
To stop these bad actors, government agencies and private actors need to stay alert, take aggressive action,
and, where possible, work together. NABP applauds the work of government agencies around the world thatare actively investigating illegal sellers of substandard and falsified GLP-1 agonists. NABP also supports theefforts of online marketplaces and e-advertising platforms, whose leaders are working hard to remove illegal
online drug sellers from their ecosystems. To protect the supply chain and promote public health, NABP
strongly encourages pharmacists and patients report illegal sellers to FDA-OCI,35 state boards of pharmacy,36
state attorneys general,37 and NABP.38
For information about NABP’s RogueRx Activity Report or the Association’s research and reporting capabilities,
please contact Senior Digital Health & Policy Expert Niamh Lewis at nlewis@nabp.pharmacy.
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ENDNOTES
1

Center for Disease Control and Prevention. Obesity and Overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm.
Published on Jan. 5, 2023. Accessed on March 19, 2024.

2

Bloomberg. Ozempic Is Making People Buy Less Food, Walmart Says. https://www.bloomberg.com/news/articles/2023-10-04/
walmart-says-ozempic-weight-loss-drugs-causing-slight-pullback-by-shoppers. Published on Oct. 4, 2023. Accessed on March 9,
2024.

3

Salon. Why Jenny Craig couldn’t last in the Ozempic Age. https://www.salon.com/2023/05/06/why-jenny-craig-couldnt-last-in-theozempic-age. Published on May 6, 2023. Accessed on March 9, 2024.

4

Fierce Healthcare. WeightWatchers buys Sequence to expand into remote prescribing of hot weight loss drugs. https://www.
fiercehealthcare.com/digital-health/weightwatchers-acquisition-sequence-allows-expansion-remote-prescribing-hot-weight.
Published on March 8, 2023. Accessed on March 9, 2024.

5

FDA. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014. Published June 4, 2021.
Accessed March 9, 2024.

6

FDA. FDA Approves New Medication for Chronic Weight Management. https://www.fda.gov/news-events/press-announcements/
fda-approves-new-medication-chronic-weight-management. Published on Nov. 8, 2023. Accessed March 9, 2024.

7

FDA. FDA Drug Shortages. https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm. Accessed on March 9, 2024.

8

Eg, buyozempiconlinecanada.com. https://web.archive.org/web/20240309191930/https://buyozempiconlinecanada.com;
ozempicchemist.com. https://web.archive.org/web/20240309184831/https://ozempicchemist.com.

9

The Economist. Expect a bumper year for weight-loss drugs. https://www.economist.com/the-world-ahead/2023/11/13/expect-abumper-year-for-weight-loss-drugs. Published on Nov. 13, 2023. Accessed on March 9, 2024.

10

Therapeutic Goods Administration (TGA). Consumers Warned About Ozempic Scams. https://www.tga.gov.au/news/mediareleases/consumers-warned-about-ozempic-scams. Published on March 1, 2023. Accessed March 9, 2024.

11

See, eg, FDA. New Jersey Husband and Wife Admit Selling Misbranded and Unapproved New Drugs. https://www.fda.gov/
inspections-compliance-enforcement-and-criminal-investigations/press-releases/new-jersey-husband-and-wife-admit-sellingmisbranded-and-unapproved-new-drugs. Published on March 23, 2022. Accessed March 9, 2024; see also Department of Justice,
Owner of Bodybuilding Drug Companies Sentenced for Selling Misbranded Drugs. https://www.justice.gov/usao-md/pr/ownerbodybuilding-drug-companies-sentenced-selling-misbranded-drugs. Published on May 9, 2016. Accessed March 9, 2024.

12

Wall Street Journal. How Dozens of Websites Sell Knock-Off Drugs, No Prescription Required. https://www.wsj.com/health/healthcare/ozempic-mounjaro-no-prescription-websites-726b3928. Published on Aug. 16, 2023. Accessed on March 9, 2024.

13

Wall Street Journal. This Drug Could Be the Next Ozempic. Bootlegs Are Already Selling Online. https://www.wsj.com/health/pharma/the-next-hot-obesity-drug-wont-be-approved-for-years-online-sellers-hawk-it-anyway-e04d7cc3. Published on Oct. 20,
2023. Accessed on March 9, 2024.

14

ClinicalTrials.gov. A Study of Retatrutide (LY3437943) in Participants Who Have Obesity or Overweight (TRIUMPH-1). https://www.
clinicaltrials.gov/study/NCT05929066. Published July 3, 2023. Accessed on March 9, 2024.

15

Futurism. Google Seems to be Running a Lot of Ads for Black Market Semaglutide. https://futurism.com/neoscope/google-adssemaglutide. Published on Aug. 24, 2023. Accessed on March 9, 2024.

16

FDA. FDA warns consumers not to use counterfeit Ozempic (semaglutide) found in U.S. drug supply chain. https://www.fda.gov/
drugs/drug-safety-and-availability/fda-warns-consumers-not-use-counterfeit-ozempic-semaglutide-found-us-drug-supply-chain.
Published on Dec. 21, 2023. Accessed on March 9, 2024.

17

Novo Nordisk. Novo Nordisk Warns of Counterfeit Ozempic® (Semaglutide Injection) Pen Found in US. https://www.novonordiskus.com/media/news-archive/news-details.html?id=166119. Published on June 15, 2023. Accessed on March 9, 2024.

