When the semaglutide, Wegovy, was introduced into the market earlier this year by the Danish pharmaceutical company, Novo Nordisk, diabetic patients breathed a sigh of relief. Finally, the supply crisis of Ozempic (also manufactured by Novo Nordisk) that was caused by off-label prescribing for weight loss would be solved, or so they thought.

The Department of Health (DH) advised that Ozempic supply will not return to normal until at least mid-2024, and Novo Nordisk explained that there will likely be “intermittent supply shortages” running into 2025.

Read more: Pharmacies pioneer private Wegovy service as drug sees UK launch

To add to the pile, pharmacy professionals have mixed thoughts and feelings about the drug itself. Could community pharmacy be facing a serious problem?

 

 

Online harm

 

The ability for patients to access their healthcare needs online is a double-edged sword. On one hand, it creates an empowered patient that is aware of health risks and associated treatments. However, when it comes to semaglutides, dangerous advertising and accessibility can pose serious problems.

UK charity, Beat, which supports those affected by eating disorders, highlights that online advertising is “extremely harmful”. Last summer, it conducted a survey with 182 individuals with experience of eating disorders to investigate how they felt about the advertisements, and it described the results as “worrying”.

Read more: NICE conditionally recommends four apps to support weight management

Beat revealed that 64% of its respondents felt they were “personally targeted by harmful adverts”, and stated that this could “reinforce harmful ideas”, “encourage harmful behaviour” and “set people back” in their recovery journeys.

Beat's director of external affairs, Tom Quinn, told C+D that weight loss drugs are “incredibly dangerous” because they can “worsen eating disorder behaviours for those unwell” or “contribute to an eating disorder developing for the first time.”

“Weight loss injections like Ozempic and semaglutide can be incredibly attractive to people with eating disorders, as they usually promise drastic results in a short space of time,” explains Quinn.

“Doctors prescribing these injections must look out for the warning signs of an eating disorder…It's also important to remember that people with eating disorders may feel compelled to lose weight even if it puts their health at risk.”

Moreover, Quinn explains that the widespread talk on Ozempic across social media is “really concerning”. He said: “While social media doesn't cause eating disorders, posts encouraging people to buy weight loss drugs can increase feelings of guilt and shame, and lead to eating disorder behaviours.”

Online pharmacies can also pose a danger. Back in November 2023, online pharmacy, Care Pharmacy, was chastised by the Healthcare products Regulatory Agency (MHRA) for advertising Ozempic online after it received a complaint about it advertising “medicinal treatment services for weight loss” and because it is a prescription only medicine (POM).

Read more: DH and MHRA ban wholesalers from exporting or hoarding semaglutide

Consequently, the MHRA announced that phrases like “special offers” and “inappropriate wording” such as “start order’”, “express checkout” and “add to cart” shouldn’t be used. Badges like “buy now”, “buy XXX” and “add to basket” should also be avoided.

Superintendent of iHeartPharmacy Group and originator of ProLongevity, Graham Phillips, said when considering online advertising, the question of “with what intent?” needs to be posed. Phillips suggests figuring out “the outcome we are seeking” and whether “we are trying to do some good”.

 

 

Public safety

 

If that’s not enough, a month prior to MHRA’s slap on the wrist, there was a case of fake Ozempic jabs in the UK supply chain. The jabs were brought in by “legitimate suppliers” from Germany and Austria, and the European Medicines Agency (EMA) issued an EU-wide alert that the fake Ozempic pens had been found at wholesalers in the EU and the UK.

There’s also the case of “fake drugs” being sold on the “dark web”, which opens the door to where the limit can be drawn on access for drugs.

Quinn says that “it's especially worrying to hear that fake injections are being advertised online”.

On September 4, Novo Nordisk announced that Wegovy would be available through specialist NHS weight management services (for qualifying patients with a “weight-related health condition” including hypertension or cardiovascular disease, along with a BMI of 35 or sometimes 30), but also privately through a registered healthcare professional. But it’s worth flagging that at some pharmacies, including at Superdrug, the service is available online.

“Superdrug Online Doctor already runs safe and effective weight loss services which provides several different treatment options for those who are deemed eligible to try them,” Superdrug’s pharmacy superintendent, Niamh McMillan, told C+D.

“For our weight loss services, we believe Superdrug Online Doctor has one of the safest and most comprehensive online services available.”

Read more: Wegovy: DH to consider pharmacy role in £40m two-year obesity pilot

McMillan told C+D that doctors “review and ensure” that the treatment is “suitable” before it is prescribed and pharmacists “provide further advice and guidance where needed”. There’s also “in-built ID and safety checks”, including a request for “photographic proof of weight”, “past medical history” including eating disorders and “informing GPs of every prescription”.

While online checks can be useful, it’s difficult to ignore the surrounding risks, especially when it comes to vulnerable individuals.

Quinn told C+D: “To ensure that people with eating disorders can't get a prescription, we're urging pharmacies and health professionals to carry out eating disorder screening as part of their health checks.”

Chief executive at Pharmadoctor, Graham Thoms, which provides clinical service for patients, said in his line of work patients cannot simply “get [Wegovy] by walking into a pharmacy” because there is a system.

