The Illegal Drug Marketplace in Your Patients’ Pockets

Gone are the days when obtaining an illegal drug required meeting a dealer in a sketchy, private location. Now consumers can access illegal and counterfeit medicines from the comfort of their own home – thanks to social media platforms like TikTok and Facebook. 

A recent investigative report by Forbes confirmed what many young people have already discovered – that TikTok has become the “it” marketplace for illegal dealers selling street drugs and controlled substances like cocaine, methamphetamine, Xanax, and Adderall. While TikTok’s guidelines clearly prohibit the promotion or sale of any illegal drugs or drug paraphernalia, a serious lack of enforcement has allowed online sellers to purchase ads targeting users who categorized their interest in topics like education and shopping. 

Traditional “street” drugs aren’t the only illegal products these social media platforms have become home to. Over the past year, counterfeit and mass-compounded weight-loss drugs have been aggressively marketed to consumers through false testimonials and misleading advertising. Among them is retatrutide – a new investigational molecule still undergoing clinical trials that has not received U.S. Food and Drug Administration (FDA) approval. And yet, online wellness companies and medical spas are promoting illegally compounded versions of the drug on Facebook, Instagram, and TikTok, enticing consumers with promises of “jaw dropping results” and “three times the fat-fighting horsepower in one clean, clinical ride.” 

What these companies do not advertise is that this black market retatrutide is largely sourced from unregistered foreign suppliers and unvetted facilities that operate entirely outside the U.S. regulatory framework. Despite being marketed with “third-party validation” and clinical-sounding language, buyers have no meaningful way of knowing what is actually in the product, where it came from, or whether the dosage is even accurate. For a growing number of patients across the world, this lack of guardrails has had devastating consequences – ranging from severe hospitalizations to acute liver failure. One 25-year-old man had to visit the emergency room three times for cardiac complications and severe stomach distress after taking the drug. 

As a compounding pharmacist of more than 50 years, I know that the front line of this crisis is in the exam room. I also know that healthcare providers have been placed in a difficult position through no fault of their own. According to a 2025 survey by the Alliance for Safe Online Pharmacies, 49% of Americans who purchase a drug online report that a practitioner recommended a specific online source – more than pharmacists, health insurers, or family and friends. Practitioners are the single most influential voice and yet only 2% have received any training on identifying counterfeit medicines or counseling patients about them, and 89% report not knowing what actions they could take. This isn’t a reflection of failure in practitioner commitment, but rather a failure of the system to equip providers for a conversation that is becoming increasingly common in their exam room. 

Patients obtaining retatrutide through social media, medical spas, or telehealth platforms are not the same as patients obtaining drugs through more traditional illicit channels because they often believe what they are receiving is a clinically validated product. This means they may present with unexplained symptoms without realizing their online purchase is even relevant to the conversation. Fortunately, providers are best positioned to bridge that gap via a few steps: 

• Asking where patients obtain their medicines is the first step in understanding the full clinical picture; 
• Where relevant, pointing them to an authoritative verification resource — such as the National Association of Boards of Pharmacy’s safe.pharmacy — requires no pharmacy expertise; and 
• Helping them understand the difference between FDA-approved alternatives and unregulated products.

The black market for retatrutide won’t be shut down by platforms, regulators, or lawmakers alone. Healthcare providers are uniquely positioned to help – as one of the most trusted voices in their patients’ lives, they may be the most powerful intervention available.

Author bio:

Fred H. Mills, Jr. is a compounding pharmacist, former Louisiana State Senator, and former Executive Director of the Louisiana State Board of Pharmacy. He is Chief Policy Officer of Americans for Safe and Effective Medicines (ASEM).

Image: Getty Images, monique28