Antidiabetic drugs are distorted into "magic pills for weight loss"
Semaglutide injection for the treatment of type 2 diabetes has been abused for weight loss; doctor: the drug has not been evaluated by a specialist, and there is a risk of misuse and abuse
"One injection and I lost 10 pounds in a week."
Semaglutide injection, a drug used to treat type 2 diabetes, is becoming a weight loss myth circulating on social media. A large number of people who need to lose weight have purchased through online platforms, purchasing agents, and even entered medical aesthetic institutions for injections.
However, the “weight loss” indication of semaglutide injection has not yet been approved in my country. Zhang Peng, deputy director of the Bariatric and Metabolic Surgery Department of Beijing Friendship Hospital, told reporters that the weight loss mechanism of semaglutide is mainly to inhibit gastrointestinal motility to enhance satiety and reduce appetite. If you purchase and use this drug without the evaluation and guidance of a physician specialized in endocrinology and metabolism, there will be potential risks of drug misuse and abuse, which may result in poor therapeutic effects or direct harm to the patient's health.
Many industry experts believe that the popularity of semaglutide has revealed the tip of the iceberg of prescription drug abuse and also exposed the chaos of online drug sales. There is still a long way to go in the compliance operation of online drug sales.
Uncontrolled weight and pills that can help you lose weight with just one injection
In the first month after injecting semaglutide, Yang Siwei, who is 172cm tall and 220 kilograms, lost 10 kilograms.
In the next five months, Yang Siwei tried to use drugs to maintain the "weight loss results." When the drug no longer brought obvious "benefits," he gave up the injections. After stopping the medication for more than half a year, his weight has now reached 230 pounds, "the highest weight he has ever had."
Losing weight was once part of Yang Siwei's life. Yang Siwei said that he had been obese since he was a child and had tried many ways to lose weight before using semaglutide. When he was in college, he tried to be vegetarian and did push-ups and other light equipment-free exercises for half an hour every day. In more than half a year, he lost weight from 210 pounds to 160 pounds, and his whole body became more relaxed.
After graduation, he entered the Internet medical industry. He was busy working and sitting for long periods of time. After get off work, he was tired and hungry. He often went to bed after eating late night snacks, and his weight "gained back" out of control again.
In medicine, there are three main methods used to solve the problem of obesity: nutritional therapy, drug therapy, and surgical therapy. According to the "Chinese Surgical Treatment Guidelines for Obesity and Type 2 Diabetes", if BMI ≥ 37.5Kg/㎡, active surgery is recommended; if 32.5Kg/≤BMI ≤ 37.5Kg/㎡, surgery is recommended; currently widely accepted surgical procedures include laparoscopic gastric sleeve resection, laparoscopic Roux-en-Y gastric bypass, etc.
In terms of drug treatment, orlistat, liraglutide injection, and benaglutide injection have been approved in China for the treatment of obesity. However, due to efficacy issues, unknown risks, number of injections, etc., some of them have been criticized on social media. There is not much discussion on it.
In Yang Siwei’s impression, semaglutide is very popular on social platforms. "Effective, safe and fast" has become a keyword, and the "semaglutide" tag on a certain social software has as many as 7.35 million views. As early as 2021, a senior working in the hospital recommended it to him and told him that he had lost 20 pounds. In October 2022, when he started taking injections, semaglutide in hospitals had become in short supply, and some hospitals mandated that people with diabetes could prescribe it.
Yan Xixi also noticed semaglutide in 2022. One of her friends lost 30 pounds in three months. Yan Xixi is 36 years old and works as a consultant in the medical beauty industry. He is 163cm tall and weighs 130 kilograms, which means he is "slightly fat." But in the medical beauty industry, "weight is part of beauty."
Although there are many channels around her where she can buy medicine, Yan Xixi believes that it is unsafe to operate without a doctor's examination. A colleague told her that she could also go to the hospital to get it. With the mentality of giving it a try, Yan Xixi went to the weight loss and bariatric department of a tertiary hospital. The doctor prescribed B-ultrasound, urine test and thyroid test for her, as well as a whole blood test worth more than 1,000 yuan.
Judging from the examination results, the doctor felt that there was no need for her to take this injection. The doctor told her that although this drug can achieve weight loss, it is aimed at people with very high blood sugar and blood lipids, but she only has high blood sugar.
Yan Xixi tried to convince the doctor that her body fat percentage was higher than normal and that her family also had hereditary hypertension. Later, the doctor felt that there was a real need to lose weight and prescribed 1.5 ml of semaglutide for her.
