In the north of England, Chloe books Friday afternoon off work to drive to six different pharmacies in search of her routine prescription. For a year, she’s injected Ozempic every Monday to manage her type 2 diabetes, but it’s out of stock in her area.
She’s had no luck for the last four months. Instead, she’s had to switch to Trulicity, an alternative drug, which requires her to start again from its lowest prescription to build up the dose. Her blood sugar levels have oscillated for a couple of weeks, leading to fatigue and headaches, as well as requiring her to self-administer uncomfortable finger prick blood tests more frequently.
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Days later, a conversation with a friend put the pharmacies’ supply problem into perspective. “She’d heard about Ozempic from the lady who does her eyebrows, and was considering buying it for £180 a month to lose weight,” Chloe – who is speaking anonymously because of this friendship and her job – tells VICE.
FDA-approved in the US in 2017 and by the EU in 2018, Ozempic is a branded name of semaglutide, manufactured by the Danish pharmaceutical company Novo Nordisk. Once injected, it mimics a hormone produced in the gut called GLP-1 which regulates insulin and blood sugar levels and is essential for the management of type 2 diabetes. Users feel fuller for longer, curbing hunger pangs.
In 2021, Wegovy, another brand of semaglutide by Novo Nordisk, was approved in the US and UK to treat obesity. Following a Wegovy shortage, doctors began prescribing Ozempic off-label for weight loss, causing a surge in sales. For the first nine months of 2022, Novo Nordisk reported a 59 percent growth in sales of GLP-1 products.
Another unexpected by-product of Ozempic’s off-label prescription is its rise as the weight loss drug du jour by those without diabetes or obesity. On TikTok, hashtag #Ozempic already has over 320 million views and counting. Although some users are diabetic or obese, others documenting their “Ozempic journey” are using the drug as a quick weight loss fix.
Elsewhere on the platform, there has been unfounded speculation from plastic surgeons that Ozempic is the “secret weight loss drug” that Kim Kardashian used to fit into Marilyn Monroe’s dress at the Met Gala this year. (The Kardashians star has never spoken about taking the drug.) The Guardian and Variety have called Ozempic “Hollywood’s worst kept secret”, and include California-based medical professionals saying “everyone” is on it – namely celebrities who can afford the high price point in the US. One doctor told VICE the medication can cost around $8,00-1,000 a month.
For Chloe, the supply problem is a hard pill to swallow. Without it, her blood sugar levels spike, which can lead to heart attacks, strokes, blindness, miscarriages and stillbirth in the long-term. “I felt angry I was unable to get my prescription,” she says. “I have battled for a long time to get my diabetes under control, and on Ozempic, for the first time in a long time, it really was well-managed.”
The shortage is affecting healthcare providers, too. Once a week, North London-based nurse Amina visits house-bound patients with type 2 diabetes and obesity to administer the drug. In November, she received a newsletter from her hospital trust employers about the Ozempic supply issue. (Amina is speaking anonymously to protect her identity at work.)
Amina told VICE her community area’s stock will only last two to three weeks. She’s already contacting other boroughs in an attempt to source it. “I called so many pharmacies today, and they can’t give me an answer,” she sighs. “I try not to show my patients, but I am deeply worried about them. You feel what they feel. I care for them like I’d want a family member to be treated, and I am actually scared.”
Ozempic has improved her patients’ quality of life, but she’s concerned their blood sugar levels will rise once off the drug and lead to unwanted weight gain. “Semaglutide is often prescribed as a preventative measure in treating cardiovascular disease, heart attacks and strokes,” she explains, “so the risk will increase if patients come off it.”
Novo Nordisk told VICE that the company is “aware of a stock shortage”, adding: “The shortage is due to unprecedented levels of demand for this medicine which has tested our manufacturing capacity.”
“Ensuring a continuous supply that meets the needs of patients and the NHS is of the utmost importance for Novo Nordisk. We are working to remedy the shortage as soon as possible.”
Its current facilities are “now operating 24 hours, seven days a week” to meet demand, the spokesperson added. In December 2021, Novo Nordisk also announced plans to build three new manufacturing facilities to ramp up production.