18

MHRA. Falsified Ozempic (semaglutide) pens identified at two wholesalers in the UK. https://www.gov.uk/government/news/
falsified-ozempic-semaglutide-pens-identified-at-two-wholesalers-in-the-uk. Published on Oct. 18, 2023. Accessed on March 9,
2024.

19

MHRA. MHRA warns of unsafe fake weight loss pens. https://www.gov.uk/government/news/mhra-warns-of-unsafe-fake-weightloss-pens. Published on Oct. 26, 2023. Accessed on March 9, 2024.

20

Federal Institute for Drugs and Medical Devices. BfArM takes over coordination in the case of counterfeiting of the diabetes drug
Ozempic. https://www.bfarm.de/SharedDocs/Pressemitteilungen/DE/2023/pm05-2023.html?nn=468782. Published on Oct. 11,2023. Accessed on March 9, 2024.

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21

Therapeutic Goods Administration. Counterfeit semaglutide vials. https://www.tga.gov.au/news/safety-alerts/counterfeitsemaglutide-vials. Published May 25, 2023. Accessed March 9, 2024.

22

Health Products Regulatory Authority (HPRA). HPRA reports increase in detentions of Semaglutide products sold illegally online.
https://www.hpra.ie/homepage/medicines/news-events/item?t=/hpra-reports-increase-in-detentions-of-semaglutide-productssold-illegally-online&id=18091526-9782-6eee-9b55-ff00008c97d0. Published on October 25, 2023. Accessed on March 9, 2024.

23

Partnership for Safe Medicines. Counterfeit GLP-1 agonists: Injected Diabetes and Weight Loss Medicine. https://www.
safemedicines.org/2023/06/fake-semaglutide.html. Published June 2023. Accessed March 9, 2024.

24

Federal Office for Safety in Health Care (BASG). Warning of counterfeit Ozempic® - Update 31.10.2023. https://www.basg.gv.at/en/
market-surveillance/official-announcements/detail/update-zur-warnung-vor-gefaelschtem-arzneimittel-ozempicr-1. Published on
Oct. 31, 2023. Accessed on March 9, 2024.

25

Reuters. Suspected fake Ozempic causes hypoglycemia in 11 in Lebanon. https://www.reuters.com/business/healthcarepharmaceuticals/suspected-fake-ozempic-causes-hypoglycemia-11-lebanon-2023-11-28. Published on Nov. 28, 2023. Accessedon March 9, 2024.

26

CBS News. FDA investigating reports of hospitalizations after fake Ozempic. https://www.cbsnews.com/news/fda-ozempiccounterfeit-weight-loss-drugs-hospitalizations. Published on Nov. 7, 2023. Accessed on March 9, 2024.

27

FDA. Warning Letter to Synthetix Inc. DBA Helix Chemical Supply. https://www.fda.gov/inspections-compliance-enforcement-andcriminal-investigations/warning-letters/synthetix-inc-dba-helix-chemical-supply-668918-02072024. Published on Feb. 7, 2024.
Accessed on March 9, 2024.

28

FDA. Warning Letter to www.gorillahealing.com. https://www.fda.gov/inspections-compliance-enforcement-and-criminalinvestigations/warning-letters/wwwgorillahealingcom-664245-10022023. Published on Oct. 2, 2023. Accessed on March 9, 2024.

29

FDA. Warning Letter to US Chem Labs. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/us-chem-labs-669074-02072024. Published on Feb. 7, 2024. Accessed on March 9, 2024.

30

European Medicines Agency. EMA alerts EU patients and healthcare professionals to reports of falsified Ozempic pens. https://www.ema.europa.eu/en/news/ema-alerts-eu-patients-healthcare-professionals-reports-falsified-ozempic-pens. Published on Oct.
18, 2023. Accessed on March 9, 2024.

31

British Columbia Government News. Province takes action to protect supply of diabetes drug in B.C. https://news.gov.bc.ca/
releases/2023HLTH0046-000554. Published on April 19, 2023. Accessed on March 9, 2024.

32

British Columbia Government News. Regulation protects supply of diabetes drug in B.C. https://news.gov.bc.ca/
releases/2023HLTH0085-000957. Published on June 16, 2023. Accessed on March 9, 2024.

33

Reuters. Demand for weight-loss drugs fuels global rise in counterfeits. https://www.reuters.com/business/healthcarepharmaceuticals/demand-weight-loss-drugs-fuels-global-rise-counterfeits-2023-10-20. Published on Oct. 10, 2023. Accessed on
March 9, 2024.

34

Science. 2023 Breakthrough of the Year. https://www.science.org/content/article/breakthrough-of-the-year-2023. Published on
Dec. 14, 2023. Accessed on March 9, 2024.

35

FDA Office of Criminal Investigations. Field Office Contact Information. https://www.fda.gov/inspections-compliance-enforcementand-criminal-investigations/criminal-investigations/field-office-contact-information

36

NABP. Boards of Pharmacy. https://nabp.pharmacy/about/boards-of-pharmacy

37

National Association of Attorneys General. Find my AG. https://www.naag.org/find-my-ag

38

NABP. Report a Suspicious Internet Pharmacy Site. https://nabp.pharmacy/forms/report-a-site.

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