After injecting 0.25 ml in the first week, Yang Siwei felt no changes. During this period, he consulted a friend who was in pharmaceutical sales, who told him that according to his weight, "just take 0.5 ml in the second week, and some people can take 1 ml."
In the second week, Yang Siwei increased the dosage to 0.5 ml. His stomach felt obviously full and he had no desire to eat. He used to be able to eat an entire Dicos set plus a pistol leg. After taking the medicine, he couldn't finish even a pistol leg. He felt greasy and nauseated after taking two bites.
But from the second month onwards, the physical reaction was no longer obvious, and his weight no longer changed significantly. In the following four months, Yang Siwei successively injected two 1.5 ml bottles and one 3 ml drug. For him at the time, “it’s going to go down if it doesn’t go up.” Later, Yang Siwei's dose reached 1 ml each time, and he no longer felt full.
Yan Xixi also didn't feel hungry, but felt a little nauseous. My food intake has been reduced to one-third of the original amount. I often eat when I wake up in the morning, but I may not feel hungry until three or four in the afternoon.
Under the guidance of a doctor, she took medicine for three months and her weight dropped to 120 pounds. The doctor asked her to undergo a comprehensive examination and told her that she could no longer rely on medicine, otherwise it would cause harm to her body. If you are not satisfied with your weight, you can continue to control your diet or exercise.
Weight regained after discontinuing medication and continued vomiting after self-medication
Public information shows that the original developer of semaglutide injection is Novo Nordisk. The company has three semaglutide drugs approved by the FDA, namely Ozempic (hypoglycemic drug for injection) and Wegovy (injection). Use weight loss drugs) and Rybelsus (oral hypoglycemic drugs).
In my country, semaglutide (Chinese trade name: Novota), which was approved for marketing in April 2021, corresponds to semaglutide injection (Ozempic) approved by the US FDA, and its indication is type 2 diabetes. . Semaglutide tablets were approved by the State Food and Drug Administration for the treatment of type 2 diabetes in January 2024.
No matter in China or the United States, semaglutide injection (Ozempic) has not been approved for weight loss indications. Professor Wei Guohong from the Endocrinology Department of the First Affiliated Hospital of Sun Yat-sen University once mentioned in an interview that many patients had come to see the doctor for weight loss needs, and the drug was even out of stock at one time, and diabetic patients were unable to take the drug normally; Later, the hospital made adjustments and strictly controlled the indications. Only doctors in the endocrinology department had the authority to prescribe, and they could only prescribe it to patients with type 2 diabetes to ensure a continuous supply of the drug.
Zhang Peng, deputy director of the Bariatric and Metabolic Surgery Department of Beijing Friendship Hospital, told reporters that when semaglutide was first introduced into my country, it was used as a second-line prescription drug for the treatment of type 2 diabetes. At the same time, the drug has a certain weight loss effect and its weight loss mechanism Mainly by inhibiting gastrointestinal motility to enhance satiety and reduce appetite. Before using semaglutide, the patient needs to be clinically evaluated by an endocrinology and metabolism specialist to decide whether it can be used. During use, regular follow-up is also required to evaluate the drug treatment effect and adverse reactions, and make timely dynamic dose adjustments. .
"There are differences in dosage forms and dosages between semaglutide for hypoglycemia and semaglutide for weight loss," Zhang Peng mentioned. Currently, it is not recommended to use Ozempic solely for weight loss treatment. Because weight loss treatments in Western countries usually require higher doses, but in clinical trials of semaglutide for weight loss, the population enrolled was European and American people, while the gastrointestinal anatomy, physiology, and metabolic functions of the East Asian population are different from those of the Western population. The difference is that whether Chinese people can tolerate the same dose or whether a larger dose is needed still requires further verification by domestic clinical studies.
At Zhang Peng's clinic, they are very cautious about the clinical application of semaglutide injection (Ozempic). If it is simply used for weight loss, there is no semaglutide Wegovy for weight loss in China, and there is a lack of reasonable Using drug dosing guidelines, drugs cannot be prescribed in an attitude of responsibility to the patient. For patients with type 2 diabetes and obesity, it is recommended as appropriate if other drugs cannot control blood sugar satisfactorily, and a series of examinations and evaluations must be conducted based on the pharmacological mechanism of semaglutide before clinical use. , the most important thing is the patient's family disease history, genetic disease history, past medical history, liver, pancreas, kidney function and thyroid examination to avoid adverse reactions.
