Online illicit trade of GLP-1 receptor agonists on telegram

Abstract GLP-1 receptor agonists, including semaglutide and liraglutide, have attracted substantial attention for their efficacy in weight management, with growing use extending beyond traditional diabetes treatment and regulated prescription pathways. Encrypted messaging platforms, particularly Telegram, have become important channels for illicit pharmaceutical trade, enabling the promotion and distribution of medicines outside regulated medical systems. Although research on online drug markets has focused mainly on illegal substances, the circulation of prescription-only medicines remains understudied. This study examines advertisements for GLP-1 receptor agonists in European Telegram-based illicit drug markets. A mixed-methods design was employed, combining automated data collection with quantitative and qualitative analyses of Telegram drug-trading channels. Using a keyword-based dictionary, posts mentioning GLP-1 products were identified and analysed for offer frequency, pricing, and co-occurrence with other substances and the linguistic strategies used to frame and promote them. Template analysis was used to examine the linguistic and marketing strategies employed in GLP-1 advertisements. Among 648,862 messages from four European Telegram drug-trading channels, 2,837 posts (0.43%) mentioned at least one GLP-1 product. Ozempic accounted for nearly half of mentions (46.5%), followed by semaglutide, Mounjaro, and Rybelsus. GLP-1 products appeared consistently over time, suggesting a stable niche market. Where prices were reported ( n = 1,382), Ozempic showed highly standardised pricing (median €250). Over half of GLP-1 posts (55.3%) co-advertised illicit drugs. Qualitative analysis identified de-medicalised framing, the absence of prescription requirements, and an emphasis on discretion, speed, and professionalism. The findings reveal a persistent niche market for GLP-1 receptor agonists on Telegram, highlighting regulatory challenges and potential public health risks associated with the normalisation of non-medical access on encrypted messaging platforms.