Why stocks of this diabetes drug are depleted in SA
After gaining about 30kg during the pandemic, Lucille Adams* was desperate to lose weight.
She discovered the “miracle” weight-loss remedy adopted by some friends — Ozempic, a weekly injection to treat type 2 diabetes.
Ozempic is the trade name for semaglutide, and can legally be prescribed by doctors in South Africa for weight loss.
But surging demand has resulted in global stock shortages. There is concern that the schedule 4 drug is being sold over the counter by unscrupulous pharmacists, and a doctor has warned of possible health risks if used incorrectly.
Global demand soared after social media endorsements by celebrities and influencers. Elon Musk tweeted about shedding 13kg. TikTok views on the hashtag Ozempic have surpassed 572-million.
Manufacturer Novo Nordisk confirmed that the drug, used in the private healthcare sector, went out of stock in South Africa in April due to “higher than expected demand leading to temporary capacity limitations”.
“Intermittent supply constraints will continue during the first half of 2023. We remain committed to continuously monitoring our product supply situation in South Africa,” said Tobeka Boltina, director of clinical, medical and regulatory affairs at Novo Nordisk South Africa.
Discovery Health has observed a “steep increase” in demand, with off-label prescriptions trumping chronic prescriptions. Off-label prescriptions are when medicines are prescribed for a condition they are not registered for or intended to treat.
Noluthando Nematswerani, head of the Centre for Clinical Excellence at Discovery, said the claims history for the last quarter of 2021 and first quarter of 2022 showed a 77% increase in diabetic prescriptions and a 224% increase in off-label prescriptions.
Adams tried numerous diets due to a medical condition, polycystic ovary syndrome (PCOS), that causes insulin resistance. Convinced by friends, she sought a prescription for weight loss early last year.
“Because he had been my doctor for so long and knows my medical condition well, he was understanding when he saw how desperate I was and agreed to put me on a dose of about 0.25mg for about six weeks.”
On hearing that certain pharmacies unethically sold the drug over the counter, she and friends bought it for about R2,400 for a six-week supply. She stayed on it for nine months.
This isn’t something that somebody should just get from a pharmacy and hope they lose some weight
— Endocrinologist Zane Stevens
“Having PCOS means that to lose weight I have to work four times harder than people without this condition. So when I saw my friends were losing between 10kg and 15kg I wanted to try it.”
However, the drug did not help her lose weight. Her husband used it to control diabetes and initially shed a few kilos.
Used as second- or third-line drug when others such as metformin or insulin injection fail to control blood sugar levels, Ozempic mimics a natural hormone called GLP-1, produced by the digestive system in response to food intake. It suppresses appetite by slowing down the emptying of the stomach into the rest of the digestive system.
Nematswerani said the 77% increase in claims came from the medical scheme’s chronic illness benefit for those diagnosed with diabetes. The 224% rise in off-label prescriptions came out of day-to-day savings.
“This steep increase in day-to-day benefit claims may be attributed to the off-label use of Ozempic for weight-loss management,” she said.
“We are aware of the shortages of Ozempic in South Africa … and we are in regular contact with the pharmaceutical manufacturers on stock levels.”
Nematswerani said another diabetes drug, dulaglutide (sold under the trade name Trulicity), also saw a “substantial increase in use” between the second and third quarter of 2022 as a chronic benefit and off-label prescription.
The Australian medicines regulator, the Therapeutic Goods Administration, said Ozempic shortages started early in 2022 when Novo Nordisk “couldn’t supply enough Ozempic to meet an unexpected increase in demand due to off-label prescribing for weight loss”.
Zane Stevens, a specialist physician and endocrinologist at Christiaan Barnard Memorial Hospital in Cape Town, said prescribing it for weight loss was “OK and there’s no danger”, but in South Africa where many people lived with diabetes, and given stock shortages, “it should be more preferentially used for people with type 2 diabetes”.
Stevens said other weight-loss injectables such as Wegovy (another trade name for semaglutide) — also made by Novo Nordisk — were more effective for weight loss.
“Apart from it not being registered for weight loss in South Africa, data shows that on average Ozempic users can lose between 6kg and 7kg, which is not a large amount of weight loss compared to about 15kg and more that other weight-loss drugs offer at high dosage.”
Ozempic is regarded clinically as a better drug than insulin, which is associated with weight gain and cardiovascular risks.
But Stevens said incorrect use of Ozempic posed risks: “This isn’t something that somebody should just get from a pharmacy and hope that they lose some weight.”
Cape Town paediatric endocrinologist Amith Ramcharan of the Red Cross Children’s Hospital warned the drug “shouldn’t be used as a quick fix”.
“It should be used to treat the condition it’s meant for, which is diabetes. People must realise that obesity is a complex disease and it cannot solely be treated by medication. People who use it still have to adopt lifestyle changes.”
He said that without doctor supervision, side-effects could include critically low blood sugar levels, gastrointestinal disturbances and vomiting leading to dehydration.
• Not her real name
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.