North Carolina shouldered the cost of the weight loss drug Wegovy for 2,800 state workers in 2021. Last year, that number shot up to 25,000 totaling $100 million.

Last Thursday, the state decided not to pay for it any longer. Celebrities and people like Elon Musk who can afford $1,000 a month for Ozempic and Wegovy can still get them. However, a nurse in North Carolina told The New York Times that finding Wegovy is like winning the lottery.

These Food and Drug Administration-approved, plant-based injectable drugs were initially developed to treat diabetes, but they also help with obesity. But demand for Ozempic and Wegovy’s weight-loss properties rose so high that diabetics had trouble finding them. There aren’t enough chemicals to keep up with the demand, creating a scarcity.

Aside from the shortage, New York University bioethicist Art Caplan has other concerns. He says the craze reminds him of the erectile dysfunction pill Viagra.

Pfizer discovered Viagra 25 years ago while trying to make a treatment for high blood pressure. When the company found men taking Viagra were getting erections, Pfizer “converted that insight into a huge blockbuster drug,” Caplan says. Competitors like Cialis started popping up and soon, a $2.46 billion erectile dysfunction market was born.

“Initially, Pfizer and the other companies tried to keep it to a medical indication, meaning this was really for people who had diabetic issues or atherosclerosis, blood flow issues,” Caplan says. “But later, the thing exploded and pretty soon, everybody 30 to 80 was starting to think, ‘Well, maybe I’ll just get some of this drug and have it with me in case something goes wrong.’ I think that could happen easily for the Ozempics and Wegovys and the other injectables.”

Caplan compares Viagra to a Band-Aid: It helps people get erections, but the problem is often a symptom of an untreated circulation issue, nerves, excessive drinking, or diabetes for many older people.

Injectible drugs like Ozempic help about half of users lose significant amounts of weight without making lifestyle changes, Caplan says. Like Viagra, the drugs put a Band-Aid over an underlying problem, he says.

“As soon as you go off [weight loss drugs], you’re gonna put the weight back on because you haven’t made any changes,” Caplan says. “So just to sell it and say, ‘Here, a magic bullet. You can use it as an injectable and it’ll be great’ means you’re gonna be on that drug for life unless you do something about the underlying condition.”

In the vein of Viagra, a big telemedicine drug, companies like Lilly use telehealth to connect consumers with providers to prescribe weight loss drugs.

“What we’re seeing is the market is so lucrative that instead of doing direct-to-consumer advertisements, [telehealth companies] are just saying, we’re gonna set up our own distribution system,” Caplan says.

Caplan predicts that like Viagra, weight loss injectables will soon face a fraud problem online with websites selling fake products.

A ‘god-send’ for some, a risk for others

In the U.S., 42% of adults are obese and 30% are overweight. With the cost of injectable weight loss drugs at $1,000 per month, prescribing them to 50 million people for life would cost around $500 billion — which could rival the $700 billion spent on all drugs last year, Caplan says.

Rather than pulling them off the market, Caplan advocates for carefully monitoring these drugs, which can be a “godsend” for morbidly obese people facing serious health concerns. But he worries about the risk-benefit ratio for users more concerned with their appearance than health.

Little is known about the effects of long-term use of injectable weight loss drugs or the impacts on children.

“Children — where obesity is also a terrible problem — could be put on it, and we don’t know what the impacts will be there,” he says. “ Maybe we’ll be lucky and the impacts will be nothing, and then the drug will prove very, very safe. But everybody needs to be aware that they’re going into a bit of an experiment.”

The cultural pressure to lose weight will spike up as these drugs become more available, Caplan predicts.

“We will see more thin people. It will become less common, if you will, to be heavy,” he says. “The other situation is we’re not doing anything to change our food industry, which is still pouring sugar into us and moving fast food upon us and advertising to kids all kinds of things that aren’t necessarily good for them.”

Karyn Miller-Medzon produced and edited this interview for broadcast with Todd Mundt. Allison Hagan adapted it for the web.

This article was originally published on WBUR.org.

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