Since its launch in 2019, the hype and demand for Ozempic has grown dramatically, owing to its effectiveness not only at treating type 2 diabetes but also for its ability to lower the body weight of obese patients.
Given its popularity, could we ever see the drug being available over-the-counter? And what would the implications of such easy access to powerful appetite suppressants be?
How does Ozempic change your body?
The active ingredient in Ozempic is semaglutide, a drug that mimics the actions of a naturally occurring hormone called GLP-1.
When we eat a meal, GLP-1 is released from cells in the intestines where it performs several key roles.
Firstly, it signals the pancreas to release insulin, helping our bodies keep our blood sugar levels under control.
Secondly, through its actions on the nervous system, it reduces both the feeling of hunger and the desire to eat. Studies have shown that semaglutide can lead to a weight loss of an average of 10 per cent over four years in patients with obesity, as well as reducing their risks of cardiovascular disease.
Newer GLP-1-based drugs, such as Mounjaro (tirzepatide), show an even greater effect, averaging 22 per cent of weight loss over 72 weeks.
Considering the lack of effective anti-obesity medications, and the desire for weight-loss solutions, it is little wonder these drugs have been highly sought after. The demand has been so high that the Department of Health and Social Care placed a ban in July 2023 preventing doctors from prescribing GLP-1-based drugs to new patients due to national shortages.
Concerningly, there is also growing anecdotal evidence that the black-market supply of Ozempic is booming, potentially putting people at significant risk.
Between January and October 2023, the UK's Medicines and Healthcare Products Regulatory Agency (MHRA) seized 369 potentially fake Ozempic pens in the UK, with reports of patients being hospitalised with dangerously low blood sugar levels, suggesting they may have contained insulin instead.
Could Ozempic ever be available over-the-counter?
Medication in the UK can generally be obtained through two main routes: via a prescription typically given by a healthcare provider, or bought over-the-counter without a prescription at a pharmacy or chemist.
Some medications do transition from prescription-only to over-the-counter. Such processes are governed by the MHRA and require pharmaceutical companies to provide substantial evidence that their medications are safe, unlikely to lead to serious side effects when given without clinician supervision, and unlikely to be misused.
The decision as to whether or not to reclassify a medication involves input from scientists, clinicians and often members of the public.
The antihistamine fexofenadine is one such medication that was reclassified from prescription-only to over-the-counter in 2020, after many years of clinical data demonstrating its effectiveness, safety and lack of side effects such as drowsiness.
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Similarly, some drugs are available over-the-counter at lower doses than are available via prescription. For example, Omeprazole, a drug commonly prescribed to treat acid reflux is available over-the-counter at lower doses than can be prescribed by a clinician.
Sometimes they are only available from pharmacies but this still improves the accessibility of medications that have minimal side effects at lower doses, whilst retaining their therapeutic effects, but may require heightened levels of supervision at higher doses.
However, while GLP-1-based drugs are generally very safe, there is still the risk of potentially serious side effects such as gallstones and pancreatitis.
Studies have also found some patients taking GLP-1-based medications developed potentially life-threatening acidosis (where their blood becomes too acidic) due to significant nausea and diarrhoea, highlighting the need for careful monitoring of how patients react to the drugs. Research into the physiology of GLP-1 and other appetite-suppressing hormones is ongoing and could lead to medications with fewer side effects and greater efficacy.
Perhaps the biggest barrier to these drugs being made available over-the-counter is the risk associated with misuse. On the NHS, they are only prescribed to people with a BMI over 35 kg/m² and obesity-related conditions like heart disease. For these people, the benefits of weight loss usually outweigh the risks of taking such drugs.
However, if they were made available over-the-counter, such stringent rules on who can access them would be removed. Given their powerful appetite-suppressive actions, the effect that these drugs could have on people who suffer from body dysmorphia or eating disorders has the potential to be incredibly dangerous.
Given the scale of the obesity crisis, multiple drug companies are busy developing GLP-1-based medications to add to those already available.
Currently, medications such as Ozempic, Wegovy and Mounjaro are taken as once-weekly injections, something not all patients are comfortable with. However, many of the medications currently in development can be taken in pill form, which has the potential to dramatically reduce the costs, due to simpler manufacturing methods, and make it simpler for patients to use.
New medications entering the market should also help address the shortages of existing drugs, which will hopefully enable more patients to take advantage of their benefits. But will we one day see any of them readily available to the public without the need for medical supervision? That seems a long way off.
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