By Nancy Glick, NCL Director of Food and Nutrition Policy
The American frontier between 1865 and 1890 was called the “Wild West” —a vast, untamed region lacking government control, formal infrastructure, and reliable law enforcement. It flourished during the gold rush when outlaws and vigilantes roamed freely.
Now a modern-day Wild West has emerged, fueled by a new gold rush and weak government controls. But instead of sparking gunfights between settlers and cattle herders, this Wild West puts public health at risk by feeding an unregulated online marketplace selling unapproved GLP-1 drugs and other substances that can cause serious harm, even death.
One of the most visible parts of this market is a large exploitative online trade in unapproved compounded GLP-1 weight-loss drugs. It emerged in 2022, when shortages of semaglutide and tirzepatide triggered FDA rules allowing compounding pharmacies to produce “non-identical” versions that were not FDA-approved. Seeing the profit potential, compounders turned inexpensive raw active pharmaceutical ingredients (APIs) into monthly injectable products, while telehealth companies and other sellers marketed them aggressively as cheaper alternatives with the same safety and efficacy as FDA-approved branded medicines.
By 2024, nearly one in three consumers taking a GLP-1 weight loss drug said they were getting the medicine from a compounding pharmacy. This prompted the National Consumers League to issue a national alert relaying FDA’s warning that compounded GLP-1s are not tested, reviewed, or approved by the FDA and may cause dosing errors or exposure to the wrong ingredients.
A year later, the national shortage of semaglutide and tirzepatide ended, and the FDA gave compounders until May 22, 2025, to stop selling their mass-produced compounded versions. Instead, compounders created a workaround to stay on the market, selling new formulations as “personalized” compounded GLP-1 drugs as microdoses and GLP-1s with added ingredients, like Vitamin B-12. However, these formulations were never tested in large clinical trials and have caused side effects, prompting NCL to issue a second alert summarizing the serious safety risks, including substandard drug potency, bacterial contamination, potentially harmful impurities, patient harm, and even death.
Yet, the exploitative market for unapproved compounded GLP-1 drugs is thriving, which is why the FDA has issued dozens of warning letters to online vendors making misleading equivalency or safety claims about these products. In April 2026, the FDA issued a proposed rule to exclude three GLP-1 drugs – semaglutide, tirzepatide, and liraglutide – from what is called the 503B bulks list. This development is significant because the rule makes clear that compounding is intended for limited purposes, not the permanent sale of mass-produced alternatives to FDA-approved medicines.
However, even with these developments, a new danger has emerged. The same regulatory loopholes that enabled the mass marketing of compounded GLP-1’s are now fueling the Wild West – a lucrative underground marketplace where “gray market vendors” sell consumers the active ingredients for semaglutide and tirzepatide and “research-grade” experimental peptides that are banned in Canada, Australia, the European Union, and by the World Anti-Doping Agency.
Gray markets refer to approved drugs being sold outside of legal channels, but this Wild West is also a black market selling unapproved drugs illegally. This is what has occurred with retatrutide, a potent weight loss drug currently undergoing clinical trials and not approved anywhere in the world, where cheap, illegal counterfeit versions sourced primarily from Chinese manufacturers are sold to consumers online in powdered form with dosing instructions.
Because black market drugs come with no guarantee of quality, purity, or dosing accuracy, global health bodies warn that knockoff retatrutide may contain substituted chemicals, toxic impurities, or completely different active compounds, resulting in serious adverse effects. This was confirmed recently when CBS News found that health problems reported to America’s Poison Centers about retatrutide surged to an average of 95 cases per month in early 2026, a 265% increase from late 2025.
Moreover, in June 2026, health authorities in Australia issued an urgent alert after multiple users of black-market retatrutide suffered from acute liver failure, major kidney injuries, and life-threatening changes in heart rate, with investigators raising the possibility that contaminants were responsible. This prompted NCL to issue a third safety alert, relaying the warnings from the FDA, the American Medical Association, and global health bodies that self-injecting research-grade peptides and experimental retatrutide is dangerous.
But warnings are insufficient to address this serious situation. While deceptive advertising of compounded GLP-1 drugs is rampant and out in the open, raw compounds and unregulated peptides are marketed through informal online channels, such as chat rooms and social media platforms, and users rely on social media tutorials and influencers for advice on where to buy the peptides and how to self-administer them. Thus, it is time to focus on social media platforms as a conduit fueling the gray and black markets for unapproved GLP-1 drugs and research peptides sold outside regulated medical channels.
Already, a November 2025 Reuters report brought to light how Meta generated roughly
$7 billion in annualized sales from so-called “higher risk” scam ads and allowed AI-generated misleading marketing of weight loss products on Facebook, Instagram, and other Meta platforms that violated Meta’s policies for fraudulent content. But Meta is the tip of the iceberg. Across platforms such as TikTok, Instagram, YouTube, Telegram, and Discord, unapproved and potentially harmful peptides are being promoted as shortcuts to weight loss, body enhancement, and longevity.
Demonstrating the extent of the problem, a study published in JAMA found more than 130,000 Instagram posts and over 230 million TikTok views of content promoting illicit injectable peptides as of May 2026. This is significant in light of a May 2026 study conducted by Sunlight, a telehealth company, which found that nearly half (45 percent) of peptide users purchasing these compounds via social media required treatment at a hospital emergency room due to experiencing severe reactions.
Of equal concern, Eli Lilly and Company, the company conducting clinical trials to bring retatrutide to market, has reported to regulatory authorities more than 14,000 websites, advertisements, social media posts and product listings that unlawfully market retatrutide in over 100 countries via internet service providers, social media platforms, and e-commerce companies. The company’s warning – that the so-called retatrutide now being sold on the black market is not a medicine but an unverified, risky substance – is playing out in reports of people being seriously harmed. For example, in mid-September, Australia’s Therapeutic Goods Administration revealed that a patient suffered a torn esophagus after using an unapproved weight loss peptide labeled as retatrutide.
The good news is that the FDA is acting against online sellers of illicit weight-loss drugs, including retatrutide. But the scale of the problem requires a coordinated response from the FDA, Federal Trade Commission, customs agencies, and state and federal law enforcement, as well as action by social media platforms to stop facilitating gray- and black-market sales of potentially unsafe, unapproved drugs.
To that end, NCL joins the patient safety community in urging social media platforms to be part of the solution. This means working with agencies like the FDA and state attorneys general to share intelligence and to take proactive steps, such as using proactive AI detection, banning coded terms used to promote illicit products, blocking searches for unapproved compounds, and permanently banning sellers who advertise gray- or black-market drugs and redirect buyers to encrypted messaging apps to complete illegal sales.
