In 2024, I’m reflecting on all of the health articles, forums, and blogs talk about the miracle drug, Ozempic / Wegovy. This seemingly started as a “designer” drug for celebrities and rich folks to lose weight and by the day becomes easier to obtain and in the hands of millions. Perhaps this truly is a miracle drug or perhaps it’s history repeating itself.

I’m not here to claim to be an expert on any of this — because I certainly am not. In fact, I am probably the exact opposite of that in this space. However, it is eerily similar the way the situation at large is trending based on my viewpoint. This article will summarize the high level themes and patterns I’ve noticed between the drugs, the rise of usage, and some of the oddities that I’ve stumbled across during my research. To emphasize, I am not a medical professional, this is not personal advice, this is just my observations. Please seek help and guidance from a medical professional and do not use this for anything other than entertainment to provoke thoughts on the matter.

Timelines

The below section highlights some interesting timelines and events. These have been selected intentionally in a way to provoke comparison

OxyContin timelines:

• 1996 – OxyContin was approved in varying doses<source>
• 2011 – Opioid overdoses / deaths peak around 15 years after the release of the drug <source> at ~15,000.
• 2012 – New prescription rates dropped by 54% through 2017 <source>
• 2018 – An estimated 3.0% or 9.9 million of Americans used prescription pain relivers in past year <source>

Wegovy Timelines

• 2021 – Wegovy was released
• 2022 – Elon Musk cites Ozempic / Wegovy as the source of his weight loss <source> <source> helping it enter into the “designer drug” category
• 2023 – American Association of Poison Control Centers reports 3,316 overdoses related to Semaglutide drugs, the same class of drug as Wegovy. <source>
• 2024 – Less than 2 years later, 6% of surveyed Americans are using or have tried Wegovy / Ozempic in the past year <source>

I couldn’t find any fun celebrity endorsements to compare Elon’s direct reference to in the early 2000s, however, I’m sure they exist, and I’m 100% certain music lyrics reference opioids throughout the 2000s. But it is less important to the overall point. The main point is that this drug went from obscure to “mainstream” in record time. It took the opioid crisis 15 years to peak in deaths — we aren’t even in year 3 of the drug’s existence, but we’ve already eclipsed the usage rate seen during some of the highest levels of the opioid crisis. We are seeing over 3,000 overdoses per year, and growing fast. Without being a medical professional and without any evidence beyond what I’ve listed above, it is possible that 15 years from now that there is a spike in adverse effects not known today. I’m not trying to sound like an anti-vax or anti-covid person, but I do approach things that seem “too good to be true” with skepticism. Let’s continue from here and see who is the target patient for Wegovy? Is addiction likely?

Who Can Use Wegovy?

According to Wegovy label, patients should only be prescribed Wegovy, if they are over 30 BMI, or over 27 BMI and show either Type 2 diabetes, hypertension (high blood pressure), or dyslipidemia (high lipids in the bloodstream) <source>. When diving into this, as of 2018 42.4% of US adults were either overweight or obese. <source> 49.64% of the population has hypertension <source> Whereas 8.6% of the population had Type 2 diabetes <source>. Given the relationship with weight, hypertension, and diabetes, it’s fair to say that Wegovy has not been overprescribed just yet in relation to the intended patient as of writing this.

<<Prediction Time>>

I suspect that either of the following will happen: 1) the requirements will lower for Wegovy or a variant in the coming years to allow for broader use cases 2) the number of adults exhibiting hypertension, type 2 diabetes, or dyslipidemia will increase or have the standard for measurement lower to allow for greater adoption. Allowing for more insurance claims and reducing the cost of the drug, this is due to the fact that Wegovy comes with a step price tag of $1,350 per month if you are not prescribed the medicine through insurance.

<<End Prediction>>

Obviously, with any drug, the goal is finding the ethical, moral, and optimized balance between wellbeing and profit. If the manufacturers feel that there can be an increase to both — why not pursue it? I know I would 🙂

Is Addiction to Wegovy Possible?

