As the medical director of Temple University Hospital’s bariatric surgery division, I’ve seen great advancements in obesity treatment over the years. This includes GLP-1 medications that have helped patients achieve significant weight loss and reduce the risk of a myriad of other serious chronic diseases.

These treatments are lifesavers for many across the country, including in Pennsylvania. Unfortunately, some bad actors have sought to prey on consumers looking to access them.

Over the last several months, the Federal Bureau of Investigation (FBI), the U.S. Food and Drug Administration (FDA), several members of the U.S. House and Senate, and attorneys general from across the country, including Pennsylvania’s Dave Sunday, have raised alarm bells about the growing market for illicit semaglutide and tirzepatide, the active pharmaceutical ingredients (API) in GLP-1s.

Following Sunday’s announcement, I similarly warned consumers against purchasing these knockoff and dangerous products. But words of warning aren’t enough to solve this problem.

Year over year, the amount of illicit API arriving in the U.S. is rising. Last year alone saw Chinese companies ship enough of it for nearly 80 million doses.

In the last two years alone, federal records showed more than 230 shipments from unregistered sellers in China, Turkey, and India arriving at our nation’s ports. The scariest part — more than 80% were allowed into the U.S. drug supply.

Without action, it’s a market that shows no signs of slowing. As the state looks to pull back on Medicaid coverage for GLP-1s to treat obesity, more consumers, particularly in communities of color that are more affected by obesity, face a greater threat of exploitation.

The online sellers of API have launched two dangerous markets: it’s either sold directly to consumers as a raw powder and then reconstituted as a GLP-1 at home, or it’s sold to illegal compounding pharmacies such as Empower and Strive, who provide their product to direct-to-consumer pharmacies including Willow and Fella.

This product is untested, likely to be impure, and extremely dangerous. The FBI, in their warning, even noted one shipment that was purported to be semaglutide failed to contain the ingredient at all.

These sellers are pulling the wool over consumers’ eyes. They go to great lengths to claim that their products are not for human use and are instead strictly for research, but their advertisements across social media tell a different story. They fail to warn of the dangers associated with their products and instead just market them as inexpensive alternatives to FDA-approved GLP-1s.

The truth is that most consumers have no idea if what they’re receiving is safe. The more than 15 deaths and 100 hospitalizations from compounded medications show the dangers of this market, and its growth will only lead to more deaths and hospitalizations, particularly if vulnerable Pennsylvanians find themselves without coverage for FDA-approved GLP-1s.

A perfect storm is brewing in Pennsylvania. It’s impossible to overstate the dangers residents face.

The federal government must increase enforcement to confiscate these drugs. The FDA should crack down on illegal compounders that continue to skirt the law. The Federal Trade Commission (FTC) can work to shut down deceptive marketing practices from these companies. Statewide, we can ensure that access to safe, FDA-approved GLP-1s is maintained, so consumers don’t find themselves turning to gray-market solutions.

As physicians, we took an oath to “first, do no harm.” Lawmakers would be smart to abide by the same principle. Illicit API is undermining the medical breakthrough of GLP-1s and putting consumers at risk. It needs to be removed from our ecosystem.

Dr. Rohit Soans is medical director of bariatric surgery at Temple University Hospital and associate professor of surgery in the Lewis Katz School of Medicine at Temple University.