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The latest craze on social media is not a dance challenge or a viral meme, but an injectable medication originally designed to treat diabetes.
Known as semaglutide and marketed under names such as Ozempic and WeGovy, the drug has recently gained popularity as a weight-loss tool.
TikTok and Instagram videos theorise Kim Kardashian used the medication to lose weight for her outfit at the 2022 Met Gala.
Celebrity doctor and republican candidate Dr Oz spruiked semaglutide on his television show, and billionaire Elon Musk tweeted that the drug featured in his own weight-loss regime.
Here’s how the surging demand for the diabetes drug has resulted in a worldwide shortage, leaving Australians waiting months for their next dose.
What is semaglutide?
Semaglutide is a medication that works by mimicking hormones that control blood sugar levels in people with diabetes.
The medication has also been found to affect appetite resulting in fewer cravings, a change in preferences away from fatty foods and less overall energy intake.
In one study, participants lost on average 15 per cent of their body weight while taking the drug.
Danish pharmaceutical company Novo Nordisk markets semaglutide under the brand name Ozempic, which comes as a once-a-week injection.
A different dosage specifically designed to tackle obesity — called WeGovy — is registered on the Australian Register of Therapeutic Goods but is not yet available in Australia.
Further studies on semaglutide have shown drawbacks to its use.
In clinical trials, 44 per cent of WeGovy patients reported nausea compared to 16 per cent treated with a placebo, while 30 per cent of WeGovy users reported diarrhoea compared to 16 per cent of placebo patients.
Trials also found that patients taken off semaglutide on average regained two-thirds of their weight once they stopped using the drug.
It means that use of semaglutide is probably not a permanent fix.
Who is using semaglutide?
Ozempic-branded semaglutide has been available in Australia since 2019 and is used by Type-2 diabetics to manage blood sugar levels.
But in recent years, the drug has gained popularity in Australia to treat obesity.
Melbourne resident Rachel* began using the drug out of a desire to lose weight.
"Even people who are a part of the fat acceptance movement have reached that mental point, after years and years of dieting and then regaining that weight, or dieting and losing a little bit, and then plateauing," she said.
"Always struggling with this niggling sense of hunger that you just can't let go of."
Rachel discovered semaglutide through a New York Times article, one that reported measurable weight loss for those who took it in clinical trials.
Her GP had never even heard of the drug from the article when Rachel raised it, and she had to be referred to a specialist to obtain it.
Rachel had tried all of the available treatments. Medications, such as appetite suppressant phentermine, caused anxiety and insomnia, and bariatric surgery had not helped her long term.
Ozempic was working for Rachel where other treatments had not.
While Rachel finally had access to treatment she found effective, its growing popularity coincided with a dwindling supply in Australia.
Rachel found she was facing increased questioning about her use.
"In some [pharmacies] … they started asking me 'do you have diabetes?'" she said.
After nearly two years of using Ozempic, Rachel could no longer find the drug anywhere.
What has caused the shortage?
The Therapeutic Goods Administration (TGA) has directly linked the flood of social media coverage with the semaglutide shortage in Australia.
"When social media posts increased about achieving rapid weight loss with Ozempic they triggered a huge demand for the product that the manufacturer was not prepared for, and it quickly developed into a worldwide shortage," a TGA spokesperson said.
The TGA does not expect Ozempic to be available in the country until at least March 2023, with other countries experiencing similar shortages.
Britain is already restricting access to semaglutide to specialist weight-loss clinics and has not made it available to GPs due to the cost.
With new supplies months away, the Royal College of General Practitioners (RACGP) has advised GPs not to initiate Ozempic for new patients until the shortage subsides.
Chair of the diabetes specific network at the RACGP Gary Deed said the sophistication of the drug treatment made supply issues an "international problem".
"They come in very sophisticated delivery devices, so it's a combination of not only the difficulty in manufacturing the medication, but also the devices required to administer them," Dr Deed said.
He said that no diabetic person would be in danger if they remained in contact with their GP and sought alternative treatments.
What impact is the shortage having?
Besides its popularity on social media and its effectiveness for some patients, another factor drew Australians to Ozempic: it was relatively affordable.
Despite the federal government estimating that obesity will cost Australia's healthcare system $87.7 billion by 2032, there are currently no treatments for obesity available via the PBS.
However due to its diabetes treating properties, Ozempic is subsidised on the Pharmaceutical Benefits Scheme (PBS).
It means increased competition between weight-loss patients and diabetics for remaining stocks of the drug.
Rachel has been forced to switch to an alternative, more expensive drug due to the semaglutide shortage, tripling the cost of her monthly prescription.
"That's a lot of money. That's a lot more than Ozempic," she said.
The Pharmaceutical Benefits Advisory Committee has not recommended the listing of semaglutide (under its WeGovy branding) on the PBS for the treatment of obesity.
In making its decision, the body said the case for doing so put forward by Danish pharmaceutical company Novo Nordisk "had poorly justified the population access it had requested, the modelled benefits were highly uncertain, and the listing would not be cost-effective at the requested price".
It went on to say that listing the drug would require an "extremely high investment with very uncertain implications for the PBS and broader health budget".
The TGA has also urged doctors to consider alternatives to Ozempic for treatment and to prioritise type-2 diabetes sufferers for prescriptions, but admits it cannot control the decision making of GPs.
"The TGA does not have the power to regulate the clinical decisions of health professionals and is unable to prevent doctors from using their clinical judgement to prescribe Ozempic for other health conditions," the TGA spokesperson said.
Anxious about her future, Rachel hopes both diabetics and people living with obesity will be viewed as patients with a genuine need for semaglutide.
"Nobody's getting semaglutide without a prescription. In every single case, a doctor looked at the patient and decided that they have a good reason to take this," she said.
"Saying that fat people are [to blame] because they're using up all the semaglutide is kind of unfair."
What are health professionals saying?
Melbourne GP Paul Nisselle said he has continued to see a big uptick in patients asking about the drug.
"They come in and say I gather there's this injection that can help you lose weight?" Dr Nisselle said.
"And I say, well, there is but you can't get it now because it's in very short supply, it's very expensive … and we've been asked very strictly by the government to restrict it to diabetics who actually need it."
Dr Nisselle compared the drugs' spike in popularity to the uptake in Viagra when it became available in Australia.
"It was not prescribed on the Pharmaceutical Benefits Scheme, and was expensive. But once people heard about it, they wanted it," he said.
"There was very good supply. So it became very widely prescribed."
Dr Nisselle warned against long-term use of the drug and said it would not ultimately solve the problem for many people struggling with obesity.
"I wouldn't be taking a glucose-manipulating drug long term by injection simply to lose weight when there's safer ways of doing it," he said.
But Dr Deed said the increased coverage and resulting demand for semaglutide treatments was not necessarily negative.
"Raising the profile of quality access to medications and disease states such as obesity and diabetes is a really good thing," Dr Deed said.
He said that both diabetic and obese people deserved access to treatment, and any debate over who needed it more was unhelpful.
"Who should get it and who shouldn't is an argument that really is just based in speculation," Dr Deed said.
"We really need to try to get delivery when the shortage is up, so you can get to improving health outcomes for all people."
*Rachel's name has been changed to protect her identity.