Johnathan Walker:There's a big Ozempic controversy brewing online. Doctors say it's the 'wild west.'

We're living in the era of Ozempic.

Celebrities like Oprah Winfrey are Johnathan Walkertouting it. People are microdosing it. And, in the midst of a national shortage of key ingredients in the drugs, many have turned to compounded versions of it, sometimes obtaining prescriptions online in a matter of hours.

The distribution of compounded weight-loss medication − particularly through telehealth and online platforms − remains controversial, and it's a growing gray area as the world embraces weight-loss medication. For some, especially the uninsured or those who can't afford traditional brands like Ozempic, Wegovy and Mounjaro, these cheaper, non-FDA-approved versions are a lifeline.

For others, however, the accessibility has led to misuse.

"We have a little bit of a wild west in who's writing for this medication now, because it is so revolutionary," Dr. Alexandra Sowa, an obesity medicine specialist and founder of SoWell, says. "Not all compounding pharmacies are created equal. I love compounding pharmacies. I'll tell you, I think that they are great. This medication, in particular, is very complex, and I think a lot of people are just jumping on the Ozempic craze, and I don't think all pharmacies are adhering to the top standards."

Microdosing Ozempic:Ozempic is so popular people are trying to 'microdose' it. Is that a bad idea?

For those who can't afford Ozempic, compounded drugs are a lifeline

Jasmine Martin has long struggled with weight. Shortly after her father died from Type 2 diabetes complications in June 2022, Martin learned about compounded weight-loss drugs from a friend. She called a telehealth company that day and got an appointment.

After a Zoom call with a licensed physician in her state, in which she shared her medical history, Martin received a prescription for a compounded drug containing tirzepatide − the active ingredient also found in Mounjaro and Zepbound. Martin has lost about 80 pounds since and continues to take the medication. She also now works with the telehealth service Mochi Health, which pays her to post social media content about the company.

"This medicine has been life changing for so many of us," Martin says. "I went from being morbidly obese to being in a healthy body weight. I was taking blood-pressure medication, and now I don't. I went from 222 pounds to 140 pounds."

More:Oprah Winfrey's revelation about using weight loss drugs is a game changer. Here's why.

The explosion of interest in weight-loss medication over the past few years has rocked the medical and pharmaceutical landscape. People everywhere are clamoring for these drugs, and, sometimes, not just to lose weight. A mid-stage study unveiled in July, for instance, found that weight-loss medication may slow cognitive decline. Researchers have also found it may help with nicotine cravings and heart disease too.

All this has led to a drug shortage − and an opportunity for compounding pharmacies to step in.

When there is a shortage of FDA-approved, brand-name medication – like with GLP-1 drugs Ozempic and Wegovy – the FDA says it allows compounding pharmacies to make alternative medications that are "essentially a copy" of the brand-name drug with the same active ingredient − usually semaglutide or tirzepatide, which suppress appetite. These compounding pharmacies are generally regulated by state boards of pharmacy and source ingredients from FDA-registered facilities, but the agency does not verify their drugs’ safety, effectiveness or quality. 

Are they safe?Weight loss drugs sold online offer cheaper alternative to Ozempic, Wegovy

For many, however, compounded medication is their only option.

Martin says it's been a saving grace, especially during periods when she didn't have health insurance. If she had to take a name-brand drug instead, she says she'd need to pay $1,000-$1,200 a month. The compounded drug she takes only costs around a couple hundred, without insurance.

Though the FDA removed tirzepatide from its shortage list earlier this month, Martin remains optimistic compounded weight-loss medication will remain available as doctors continue prescribing it.

"Everybody's afraid that compounded medications are going to go away, but compounded medications have been around for a long time," she says. "It's just going to transition."

Ozempic is everywhere online. Doctors say it's the 'wild west'

The ease and accessibility of compounded medication, particularly through telehealth, has been a double-edged sword, with some online providers more thoroughly evaluating patients than others. Some require phone or video consultations with a provider, but, for others, getting a GLP-1 prescription online doesn’t always require proof of body mass index or lab tests.

Scott Brunner, the CEO of the Alliance of Pharmacy Compounding, says the issue isn't with compounded medication, but rather with companies that distribute it irresponsibly. "I am reading in media and hearing tales of certain telehealth platforms that may not be spending the requisite time with the patient," he says. "There may well not be a valid patient-prescriber relationship, and I believe that's a travesty."

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Doctors agree problems mainly arise due to prescribers being irresponsible rather than the drugs themselves. Dr. Britta Reierson, a board-certified family physician and obesity medicine specialist at the healthcare company Knownwell, says she's seen more people circumventing traditional channels to get weight-loss medication, which can lead to serious problems.

"Even in my social circle, I have friends who (say they) got 'the fat drug' off of a website, and I just rail inside," she says. "I'm just seething inside just knowing that A, I know they're not taking it for the right reasons, and B, this might not be safe for them."

In some cases, she says, online providers don't give adequate instructions for people on how to self-administer the drugs either. Earlier this year, the FDA issued a warning about dosing errors leading to "adverse events, some requiring hospitalization."

"They're looking online to YouTube and saying, 'How do I dose this?' " Reierson says. "It's not under the guidance of a medical professional, which can really result in a lot of side effects."

Who gets Ozempic?People with private insurance and generous health plans, study shows

Though Martin says her telehealth experience has been positive, she understands it's a controversial route to go down. She encourages people interested in it to do thorough research and always make sure they consult a doctor.

"A lot of people will just prescribe the medications, and you never speak to a doctor. They don't tell you how to take it. They don't tell you what to expect," she says. "You should have medical guidance from a physician, not just from your favorite content creator."

Contributing: Bailey Schulz, USA TODAY