Weight Loss Wars: The OzempicTM shortage and other curiosities.
In the wake of the unprecedented demand for the diabetes and weight loss medication semaglutide (approved in Canada as OzempicTM & RybelsusTM, and WegovyTM, respectively), there have been shortages in our country and around the world. In fact, Wegovy has not even been brought to market in Canada, driving patients and their clinicians to use Ozempic “off-label” for therapeutic weight loss in obesity, and still others for so-called “vanity” weight loss. The problem (well, one problem) is that this off-label use is making it difficult for diabetic patients to access their needed Ozempic.
At the risk of getting a bit technical, semaglutide works by mimicking glucagon-like peptide 1 (GLP-1), a hormone that is secreted by certain cells in the intestine. Release of GLP-1 results in the secretion of insulin, which then acts to move glucose (sugar) out of the bloodstream and into tissues. This is how it helps control blood sugar in type 2 diabetes (it also inhibits secretion of glucagon, which normally raises blood sugars). GLP-1 also slows down intestinal secretions and motility, including emptying of the stomach, causing a person to feel full faster.
Interestingly, the weight loss effects of semaglutide do NOT appear to be related to these glycemic (blood sugar) effects. Instead, research shows that this is mediated by neuronal effects (nerves in the brain, gut, digestive organs, etc.), affecting appetite, hunger, and satiation.
There is no question that semaglutide, in its various forms, is more effective and better tolerated than other prescription treatments in the past that tried to curb appetite. Many of those had disastrous results (cardiovascular risk with stimulant-type agents, anal leaking of undigested fats with orlistat, to name a couple). The science has definitely evolved, but there are still important risks to be discussed with your doctor and pharmacist.
But I digress.
At the time of writing, it’s very hard to find a reliable supply of Ozempic. Pharmacies’ ability to get quantities is hit-and-miss. Patients are traveling back and forth, from their family pharmacist, to another pharmacy that was able to get some this week. It is a disaster.
In such situations, Health Canada makes access for patients a priority, and allows compounding pharmacies (like Marchese’s) to reproduce on-patent commercial drug formulas temporarily. i.e. until the shortage is officially alleviated (and if, by some miracle, they are able to find an approved supply of the active drug ingredient. Importers and distributors are also the heroes in these cases.). No doubt, commercial manufacturers are not crazy about this, but the public’s needs come first. Not sorry.
Compounding pharmacies often have to make tremendous investments and, therefore, take big financial risks, when responding to a shortage with a compounded version. When Children’s TylenolTM ran out of supply during the pandemic, compounding pharmacies helped countless kids across the country. And then got stuck with inventory when the commercial supply returned.
Big Pharma corporations with deep pockets have tried to sue small compounding pharmacies in the U.S. in an effort to discourage them from addressing the public need. This seems just, well, wrong. It has definitely scared many compounding pharmacies from coming to the aid of their patients. Once the shortage eventually comes to an end, there is the very real possibility that the helpful pharmacist may have to immediately stop producing the compounded version, and get stuck with a ton of $$$ inventory. The right thing would be to ensure that the pharmacies (and their suppliers) that risked so much to keep the public supplied during the shortage crisis are at least permitted to sell through their remaining inventory.
I am pleased to announce that, in addition to our diabetes and obesity prevention and management programs, Marchese Pharmacy has been able to procure semaglutide from a Health Canada-approved supplier. We are now providing compounded, sterile, semaglutide 1mg/ml injection for patients and their prescribers who need it, anywhere in Canada. We have committed to making it a more affordable option. In Ontario, we can also supply pharmacies who need semaglutide for their patients on a central fill basis. Call us today with your questions.