Ozempic: 'We created a monster'

“In 27 years of practice, this is unheard of,” said Dr. Yves Robitaille, specialist in internal medicine at the Center for Metabolic Medicine in Lanaudière. “When people are referred to us for diabetes or hypertension and I discuss with them the possibility of being medicated, they generally want to avoid it. When it is for obesity, they come for a consultation with the sole aim of having a prescription for Ozempic and often, they are more open to changing their lifestyle,” reports the doctor who follows dozens and dozens of obese patients.Since the advertisements on nail fungus, which indirectly promote Jublia “we know that advertising works well with patients. But there's such great fervour [for Ozempic], it’s unheard of,” said Dr. Benoît Heppel. Not a week goes by without patients coming to see the family doctor in Sherbrooke, Que., to obtain GLP-1 agonist treatment with weight-loss properties.Somehow, said Dr. Heppel, he understands them since in the media, “it is presented as a miracle drug, so overweight people see it as an easy solution to a problem that takes up a lot of space in their lives."Dr. Heppel said he has even seen one patient stop his anti-diabetic treatment to raise his blood sugar in order to get coverage for Ozempic from the provincial health insurer, the Régie de l'assurance santé du Québec (RAMQ).Indicated for the treatment of type 2 diabetes, Ozempic is only reimbursed by the RAMQ when it's prescribed for this condition and meets to very specific criteria. Since 1997, RAMQ regulations have in fact excluded all medications against obesity and, consequently, the public drug insurance plan does not cover them. This situation has been criticized by the majority of specialists, who demand that obesity finally be recognized by the province as a chronic disease.Many of these doctors prescribe Ozempic off-label.“Its molecule, semaglutide, is approved by Health Canada for type 2 diabetes, at a dose of 1 mg, and for obesity, at a dose of 2.4 mg," said Dr. Marie-Philippe Morin, a specialist in general internal medicine and bariatric medicine at the University Institute of Cardiology and Pneumology of Quebec Depending on the profile of her patients, Dr. Morin said she prescribes Ozempic or other drugs indicated for the treatment of obesity, such as Saxenda or Contrave.Dr. Mathieu Pelletier, a family doctor who practises in the region of Joliette, said that based on the Canadian clinical practice guidelines for obesity in children and adults, “It is safe and scientifically correct to prescribe Ozempic. We cannot wait until these people are diabetic or develop other comorbidities. (The guidelines) recommend introducing pharmacotherapy early to prevent obese patients from presenting complications or becoming candidates for bariatric surgery."He has been asked by overweight patients to prescribe them Ozempic, but Dr. Pelletier said he has declined such request“I've never been bothered about that,” he said, adding that “generally, it's [he] who talks about it to patients who have already tried the dietary approach and exercise." Unlike in the United States, where Ozempic is prescribed everywhere, several family doctors and specialists interviewed by Profession Santé adopt the same posture as Dr. Pelletier. They only prescribe this medication on a case-by-case basis, after first trying non-pharmacological lifestyle interventions.Dr. André Carpentier, an endocrinologist at the Sherbrooke University Hospital Center, is something of an exception. He no longer prescribes Ozempic off-label.“Some patients are disappointed, but that’s how it is,” he said. “Our diabetic patients no longer have access to it even though they have serious medical reasons for taking it. I no longer want to bog down the system with this.”Since this summer, Ozempic has been in short supply. Initially, Health Canada and the drug's manufacturer, Novo Nordisk, announced a temporary interruption in the supply of the 1 mg pen which was expected to last until mid-October. Now, the company expects the shortage to continue until March 31, 2024 and as of recently, it is also reporting intermittent shortages of its reduced-dose pen (0.25/0.5 mg) until the same date .This situation would be attributable to “increased demand for the product globally and general supply constraints,” explained Novo Nordisk by email. Some suspect the Danish laboratory of favouring the American market where its treatment, which is all the rage, is sold for US$1,000 per month, compared to $300 to $400 in Canada.The off-label prescription of Ozempic is certainly not the cause of these shortages, but it contributes to them. Moreover, “diabetic patients are worried,” observed the president of the professional council of Diabète Québec, endocrinologist Rémi Rabasa-Lhoret. There are certainly alternatives, such as Trulicity or Victoza, but comparatively, “semaglutide is super effective” in controlling blood sugar, added Rabasa-Lhoret, who is also the director of the Metabolic Diseases Research Unit at the Montreal Clinical Research Institute.He said he is concerned about Ozempic shortages.“The risks of hyperglycemia and complications are palpable. Patients will end up in the emergency room.”In response to this issue, the College of Physicians, the Order of Pharmacists and the Order of Nurses of Quebec published on November 17 a notice to raise awareness among their members. They ask prescribers to avoid, if possible, starting semaglutide treatment in new patients and to “ensure that the treatments started are still required by referring to the criteria for use determined by the National Institute of excellence in health and social services (INESSS), or by other recognized learned societies”. The three orders also recommend that pharmacists “limit the distribution of the medication to one month."In pharmacies, “it is not so much the popularity of the product that disturbs us, it is the stock shortages which add to the workload,” said the president of the Quebec Association of Pharmacists Owners, Benoit Morin.Behind their counter, professionals must deal with dissatisfied, deprived or simply worried customers, and offer them replacement treatments: Trulicity or Victoza for diabetes, and Rybelsus or Saxenda for weight loss.Sometimes, pharmacists who have just been restocked with Ozempic pens of 1 mg—increasingly rare—or 0.25/0.5 mg, which are more common, receive visits from unknown patients. In Facebook groups, such as “Ozempic-Québec user tips and advice,” word spreads quickly, with some not hesitating to travel dozens of kilometres in the hope of obtaining their treatment.These hopes are often dashed. Practices can certainly vary from one pharmacy to another, but overall, regular patients are prioritized and even more so those living with diabetes. This reality also makes some clinicians fear the development of a black market for semaglutide, similar to what happened with Viagra.It probably doesn't help that patients and consumers have received mixed messages about Ozempic. While Novo Nordisk states that Ozempic "should only be used in appropriate patients, in accordance with its Health Canada-approved product monograph" and that it "does not promote, suggest or encourage not off-label use," the drug manufacturer also continues to promote Ozempic and Rybelsus to the general public, as recently in the aisles of the Eaton Center in Montreal, or during broadcasts of Canadian matches.Between these advertisements that she considers “terrible” and the media coverage of the Ozempic shortage, “we have created a monster,” lamented Dr. Patricia Doucet, a family doctor in Shawinigan, Que.Dr. Doucet said she continues to see “people come into [her] office who want Ozempic to lose five pounds. I have to explain to them that it is reserved for a specific clientele, that it is not a magic product, that they must first reconsider their lifestyle habits, et cetera."This article was translated from French and originally ran in our sister publication Profession Santé.

Ozempic: 'We created a monster'

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