Nearly 2/3rds of patients who stopped taking Wegovy gained back the weight they had previously lost, less than 1 year after stopping the usage of the drug. <source>. What does this sound like? Dependence. I definitely wouldn’t label this an addiction, at least from the information available today. Perhaps as the drug becomes more generally available or more “alternatives” are created, this dependence will become more pronounced?

It seems from my research so far that 1) Wegovy is acceptable for a large portion of the US population, but has only been used by a small percentage so far. So, what can the company do to increase the usage of Wegovy?

Doctors Paid for Endorsing Wegovy

Doctors recommend things all of the time, in fact, 9 out of 10 recommend this blog (kidding). In this case, the number of doctors endorsing Wegovy and Ozempic is on the rise and so is the amount of money being spent to do so. To be precise, 25.8M was spent from 2013-2023. <source>. This certainly doesn’t feel like a large amount over a decade, considering the industry spent over 12 billion on this as a whole in 2022. This hardly feels like a parallel to the opioid crisis! BUT let’s look at the federal lawsuit against Purdue the manufacturers of OxyContin…

Purdue’s drugs in violation of the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b) (AKS).

a. Purdue paid the highest-volume OxyContin prescriber in the United States over $160,000 between 2013 and May 2018 because he was, in the words of Purdue’s employees, “the biggest prescriber in CT,” “the #3 prescriber of opioids nationally,” and “very important to our success,” even after he indicated that if he stopped receiving speaking assignments from Purdue, “the love may be lost.”

b. Purdue paid the highest-volume OxyContin prescriber in Medicare
approximately $475,000 between 2013 and January 2017 to deliver speeches and advice even though Purdue observed he was “not a strong speaker or presenter” and “attendees couldn’t follow him,” he engaged in “heavy prescribing, particularly in large doses for long periods of time,” and was excluded by Florida Medicaid.

c. Purdue paid more than $110,000 to a high-volume prescriber who demanded speaking assignments or else he would “re-evaluate the use of [Purdue’s] products.”

<source>

Now these numbers feel a lot more similar between the two drugs. However, I have no evidence that the manufacturer’s of Wegovy are giving kickbacks in violation of the law. Again, I am drawing parallels between the two scenarios to provoke thoughts and conversation.

Getting a Prescription

During COVID, there was a significant increase in ADHD prescriptions, by over 10% for key age groups <source>. This was due to the fact that these prescriptions could be completed online, compared to the in-person requirements prior to COVID. This led to the creation of many startups that attempted to capture this market, such as Done and Cerebral who are under investigation by the DEA <source>. This has led to comparisons to the opioid epidemic for Adderall and other related drugs <source>. For Wegovy, when I Google “Wegovy Prescription Online”, I’m immediately given paid ads for PlushCare, Ro, and SesameCare. Some even claiming to get a prescription in just 15 minutes. This certainly feels like the flood gates are open here. Personally, I’ll hold off on the Wegovy online prescriptions for now. Will we similar crackdown and enforcements by the DEA here? Or is this too new for us to understand as a society?

Closing Thoughts

Let me say this a few more times to emphasize. I am not a doctor I am not an expert. I am purely provoking conversation and debate to get to a better understanding of the situation :). I’m putting Cunningham’s Law <source> in full effect here since I am very likely wrong to draw these comparisons since I am not an expert!

That being said, there are clearly parallels between the rise and usage of opioids and drugs like Wegovy in the United States. There are also parallels related to the ease of getting a prescription, as well as similarities in the way drug manufacturers incentivize or pay doctors to promote their drug. All in all, it seems there is a low likelihood of becoming addicted — and the negative medical side effects are not more severe than symptoms like nausea, diarrhea, and some other somewhat mild symptoms. So this doesn’t feel similar in terms of impact at this time. That doesn’t mean new variants with different requirements and ingredients won’t be produced in the future with worse side effects. So overall, what do you think? Are we on our way to history repeating itself? Or perhaps is it only rhyming in this case?