“Drained down” by patients looking for the medicine

On Wednesday, TV 2 reported that the use of the diabetes medicine Ozempic as a slimming treatment has exploded in Norway.

In October this year, an average of 15,000 packs of the medicine were sold on white prescription. In April last year, an average of 2,000 packs were sold.

A white prescription means that the patients themselves have to pay, and the Norwegian Medicines Agency therefore assumes that these are people who use it for slimming treatment.

No clinical studies have yet been conducted on the use of Ozempic for patients struggling with obesity. Thus, it is not not approved.

Patients must therefore have the medication prescribed by their GP “off label”.

This means that the doctor has a special responsibility to follow up the patient, both when it comes to the effect of the treatment and any side effects.

– Several times a week

Marte Kvittum Tangen is head of the Norwegian Association for General Medicine.

She says that prescribing medication “off label” is not very common.

But recently, a number of doctors have given feedback that they are almost run down by patients who might consider trying Ozempic.

– Many receive requests several times a week from patients who want to try. So this is another treatment option that has become very familiar to patients, she says.

HUGE DEMAND: Leader of the Norwegian Association for General Medicine, Marte Kvittum Tangen, tells of an enormous demand for Ozempic.  Photo: Magnus Nøkland / TV 2

HUGE DEMAND: Leader of the Norwegian Association for General Medicine, Marte Kvittum Tangen, tells of an enormous demand for Ozempic. Photo: Magnus Nøkland / TV 2

– A special responsibility

GP Morten Munkvik sits at a doctor’s office in Stavanger. He is one of those who have chosen to give Ozempic to patients with weight problems.

CHANGING PRACTICE: General practitioner Morten Munkvik has offered his patients Ozempic, but now believes that this should no longer be done.  Photo: Private

CHANGING PRACTICE: General practitioner Morten Munkvik has offered his patients Ozempic, but now believes that this should no longer be done. Photo: Private

– But I had never written it out straight away. You have to try other things first, and we know very well the patients who ask for this, says Munkvik to TV 2.

He emphasizes that doctors are free to prescribe anything “off label”.

– If enough things click in the right direction, it may well be that you print “off label”, but there must be a good foundation and history behind it. A special responsibility follows because the medicine is not pre-approved.

– Why do many doctors do this?

– Because you know it is quite safe and you have a lot of data on it. It is a safe medicine to give and nothing controversial or problematic to prescribe, as long as this is followed up.

Munkvik has recently changed its practice, and will no longer issue Ozempic to patients with weight problems. Read why further down in the case.

– Very risky

Daniel Sørli is a doctor and founder of the private medical service Dr. Dropin.

He personally would not prescribe Ozempic to his patients, and has also given clear advice to the doctors in the company that they do not dispense medicines that are not approved in Norway.

– Many believe that Ozempic is a shortcut to something many have wanted for a long time. But it can be very risky before you know how this works in a longer perspective, says Sørli to TV 2.

CRITICAL: Daniel Sørli is critical of the use of Ozempic for the treatment of overweight people.  Photo: Yngve Sem Pedersen / TV 2

CRITICAL: Daniel Sørli is critical of the use of Ozempic for the treatment of overweight people. Photo: Yngve Sem Pedersen / TV 2

The doctor and the entrepreneur acknowledge that the use of “off label” is difficult. For some patient groups, for example people with very rare cancer diagnoses, offering medicines that have not been approved can be a good alternative.

– But for a medicine like Ozempic, it is far more controversial, says Sørli.

– Extra responsibility

He believes it doesn’t always pay to be the first one out.

– There is a good reason why testing of new medicines goes through long processes where you gradually test it on a larger and larger population. There are also glaring examples of things that have gone wrong when shortcuts have been taken, says the doctor.

Nor does Kvittum Tangen hide the fact that she finds it problematic to prescribe medicine that has not been approved.

– The consequences are that you take on additional responsibility when you prescribe medicine that has not been approved. Then you have to pay attention to whether this has an effect for the patient, or whether it causes any side effects, she says.

ONCE A WEEK: Patients taking Ozempic must inject themselves with a syringe once a week.  Photo: Marie Grensbråten Lorvik / TV 2

ONCE A WEEK: Patients taking Ozempic must inject themselves with a syringe once a week. Photo: Marie Grensbråten Lorvik / TV 2

Despite this, the association believes that it should exist as an opportunity for doctors.

– We depend on having a broad and large toolbox, and patients are very different. Sometimes it is knowledge based on experience that lies behind a prescription, and not what is documented in studies. It is part of the art of medicine, treating the right patient correctly.

In short supply

Due to the explosive increase in use both in Norway and in other parts of the world, severe shortages of the medicine have been reported.

Kvittum Tangen is therefore quite clear on what she believes GPs must do now, if patients ask about Ozempic.

– It should certainly be limited for those who have an indication for it, and for patients who need treatment for type 2 diabetes and have no other options, she says and adds:

– We do not want Ozempic to be printed on a white prescription.

GP Munkvik also says that he believes it is problematic that the medicine is used up by those who do not need it due to chronic illness.

– Would you print it now, considering the shortage?

– I think it is unfortunate that there is a lack of good medicine. Those who use this for weight control can perhaps reduce the dose to keep things going until more medicine arrives, he says and adds:

– It is perhaps also wisest to give Ozempic to diabetics. There are alternatives overweight people can get.

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