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In the face of ongoing shortages of the obesity and diabetes medications known as GLP-1s, patients have resorted to a wide array of sources for the drugs, including medical spas and telehealth sites that prescribe compounded versions of the drugs. But a new paper published in JAMA Network Open highlights one of the riskiest sources of non-branded drugs: illegal online pharmacies that bypass prescription entirely.

Researchers from the University of San Diego and the University of Pécs in Hungary found that semaglutide ordered from these illegal sites contained significantly more of the drug than labeled. One sample also contained signs of potential bacterial contamination during manufacturing.

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“It’s just a very, very risky business, going online and buying this product,” said Tim Mackey, a professor of global health at the University of California, San Diego and co-author of the study. “Just because it’s online and it’s accessible and it can be sold without a prescription, does not mean it’s authentic.”

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