Beyond the more apparent environmental challenges of rising medical waste from at-home injectables like Glucagon-like peptide-1 (GLP-1) agonists, pharmaceutical companies are grappling with a quieter but equally urgent issue: the risk of contraband. Used injectors can be tampered with and then resold in black or grey markets, posing serious risks to public safety and significant liability for manufacturers. This makes stricter oversight across the entire product lifecycle, from production to final disposal, extremely crucial.
In addition to concerns about safety and sustainability, providers now face the added challenge of preventing these products from re-entering circulation through unauthorised and potentially dangerous channels.
Exponential demand, illegal supply, and safety risks for users
When counterfeit drugs find their way into real medicine cabinets, they expose serious vulnerabilities within pharmaceutical supply chains and highlight the urgent need for robust product retrieval and verification systems. In one of the most high-profile cases, adulterated versions of the injectable blood thinner heparin resulted in at least 81 deaths and hundreds of adverse events in the US alone.
In recent years, with GLP-1’s transforming obesity and diabetes care outside clinical settings and surging in popularity, with prescriptions climbing nearly 40% each year between 2022 and 2024, the risk of falsified or unsafe products entering patients’ homes has never been greater. These medications, often expensive and not always covered by insurance, difficult to access, and mostly prescription-based, keep demand well above supply. This combination fuels a growing underground demand as people seek cheaper, faster, and more convenient access, even if that means turning to unregulated, risky sources.
The soaring popularity of weight-loss drugs, for instance, has made them a frequent target for counterfeiters. In June 2023, UK journalists discovered drugs being sold on Facebook, while Nigerian authorities uncovered counterfeit pens containing insulin across nine countries. Most recently, the FDA was notified in April 2025 that several hundred counterfeit units of semaglutide injection 1 mg had infiltrated the US supply chain.
Scammers, con artists, and swindlers have also set up shop online to take advantage of the frenzied demand for new weight-loss drugs. Ranging from discounted offers and sales without prescription to fake profiles on Facebook and fake offers on Craigslist, new avenues continue to crop up, luring in unsuspecting victims. From January to April 2024, McAfree tracked 176,871 phishing emails and 449 malicious websites, a 200% increase from the previous quarter.
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By GlobalDataEngaging with these unauthorised sources exposes consumers to significant health risks, besides the obvious financial losses. McAfee also shared the story of a woman managing her diabetes with semaglutide who turned to online sellers after local pharmacies ran out of stock. The pens did arrive, but they looked different, and the packaging seemed off when realisation struck that they contained insulin instead of the intended medication. Without these visual clues, she could have accidentally injected a potentially deadly dose.
The challenge for manufacturers
The primary challenge is the absence of a standardised, user-friendly return mechanism that allows patients or providers to securely send back potentially counterfeit items while enabling internal teams to manage returns efficiently and in compliance with regulatory guidelines. This gap is particularly evident with injectables, complex delivery devices, and pill-based therapies where verification requires intact packaging, original labels, or device components.
This reflects wider industry concerns, with the World Health Organization (WHO) estimating the global counterfeit drug market at between $75bn and $200bn and INTERPOL’s Operation Pangea XV seizing over three million fake medications across 94 countries.
In a nutshell, vulnerabilities exist across three high-risk product categories. Injectables are particularly prone to tampering, label swapping, and repackaging. Pens and delivery devices are complex and difficult to authenticate visually, while oral tablets are often exposed to gray-market resale or substitution.
How improper waste disposal adds to the problem
When it comes to injector pens, they are sleek, durable, and often feature recognisable pharmaceutical branding – qualities that make them especially appealing to counterfeiters.
If used injectors aren’t properly disposed of, they become vulnerable to collection and tampering. These pens can then be conveniently refilled with saline, diluted medications, or completely unsafe substances, and yet to the average consumer, a reused pen may appear identical to a genuine one. When counterfeit or reused injectors bearing a provider’s or manufacturer’s banding circulate in the market, any resulting harm, whether it’s infections or ineffective dosing, can severely undermine public trust. Even if the company is not directly at fault, negative outcomes are often attributed to the original brand.
From reactive containment to proactive strategy
One initiative that could help meet the needs of both manufacturers and end-users is PureWay‘s retrieval programme with secure containers in various sizes, a discreet inner box, and space for original labels and bags to ensure complete tracking. This system also includes clear, graphics-based instructions to guide proper returns and was tested for quick deployment, ready for use once approved. Several other enhancements are under development, including optional text alerts for patients, cross-product compatibility for injectable and non-injectable medications, and tamper-evident components to prevent post-return interference. Still in its pilot phase, the approach is proving effective, enabling a shift from reactive containment to a coordinated, proactive strategy that improves internal coordination and time-to-resolution for suspicious product reports.
By using designated disposal systems such as mail-back sharps containers, companies can prevent illegal reuse and counterfeit circulation, reducing costly lawsuits, regulatory penalties, and product recalls.
How circularity can close the loop
Ultimately, it’s not solely a matter of logistics. It’s about protecting the patients, safeguarding the brand, and ensuring regulatory compliance. Without cradle-to-grave oversight, providers cannot fully track or manage their products throughout their entire lifecycle. This blind spot can lead to serious consequences: counterfeit versions circulating in shadow markets, compromised patient safety, and erosion of trust in legitimate care pathways.
Circular systems, on the other hand, give providers full oversight of their products from distribution to disposal, so they know exactly where every injector ends up. It ensures that used injectables are collected and processed securely, preventing them from falling into the wrong hands. Also importantly, when patients know their medical waste is managed responsibly, it improves confidence in their treatments and encourages adherence to medication regimens. By combining accountability, safety, and transparency, circular systems can, in fact, reinforce trust across the entire healthcare ecosystem.
