The explosion in our use of semaglutide (Ozempic and Wegovy) after its FDA approval for chronic weight management in 2021 was accompanied by another trend that caught the attention of researchers. That’s a dramatic increase in the number of calls to poison control centers across the United States.
Jordan Miller, then an undergraduate at the University of Texas at San Antonio, wanted to know whether the spike in poison control cases was directly related to the FDA’s expanded approval of semaglutide, or whether the timing was simply coincidental.
Glucagon-like peptide-1 receptor agonists (GLP-1RA), originally introduced as a treatment for type 2 diabetes, quickly became widely available after the FDA approved semaglutide for weight management. As demand for the drug accelerated, poison control centers also began reporting a spike in calls, citing semaglutide as a standout over other drugs.
“One of them was semaglutide, which is a very strange category,” said David Hung, Miller’s research supervisor and the Romo Endowed Professor in the UT San Antonio Department of Statistics and Data Science. “We suspected the spike in calls was due to misuse and mishandling of this drug. We thought this might be due to the FDA’s approval of this drug for weight management.”
Professor Miller, working with Mr. Han through the Chancellor’s Undergraduate Research Fellowship, collaborated with Robert S. Miller, Pharm.D., a Long School of Medicine researcher and senior toxicology information specialist, and Sean M. Barney, M.D., professor of emergency medicine and medical director of the South Texas Poison Center, to analyze poison control data from across the country.
Miller then presented his research at UT San Antonio’s Los Datos conference, where the project won first place.
Significant increase in poison control inquiries
Prior to 2021, poison control centers nationwide typically handled 1,000 to 1,500 GLP-1RA-related cases each year. Since mid-2021, that number has nearly doubled, with poison centers recording more than 8,000 GLP-1RA-related calls by 2023.
Although most incidents were due to accidental medication or treatment errors rather than intentional misuse, the researchers were surprised by the magnitude of the increase.
“In this chart that tracks increases with specific drugs, we didn’t expect semaglutide to be so incredibly dominant,” Jordan-Miller recalled. “I expected him to be in the lead, but it was amazing. On the other hand, it’s natural to get so much media attention.”
Han said the project shows how data science can uncover meaningful public health trends, rather than just producing statistics.
“This study quantifies the public health impact of these drugs,” he said. “Statistics, data science, analytics, machine learning, and AI are meant to help people. We use them to transform data from any field into meaningful insights and informed action. Without that focus, it’s empty, numbers with no real impact.”
Research questions that pay off
The project began after Miller decided to ask her professor about research possibilities, but she almost skipped that step.
“You have nothing to lose by asking,” she said. “When you have a professor that you’re really good friends with and respect, you have nothing to lose by asking what they’re working on or if they have a space for a research assistant. I was really lucky because Dr. Han said, ‘I’m here to help. You choose what you want to research.'”
The researchers’ analysis showed that the FDA’s approval of semaglutide for weight management marked a clear turning point. Both the number and type of poison control inquiries changed significantly after approval. This reflects the rapid expansion of semaglutide use not just to diabetics, but to a much larger number of people seeking weight loss.
“It’s one thing when a GLP-1 (RA) drug is sold to a diabetic patient, and a completely different story when the drug is used for weight management,” Han explained. “So we needed to quantify this evidence to show that it comes from FDA approval and how to reduce that risk. We need to better educate the public because we still don’t fully understand how this drug works in the body and its long-term safety.”
Preventable dosing errors led to many incidents
Researchers found that many poison control incidents could have been avoided with better patient education. Semaglutide is designed to be injected once a week, rather than daily. Patients also begin treatment at a low dose and gradually increase the dose over time.
Data shows that two of the most common mistakes are taking the drug daily instead of weekly and starting at the highest dose immediately without following the recommended gradual schedule.
“Can you imagine doing something you’re supposed to do little by little, but doing it as hard as you can and seven times as often as you should?” Jordan Miller said.
Miller and Han say many of these medication errors could be prevented by improving education at every step of the prescribing process, from the doctor’s office to the pharmacy counter.
This research was featured as a cover story in the following journals: significancethe flagship journal of the Royal Statistical Society and the American Statistical Association. The results of this study were also published in the following journals: Journal of Medical Toxicologythe official journal of the American Society of Medical Toxicology.