In the drug instructions for semaglutide, it is clearly mentioned that the drug may increase the risk of pancreatitis, gallbladder disease, and acute kidney injury. Some patients with diabetic retinopathy may have their conditions worsen, including medullary thyroid cancer and 2 Patients with a family history of multiple endocrine neoplasia syndrome should not use this drug. In September 2023, the U.S. Food and Drug Administration further updated Ozempic's instructions to increase its potential risk of intestinal obstruction. In October 2023, a Canadian research team reported that semaglutide can cause intestinal obstruction. and increased risk of pancreatitis. Secondly, the drug acts on the nerve center, so people suffering from depression, bipolar disorder and other mental illnesses should not use it.
Zhang Peng has met many patients who obtained semaglutide through other means and used it to lose weight on their own. He found that most people use it irregularly—following their own feelings, or accepting information and advice from non-specialist doctors on social media. If you use the wrong dosage or increase or decrease the dosage at will, you will not only fail to achieve good therapeutic effects, but may even harm your body.
Zhang Peng emphasized that after stopping the drug, most people's blood sugar and weight will rebound, and even fall into a vicious weight cycle of weight loss - weight gain - weight loss - weight gain again, which not only leads to more weight loss, but also leads to metabolic disorders and aggravates fatty liver disease. and diabetes, etc. Therefore, patients also need evaluation and guidance from endocrinology and metabolism specialists on whether and when to stop taking medication. Zhang Peng mentioned that a clinical trial showed that patients treated with semaglutide recovered more than 50% of their lost weight one year after stopping the drug.
Yan Xixi rebounded. After her doctor stopped prescribing her medication, she gained three to five pounds. The sudden rebound made her feel very uncomfortable.
At the beginning of 2023, Yan Xixi purchased a bottle of semaglutide on an online drug purchase platform. She thought she was familiar with this drug, so she took twice the original dose for the first injection. Then I vomited for three consecutive days. After I emptied my stomach, I also vomited even after drinking water. She went to the hospital urgently to get an anti-emetic injection. One injection failed to stop the vomiting, so she received another injection. The doctor told her not to take the medicine blindly. "I feel so uncomfortable and scared that I will never fight again."
Antidiabetic drugs are promoted online as weight loss drugs
Semaglutide, which requires examination and other means before being prescribed in hospitals, can be found everywhere on e-commerce platforms. A reporter recently purchased Semaglutide Injection from a number of pharmaceutical e-commerce platforms and found that non-diabetic patients can easily prescribe and purchase the drug. There are many loopholes in the online drug sales process.
Log into a drug purchasing platform to search for the prescription drug "semaglutide" and enter an online store called "XX Pharmacy Flagship Store". The reporter found that when filling in the consultation information page, you only need to select the option of diagnosing type 2 diabetes to submit a prescription request. In the "Inquiry and Prescription", a general practitioner from the Internet hospital sent questions such as "whether there is any history of allergies, drug contraindications, and injection dosage."
After a simple inquiry, the doctor issued an electronic prescription for an Internet hospital. The prescription pad shows three handwritten signatures: the physician, the preliminary pharmacist, and the reviewing pharmacist. As a non-diabetic patient, the reporter spent 770 yuan to successfully purchase a box of 3 ml dose of semaglutide injection.
The "Internet Diagnosis and Treatment Management Measures (Trial)" issued by the National Health Commission in 2018 has clearly stated that Internet diagnosis and treatment activities are not allowed for first-time patients. However, issuing prescriptions based on the information filled in by the patient online obviously does not meet the regulatory requirements.
There are even online drug purchasing platforms suspected of off-label promotion. The reporter found that some online pharmacies even recommended endocrinologists from tertiary hospitals on the semaglutide drug display page, saying that "semaglutide is a GLP-1 receptor agonist that can inhibit the feeding center. , effectively enhances the feeling of fullness, reduces appetite, and has the effect of losing weight, and it only needs to be used once a week." Then the weekly injection dose and injection method were also introduced.
According to the "Interim Measures for the Review and Management of Advertisements for Drugs, Medical Devices, Health Foods, and Formula Foods for Special Medical Purposes" issued by the State Administration for Market Regulation in December 2019, "drug advertisements involve drug names, drug indications or functional indications, pharmacological effects and other contents shall not exceed the scope of the manual.”
“When laws and regulations are unclear, there will be sideline businesses,” said a practitioner in the Internet pharmaceutical field. He believes that the popularity of the semaglutide market reflects its huge demand in the field of weight loss. Diabetes drugs are currently being abused as weight loss drugs, or more clinical trials can be conducted to test whether obesity can be used as one of the indications. Or issue strict management regulations.
