Ozempic: David Davison, a Nova Scotia licensed physician based out of Texas, lost his license last month for illegally prescribing the so-called wonder drug Ozempic to thousands of American patients, to be filled in British Columbia in Canada.
According to reports Davison wrote as many as 17,160 prescriptions for Ozempic in the last three months, creating a fear in Canada that the country might run out of the drug for those who really need it – people suffering from Type 2 diabetes. The drug was first touted as a medicine for patients with Type 2 diabetes while the prescriptions for whom Dr Davison was getting the drugs filled for was cosmetic purposes – that is those looking to lose weight quickly.
BC Health Minister, Adrian Dix announced last month that it would restrict the sale of the drug to non-residents after the demand for Ozempic surged from across the border. In a statement, he said, “It is important to ensure prescribing Ozempic is happening within clinical practice requirements to prevent the very serious issue of diverting the B.C. and Canadian drug supply to the American market.” Pharmacists cannot legally process prescriptions from American Physicians unless a Canadian physician has signed them as well. Therefore, before dispensing any medicine, it is up to the pharmacist to determine if the dispensation is appropriate.
When did Ozempic come to the market and why everyone is going ga-ga over it?
It was way back in 2012 when Denmark-based researchers at Novo Nordisk came out with semaglutide, to be injected once a week as a diabetes therapy a longer-acting alternative to liraglutide. Novo Nordisk is spread in about 77 countries, employing about 41,700 people. However, it was in 2017 that the drug, with the brand name Ozempic, was initially approved as a treatment for diabetes. By 2018, when it was launched, the drug became a blockbuster hit as apart from controlling blood sugar in a diabetic, they also lost the extra fat in their body within a few months of using the drug.
How does the drug work in a diabetic patient?
GLP-1 is a hormone that is produced in the gut in response to food intake. GLP-1 is Glucagon-like peptide-1 a 30 or 31-amino-acid long peptide hormone deriving from issue-specific Posttranslational processing of the proglucagon peptide (Wikipedia). By stimulating insulin secretion from the pancreas and reducing the amount of glucose produced by the liver, it helps in regulating blood sugar levels. The drug also slows down the rate at which the food leaves the stomach, thus reducing appetite and resulting in quick weight loss.
Says Dr Aman Khurranna, who is a practising family physician in Toronto, “Semaglutide is a synthetic version of GLP-1 that has been modified to last longer in the body. When injected once a week, it can provide sustained blood sugar control and help to reduce the risk of complications associated with type 2 diabetes. Specifically, when semaglutide binds to GLP-1 receptors on pancreatic beta cells, it stimulates the release of insulin in response to elevated blood glucose levels. It also reduces the release of glucagon, a hormone that raises blood glucose levels, from the alpha cells in the pancreas. This helps to lower blood glucose levels and promote glucose uptake by the body’s tissues.”
Overall, Ozempic’s mechanism of action involves stimulating insulin secretion, reducing glucagon secretion, and promoting weight loss through appetite suppression, all of which can help to improve blood sugar control in people with Type 2 diabetes.
For diabetics who are on insulin, which they have to inject every time before a meal, Ozempic certainly is a convenient medication, as it improves their quality of life. Instead of injecting themselves 2-3 times a day, they will have to inject just once a week and therefore, is being termed as a boon for them.
How does Ozempic work for weight loss?
The science behind weight loss when using Ozempic (semaglutide) is thought to involve a combination of factors, including appetite suppression and improved glucose control. Says Dr Khurranna, “As a GLP-1 receptor agonist, semaglutide can slow down the rate at which food leaves the stomach, which can lead to feelings of fullness and reduce appetite. This effect can help to reduce calorie intake and promote weight loss. Therefore, weight loss can also be a side effect of improved glucose control in people with type 2 diabetes. High blood sugar levels can lead to increased appetite and insulin resistance, which can make it difficult to lose weight. By improving glucose control, semaglutide may help to reduce appetite and improve insulin sensitivity, which can facilitate weight loss. This side effect of the drug, I feel is widely being misused by many. For a diabetic, who is obese, it is important for them to control their weight, which can help lower blood sugar levels. But not for a regular person.”
