Illegal peptide products pushed through social media are promising to improve Australians’ looks and libidos, increase muscle tone or fight the effects of ageing – but they also come with multiple risks.
The popularity of these illegally imported products, like retatrutide, however, are presenting problems, with patients seeking advice about administering these unknown and unregulated products into their bodies.
‘There is a peptide for just about anything,’ said Dr Jack Collins, Senior Lecturer at the University of Sydney, in a PSA26 panel on medical cannabis and peptides.
‘These are not approved goods, so not only do we not have clarity on the ingredients; we don’t have clarity on the long-term effects,’ said panellist Professor Tony Lawler, Head of the Therapeutic Goods Administration.
‘The other thing that’s really concerning is we don’t have any clarity or certainty or assurance around the manufacturing chain.’
If the problems surrounding cold chain delivery have caused problems for people ordering GLP-1 RAs, Prof Lawler said, when it comes to peptides, ‘this is like that on steroids’.
A slew of adverse effects
Associate Professor Angela Chiew, clinical toxicologist for the NSW Poisons Information Centre (PIC), told the panel she has treated a number of patients who have experienced severe complications after using illegal peptides.
‘I have treated a patient with severe anaphylaxis from peptides,’ she said.
‘He couldn’t tell me what it was. His anaphylaxis was so severe that he needed four doses of adrenaline and got a cardiac complication from it.’
Retatrutide, an experimental peptide used to manage obesity and diabetes, is also seeing increasingly common use, and A/Prof Chiew said the PIC has heard from children as young as 14 who have started vomiting after taking it. Among the other adverse effects experienced by users are hepatotoxicity and injection site abscesses.
And while peptide users are sometimes stereotyped as belonging to particular demographics or subcultures, such as young men aiming for muscle growth, A/Prof Chiew highlighted that the diversity of peptides means there is broad appeal.
‘I think this is going to be a real issue that’s going to be across age groups, across the sexes – there is a peptide for everyone.’
A matter of mistrust
Even though members of the public are seeing adverse effects from peptide use, that often does not prompt them to stop taking them, reflecting a broader lack of trust in authorities.
‘There’s a growing proportion within the population – not just in Australia but everywhere – that struggles with trust in public institutions, and that includes health institutions and regulators,’ Prof Lawler said.
Nonetheless, pharmacists have an opportunity to engage with people who seek their advice when taking peptides, such as supplying sterile injection equipment and advocating against unsafe injection methods.
Peter Guthrey, Senior Pharmacist, Strategic Policy, at PSA, said one patient had sought bacteriostatic water from him to rehydrate a product that had been delivered to them in a vial. The patient planned on refrigerating the vial and drawing out doses over a period of time and administering it with a different syringe on each occasion.
‘I asked questions like “What was the dose? How often do you do it? What site is it? Did they send you any consumables?” The answer to all those questions was “no”.’
Dr Collins acknowledged the difficulty of a situation like the one Mr Guthrey described.
‘We’re probably used to supplying consumables to people using illicit drugs, but that’s a different conversation,’ he said.
‘In this case, they are using a product that is a health product, for want of a better term. They’re injecting themselves, and I think we probably have quite a role to play; it’s just learning how we negotiate those conversations.
‘I think we still have an opportunity to have a bit of a chat about what they’re using, what they even know, what strength they think it is, and clarifying some of the risks.’
Needing needles
One consequence of the broader peptide uptake, according to A/Prof Chiew, is that needle exchanges are reporting that they’re running out of syringes to supply to recreational drug users, which has consequences for preventing spread of blood-borne viruses.
‘But we can take lessons from that group in that you can teach them about how to reduce infection,’ she said.
‘By telling them what the potential risk with peptides could be and when to seek medical help, I think we can take a real harm minimisation line with this group as well, while educating them at the time that they’re not yet regulated drugs.
‘And it looks like we’re going to have to get more needles and syringes, unfortunately, because I don’t think peptides are going anywhere.’
Prof Lawler pointed out that, as the experience of vaccine skeptics has shown, ridiculing people doesn’t help to change their behaviour. A lot of people who use peptides, he believes, know that there is risk and that they’re potentially doing something that’s beyond normal welfare.
‘I think that the real issue is just being very clear to people that they’re not safe,’ he said. ‘They’re absolutely not safe medicines.’
