The FDA's adverse event database shows significantly higher misuse signals for semaglutide than other GLP-1 drugs — including use without prescriptions and drug abuse reports — though the signal is comparable to other weight loss medications.
PRR 4.05 for drug abuse reportsSemaglutide had 4 times more 'drug abuse' reports proportionally than other GLP-1 receptor agonists in the FDA adverse event database (2018–2022)
What the researchers found
Semaglutide showed significantly higher signals for misuse-related adverse events compared to other GLP-1 drugs. Its proportional reporting ratios (PRR) for 'drug abuse' (4.05), 'drug withdrawal syndrome' (4.05), 'prescription drug used without a prescription' (3.60), and 'intentional product use issue' (1.80) were all significantly elevated (p<0.01) versus other GLP-1 receptor agonists.
However, when compared to the phentermine-topiramate combination (an established weight loss drug with known misuse potential), semaglutide showed no significant differences in misuse signals. This suggests semaglutide's misuse signal may be in line with other weight loss medications rather than uniquely problematic.
Why it matters
As semaglutide went viral as a weight loss drug, reports emerged of people using it cosmetically without medical need, obtaining it without prescriptions, and diverting it from diabetic patients. This is the first study to formally quantify misuse signals in pharmacovigilance data. The findings raise questions about how to balance expanded access with appropriate use monitoring.
The numbers in context
31,542 total AERs (Jan 2018–Dec 2022) · semaglutide: 8,249 reports (26.1%) · dulaglutide: 11,858 (37.6%) · semaglutide vs other GLP-1s: PRR 4.05 for drug abuse · PRR 4.05 for withdrawal · PRR 3.60 for use without prescription · all p<0.01
How the study worked
Descriptive pharmacovigilance analysis of the FDA Adverse Event Reporting System (FAERS) database from January 2018 through December 2022. Researchers extracted all adverse event reports for seven GLP-1 receptor agonists and the phentermine-topiramate combination. Misuse-related events were identified using specific adverse event terms. Reporting odds ratios (ROR) and proportional reporting ratios (PRR) were calculated to detect safety signals.
Who was studied
All adverse event reports for GLP-1 receptor agonists and phentermine-topiramate in the FAERS database (Jan 2018–Dec 2022)
What this study cannot tell us
FAERS is a voluntary reporting system with well-known limitations: under-reporting, reporting bias (media attention on semaglutide likely inflated reports), and inability to establish causation. The 'drug abuse' and 'misuse' adverse event categories in FAERS are broad and may include cases of off-label use that aren't truly misuse. The study can't distinguish between recreational misuse and cosmetic off-label use by non-obese individuals. Media coverage of semaglutide may have disproportionately influenced reporting.
How to read the evidence
Pharmacovigilance data from FAERS provides early safety signals but is highly susceptible to reporting bias — especially for drugs with enormous media attention. The elevated signals are concerning but could be artifacts of increased reporting rather than increased misuse. Low-moderate evidence that requires confirmation from empirical studies.
When this study was published
Published in 2023 with data through December 2022. Since then, semaglutide prescriptions have continued to surge and tirzepatide has gained significant market share. More recent pharmacovigilance data would likely show different patterns.
The bigger picture
The semaglutide misuse question sits at the intersection of public health, media culture, and pharmaceutical regulation. When a prescription drug goes viral on social media, demand can outstrip appropriate use. This study provides early evidence that the cultural buzz around semaglutide has translated into measurable misuse signals in pharmacovigilance data — though whether this represents a genuine safety problem or an artifact of media-driven reporting bias remains to be determined.
Questions still open
- Are the elevated misuse signals driven by genuine misuse, or by the massive media attention that increased all reporting about semaglutide?
- Should semaglutide prescribing be more tightly regulated, or would that restrict access for patients who genuinely need it?
- Do the 'withdrawal syndrome' reports indicate a physiological dependence, or are they reflecting rebound weight gain after discontinuation?
Common questions
Does this mean semaglutide is addictive?
Is it dangerous to use semaglutide without a prescription?
Read the original research
Is There a Risk for Semaglutide Misuse? Focus on the Food and Drug Administration's FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset.
Pharmaceuticals (Basel, Switzerland), 16(7)
Citation
Chiappini, Stefania; Vickers-Smith, Rachel; Harris, Daniel; Papanti Pelletier, G Duccio; Corkery, John Martin; Guirguis, Amira; Martinotti, Giovanni; Sensi, Stefano L; Schifano, Fabrizio. (2023). Is There a Risk for Semaglutide Misuse? Focus on the Food and Drug Administration's FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset.. Pharmaceuticals (Basel, Switzerland), 16(7). https://doi.org/10.3390/ph16070994