On Twitter, some diabetic Ozempic users and their family members have responded to the shortage by scapegoating those taking the drug for obesity reasons. One tweeted: “Get your fat butt on a treadmill instead.” The stigmatisation has brought a contested issue to the fore: whether obesity should be defined as a disease at all. Medical professionals in the US, where the American Medical Association defines obesity as a disease, told VICE that obese patients are also in need of the drug because obesity can contribute to heart disease, strokes and type 2 diabetes itself.
They say this definition is consistent with the latest scientific evidence, and if not defined as a disease, places the onus on individual lifestyle or moral failings. However, fat activists say obesity doesn’t always reflect poor health and, in the UK, the National Institute for Health and Care Excellence (NICE) defines it as a medical condition and not a disease.
Are celebrities and the rich responsible for the current Ozempic shortage? Michael Albert, MD, co-founder and Chief Medical Officer of Accomplish Health, a New-York based telehealth medical weight management practice, believes there is no evidence to suggest this. “The US has roughly 100 million adults with obesity,” he says. “It is no surprise these treatments are experiencing unprecedented demand because we now have treatments that work, even if they are being used largely off-label.”
Dr Michael Glickman, who started a US medical practice catering towards those with obesity, agrees. “We don’t have evidence to prove that, as there is a very high bar to prove something like that,” the Revolution Medicine founder says. Anecdotally, however, he’s noticed a trend for “new patients coming in who heard about the medications online or via social media”.
“Patients are calling us and already know exactly which medication they want to try,” he says. “In the past most patients didn’t know about these medications and doctors would be the ones introducing them to all of the options available.”
Both Amina and Chloe separately told VICE that they have found internet suppliers offering Ozempic without needing buyers to demonstrate evidence of diabetes or obesity, indicating a shift towards the drug being more readily available for mass consumption – albeit with little understanding of the severe side effects. Those flying blind and taking Ozempic as a quick weight loss fix are at risk of its potential side effects, including thyroid tumours, pancreatitis and kidney failure.
“I could make my BMI up and put it in my [online shopping] basket,” Amina says. “Patients need it – it’s a drug for life and people are buying it haphazardly without understanding the serious risks.”
Before issuing an Ozempic prescription, Chloe and her doctor had a compulsory conversation about side effects. She was trained to correctly administer injections to avoid bruising or calluses and was provided with a sharps bin for needle disposal and a blood test every six months to ensure the drug wasn’t damaging her organs.
“It’s scary a drug to treat diabetes and obesity is available to buy off prescription,” she says, “with zero of these necessary precautions in place.”
In Australia, the Ozempic drought is nothing new. In May, Novo Nordisk told Australia’s government-run Therapeutic Goods Administration to urge healthcare professionals to avoid prescribing Ozempic off-label due to a supply problem, and on November 15, an update stated there will be no Ozempic in the country until March 2023.
Type 2 diabetes patient Tricia Nelson, 51, lives in Adelaide and was prescribed Ozempic in May after a previous drug negatively affected her pancreas and liver. Her pharmacist said Ozempic wasn’t in stock and warned there was already a lengthy waiting list. Tricia rang 44 chemists, but couldn’t source it and was put on insulin instead, which is used as a short-term fix to bring down blood sugar levels.
“[It] isn’t good for my pancreas and liver either,” she says of insulin. “The doctors want me on Ozempic – it will help get my organs working, but there’s none available in my county. It’s caused me a lot of stress – my skin’s aged, my hair is falling out – I don’t know what to do anymore.”
The Ozempic drought sporadically affected Glickman’s clients for most of 2022. He worked with patients – some of whom have diabetes – to ration supplies by slightly decreasing the doses so it lasted longer.
“For patients who couldn’t get the Ozempic refill they needed, we rationed the medication available at their homes,” he says. “It’s not ideal because if they’re not staying on the optimal treatment, that’s where we could start to see risks, such as an increase in weight regain and blood sugar, but it’s better than going cold turkey off the medicine entirely.”
Glickman’s patients had the advantage of being able to plan ahead. But like what happened to Chloe, there will be other diabetic users – unaware their medication supply might soon run out – who might be at risk of ending up in A&E if they abruptly lose access to Ozempic.
“My situation is just the tip of the iceberg,” Chloe warns. “It scares me to think how many more people in the UK will have their Ozempic supply compromised with no pre-warning – by those without diabetes or obesity – trying to get thin.”
