Most writing about counterfeit medicines is speculative. This one is not: the researchers placed orders, opened what arrived, and put it through a laboratory. The market they ordered from is a different market from the one this site covers, and the difference is exactly one thing — whether anybody asks for a prescription.
Mapping it first
The team evaluated 1,080 search-result links. 317 of them, 29.35%, belonged to online pharmacies; 183 of those led to legal pharmacies and 134 pointed to 59 unique illegal pharmacy websites. [1] Traffic analytics for July to September 2023 showed the top 30 domains affiliated with those illegal pharmacies taking more than 4.7 million visits. This is not a fringe. It is a substantial consumer market operating in plain sight of a search engine, and it sits underneath the market this site does cover without being the same thing.
What they ordered and what came
Six test purchases were placed with the illegal pharmacies offering semaglutide at the lowest prices. Three injection vials were delivered. The three orders for prefilled Ozempic pens never arrived at all — the money was taken and nothing shipped.
That is worth pausing on before any laboratory result. Half the orders were simply theft. For those buyers the product quality question never came up.
What the laboratory found
All three delivered vials were assessed as probable substandard or falsified products. Visual inspection of the packaging failed between 59% and 63% of the criteria applied.
The chemistry is where it gets strange, and the two headline measurements point in different directions. Semaglutide content exceeded the labeled amount by 28.56% to 38.69% — more drug than the label promised. Measured purity, meanwhile, ran between 7.7% and 14.37%, against the 99% the labels claimed. Those are different assays and the abstract does not reconcile them; this page will not guess at how they fit together either.
Two findings were reassuring. No viable microorganisms were present at the time of testing, and no peptide-like impurities were identified. One was not: endotoxin was detected in all samples, at 2.1645 to 8.9511 EU/mg. Endotoxin is bacterial cell-wall debris, and sterility does not remove it — a product can be free of living bacteria and still carry what dead ones left behind.
What it does not prove
That compounded semaglutide is unsafe. The regulated compounding question is separate and has its own evidence, covered in the 503A and 503B explainer. A licensed compounding pharmacy dispensing against a prescription is not the same actor as a website selling vials to strangers, whatever the two have in common on a price comparison.
It also cannot tell you a rate. Three vials from six orders at the cheapest end of the illegal market is the entire sample. It establishes that this happens and what it looks like when it does, not how often.
The practical test
One question separates the two markets and it is easy to ask: does anybody require a prescription before taking the money? If the answer is no, nothing about the product has been checked by anyone, including whether it will arrive.
Price is the usual reason people cross that line, and the gap is real — the lowest published figures in the price check are still above what a no-questions seller advertises. What the extra buys is a chain of people who can be held responsible, which is also what dosing from a vial depends on when something goes wrong.