According to the National Library of Medicine, clinical trials on people on semaglutide lost an average of 14.9% of their body weight over 68 weeks, compared to 2.4% in the placebo group. Overall, the science behind weight loss when using Ozempic involves a combination of appetite suppression, improved glucose control, and potentially other factors that may be related to its mechanism of action. It is important to note, however, that weight loss may vary from person to person and not all individuals may experience significant weight loss with the medication.
Today, Ozempic has become the darling of social media influencers. Whether it is Instagram, Twitter, Tik Tok or Facebook, people are proudly displaying their before and after pictures of their bodies after losing as much as 210 lbs after using Ozempic. Hashtag Let’s talk Ozempic and weightloss, has been trending for a year or more now. #Ozempic has been viewed on Tik Tok as many as 600 million times. As many as 3.5 million prescriptions worth nearly $1.2 billion were dispensed for Ozempic by retail drugstores in 2022 in Canada, according to data provided to the National Post from IQVIA CompuSript. That’s up from just over 81,000 scripts worth $26 million in 2018, the year Health Canada approved the drug.
Twitter head Elon Musk, and Hollywood stars like Chelsea Handler, and Kyle Richards are just among a few celebrities who have proudly claimed to use the drug to lose weight. And how many followers do just a few of them have – millions of them? So, if they advertise or even talk about anything, it has to trend and many followers will merely follow them without doing their own research or realizing what is good for them.
The only benefit for diabetes-using Ozempic is it lowers blood sugar while for those who use it for weight loss, is just that. However, side effects are too many to count – nausea, vomiting, vision changes, mood swings, a light-headed feeling, hoarse voice, breathlessness, symptoms of pancreatitis causing severe pain in the upper stomach area, fast heart rate, gall bladder problems, dizziness, headaches, weakness, sweating, confusion, low blood sugar, kidney problem, to name a few.
Worst of all, those who have used it for weight loss and then stop it after they have reached their desired weight, their weight bounces back with a vengeance. According to a study in the Journal of Pharmacology and Therapeutics, the majority of people who have used semaglutide for weight loss will gain it back within a year of stopping the medication. And controlling that then, is not easy said Dr Karla Robins of a Charlotte, North Carolina-based family physician, while talking to the media. So, it is not all rosy and the side effects of this wonder drug should not be ignored if taking it for aesthetics only.
While more research is needed and approval for using Ozempic for weight loss, it is no wonder or boutique drug. Its side effects for those looking for quick weight loss, are too many to be ignored. While some have reported a reduction in the urge for alcohol, others experienced flushing and toxicity when consuming alcohol. Ozempic is also reported to interact with other medications like acetazolamide, antipsychotics or other antidepressant medicines. Some animal studies have also reported increasing thyroid C-cell tumours in rats though researchers have not reported the same on humans yet. Ozempic is still a new drug and caution should not be thrown to the wind when using it unless prescribed by a doctor.
There may be many reasons that someone on Ozempic might have to stop using the drug. It could be due to a shortage of supply or due to the fact that you have run out of insurance and has become too heavy for your pocket. And once Ozempic is stopped, your appetite may go up much before you started on the drug, thus making you put on more pounds than before.
Over the years, there have been weight loss drugs, capsules and appetite suppressants have come and gone in the market. Most have merely benefitted the pharmaceutical companies while people are still being used as guinea pigs. Way back in Nazi Germany, methamphetamine became a rage and was also declared a wonder drug to help depressed people. It was also sold to housewives to alleviate their spirits and it helped them melt away some extra fat. At the end of the day, methamphetamine is now only an opioid and no medicine to cure a sick mind or a body.
Ozempic is nothing but bad news as its relief is nothing but temporary. Not many non-diabetics will be able to continue using it as it is expensive on the pocket and not much insurance still cover it. If people with diabetes stop using the drug or halt treatment, their blood sugar will rebound to pre-medication levels. After all Ozempic treats a chronic disease of diabetes, and therefore, the condition will be worsened if it is stopped. Same if used for weight loss – once stopped, weight is back. After all, it is just yet another drug which can be termed addictive as once you are on it, there is no going back. It is medicine for some, and poison for others.