He told C+D that community pharmacists are required to complete their continuing professional development (CPD) training course online to activate the service – which he describes as “the backbone” of the way pharmacists provide the “weight management” service.

Read more: One in 20 new diabetes cases could be linked to COVID, research shows

Thoms explains that through Pharmadoctor, initial consultation and monthly reviews are done face-to-face, so that “there is no danger of a patient lying”. In a review meeting, the pharmacist would ask the patient questions, including how they are getting along with their calorie intake and exercise, which are planned in advance when patients qualify to receive Wegovy.

 

 

Where does the onus lie?

 

It seems like there’s a pendulum of whether pharmacists should refuse to provide the service over concerns on patient health, versus providing the service as a source of income.

It’s no secret that independent pharmacies are facing financial difficulties; C+D has received concerns over whether sealing the deal on the Pharmacy First ambition was the correct move, and the pharmacy stores’ market has seen increasing numbers of sales with LloydsPharmacy bidding farewell this year. Thoms told C+D earlier this year that pharmacies could be making £280,000 a year by offering the service.

Phillips explained to C+D that he offers Wegovy to his patients but “very selectively” because he feels “dubious about the net benefit”.  He said: “There are no shortcuts [to losing weight].”

When asked about Wegovy possibly relieving community pharmacists of financial burdens, Phillips said although he’s aware that there is a “huge shortfall in our funding”, he thinks community pharmacy should be “properly funded, doing good stuff” - he describes this as “professionalism.”

“So the first thing you have got to look at, is focus on all of the lifestyle issues: exercise, sleep, low-carbohydrate diet, don't eat junk food, and so on and so forth,” explains Phillips.

“It’s part of the solution, but it’s not the solution itself”.

Phillips adds that the drugs “address the symptoms” but not “the root cause” – which he is more interested in. Therefore, when meeting with a patient, he “addresses their lifestyle” first and says this is where he thinks “the profession needs to go.”

Read more: Novo Nordisk to hit 700k injection pen recycling target as it eyes expansion

Phillips will turn away patients who he deems are not suitable to receive Wegovy, and suggests pharmacists should be tackling “food addiction” which is a “long-term solution” to the obesity crisis. Some of the most recent data from NHS Digital revealed that there were over one million hospital admissions where obesity was a factor during the 2019-2020 period.

While speaking to C+D, Thoms echoed similar concerns on Wegovy but highlighted that pharmacists are “drug experts” who have been delivering “increasingly more complex services, within certainly the last 10 years.”

Thoms said: “You've seen the Pharmacy First [service]; pharmacists were commissioned by the NHS to deliver even more clinical services, and that’s because they are drug experts - so they're in the best place to provide this.”

At Pharmadoctor, pharmacists use the “propriety consultation software”, which asks them to take note of weight, height, BMI and so on; and answer a series of medical questions that “underpin the service”. Only then can pharmacists decide if a patient is qualified to receive Wegovy.

On the topic of BMI, Quinn said: “Some weight loss injections are now available on prescription for people of a certain BMI. This is very concerning because people of all weights, BMIs and sizes develop eating disorders.”

Read more: 'The obesity epidemic shows no signs of slowing – but pharmacy can help'

One side effect of Wegovy is weight rebound after the patient stops injecting.

“We’re also worried about what happens after somebody finishes their prescription,” says Quinn.

“If somebody gains weight after taking an injection, this could trigger feelings of shame and guilt, which could contribute to an eating disorder developing.”

Superdrug also offers patients alternative solutions to weight loss. McMillan told C+D about the “range of weight loss treatments” on offer at Superdrug, supported by the Weight Loss Support Guide, Weight Loss Tracker, Food Diary and Weight Loss FAQ page.

 

 

Another battleground?

 

As obesity rates continue to rise in the UK, with one in every four adults and one in every five children estimated to be obese, some might consider semaglutides a potential solution to the problem. Obesity increases the risk of some health conditions, including type 2 diabetes, coronary heart disease and some types of cancer.

Read more: What would ditching anti-obesity measures mean for pharmacy weight-loss services?

But it comes as no surprise that Wegovy is facing stock difficulties. In October 2023, it was reported by C+D that independent pharmacies are only able to offer Wegovy to “one weight loss patient…per month”, as a result of the strict purchasing quotas for the drug.

A spokesperson from Novo Nordisk said the supply “will continue to be constrained”, and that it has “restricted quantities to create a steady level of supply”. The purpose of that is to keep NHS access prioritised.

While patients endure difficult access to GPs and long waiting lists to specialist services, it’s difficult to imagine what this will mean for Wegovy and its role in supporting patients in their weight loss journeys.

Could this be a cause for another battleground between pharmacists and GPs? Or should Wegovy be scrapped altogether, especially when vulnerable groups of the public are at increased risk?

Perhaps those questions can be answered when we know what the long-term effects of Wegovy are…

 

If you’re worried about your own or someone else’s health, you can contact Beat, the UK’s eating disorder charity, 365 days a year on 0808 801 0677 or beateatingdisorders.org.uk