The regulatory dilemma of online prescription drug sales
The “availability” of semaglutide has revealed the tip of the iceberg of prescription drug abuse, and also presented the problems of supervision and management of online sales of prescription drugs.
In December 2023, the State Food and Drug Administration announced the third batch of typical cases of drug online sales. Among them, many platforms sold drugs without approval documents and other factors. The local market supervision and administration administration imposed confiscation of the drugs involved in the case on these sales entities in accordance with the law. Confiscation of illegal gains, fines and other administrative penalties.
According to many experts, determining the compliance and authenticity of prescriptions is undoubtedly the most critical aspect of regulating online prescription drug sales.
On January 29, a reporter called the customer service of a drug-buying platform. The customer service said, “For example, some state-controlled drugs require a prescription. Prescription drugs that can be purchased in ordinary pharmacies do not require a prescription.” Regarding Semaglutide Injection Which one it belongs to, the other party did not give a clear reply.
The issue of online sales of prescription drugs in China has always been controversial. Supporters say that people who generally buy medicines online are people who are returning for medical treatment. For example, patients with chronic diseases such as diabetes and hypertension take large amounts of medicines frequently. Online sales of prescription drugs can provide great convenience to these patients. Opponents believe that the safety of prescription drugs sold online is difficult to guarantee, the authenticity of the drugs is questionable, and the qualifications of practicing pharmacists in online pharmacies need to be verified.
As a clinician, Zhang Peng also expressed concerns about the ability to purchase prescription drugs at will on the Internet platform. Because there are differences between people, doctors need to conduct medical history inquiries, physical examinations, laboratory tests and imaging tests before issuing prescriptions for patients. , disease diagnosis can be made. On this basis, it is necessary to further judge the possible efficacy and adverse reactions of the drug to the patient to decide whether it can be prescribed, so as to protect the patient's interests to the greatest extent. However, some e-commerce platforms are rather hasty in diagnosing the diseases of drug buyers. They make disease diagnoses without detailed medical history inquiry and examination, and without clinical basis. This is irresponsible and may not only cause drug misuse, but also cause Drug abuse causes harm to patients' health and is contrary to the standards of the medical profession.
Li Zihao from the Research Institute of the China Medical Materials Association emphasized that medical treatment should be "prescription first and then medicine", while purchasing medicines on the Internet platform is a process of "prescription first and then medicine". The harm caused by this is obvious. For example, lack of common sense about drug use often leads to drug abuse. Therefore, we can appropriately refer to some advanced international experience, network the medical system, share information, and verify prescriptions conveniently and quickly. At the same time, we can also avoid potential risks caused by irregular prescriptions.
"In order to ensure the safety of patients' medication, the current "Prescription Management Measures" and "Prescription Review Standards for Medical Institutions" clearly stipulate that after doctors prescribe prescriptions for patients during diagnosis and treatment activities, pharmacists must review them," said the Standing Committee of the Rational Drug Use Committee of the China Traditional Chinese Medicine Association. Deputy Chairman Kang Zhen emphasized that in reality, some platforms skip the traditional prescription issuance and review process and directly turn prescribing into "selling drugs." This type of behavior seriously violates my country's drug management regulations and also undermines the safety of patients' medication. Hidden dangers were laid. "The side effects and incompatibility of drugs require professional pharmacist services. The lack of this link may lead to health damage, drug-induced disability and other problems."
Kang Zhen also understands that many patients choose to purchase drugs online in order to save time and cost and hope to obtain faster medical services. However, this is actually a problem of insufficient services in physical medical institutions. The serious shortage of professional pharmacists in China is also one of the reasons.
Recently, Yang Siwei began to try meal replacement methods to lose weight. He bought meal replacements worth less than 3,000 yuan, used energy bars to replace staple foods, and carried out a low-carb diet. And a nutritionist provides guidance every day. With feedback and interaction from the outside world, I feel more motivated. At the same time, his physical condition has met the standards for weight loss surgery, so he is also considering whether to undergo weight loss surgery.
Yan Xixi still kept the unfinished injection in the refrigerator, but she had decided not to use it again. One of Yan Xixi's colleagues lost 30 pounds in three months, and then gained the 30 pounds back in another three months. Yan Xixi plans to control it through diet and weigh herself every morning. "Today I have a wild meal, and tomorrow I will control it for one day or three days. I will never go back to eating casually before." She feels that semaglutide The biggest gain for her is that she developed the habit of controlling her appetite through external force. "The medication was stopped, but the habit continued as if it wasn't that difficult."
(Yang Siwei and Yan Xixi are pseudonyms in the article) (Beijing News reporter Li Cong)