Inside a brown parcel, under layers of plastic and wet foil wrapping, nestled in between two no-longer frozen ice packs, is a vial of red liquid.
This is replica Ozempic — ordered without a script via text, paid for through PayPal, and sent to a suburban post office.
A Four Corners investigation has discovered vials like this are being illegally shipped across the world from a house on the outskirts of Sydney.
Right under the nose of authorities, they are being delivered to people desperate to access these hard-to-find weight-loss drugs.
It sounds like a dodgy scheme you would find on the dark web.
Instead, this sophisticated operation is finding its customers by bombarding GPs and specialists with advertising emails and faxes.
We ordered one of the red vials to track down who’s behind the operation and found a complex web of fake pharmacies leading back to one man in Sydney’s south west.
Side effects
Michael Fox ignored the faxes at first.
Like many medical practices around the country, his GP clinic, in a small north-east Tasmanian fishing town, still relies on antiquated fax services to send pathology forms and scripts.
Pharmacists had sent the clinic product lists before, but these faxes were different.
“BREAKTHROUGH MEDICAL WEIGHT LOSS SOLUTIONS,” one read. The faxes kept coming.
They promised cheap access to compounded versions of the medications Ozempic (which includes the active ingredient semaglutide) and Mounjaro in the middle of an unprecedented global shortages.
In Australia, Ozempic is only approved and subsidised for patients with diabetes, but doctors can use their own discretion to prescribe it for patients wanting to lose weight — at full price. Mounjaro has no PBS subsidy at all and can cost up to $700 a month for the highest dose.
When shortages of the brand-name versions took hold last year, Dr Fox and other doctors at the clinic started sending dozens of patients to the pharmacy behind the faxes.
“Some patients lost 20 kilos and that was really good,” Dr Fox said.
At first he only saw the usual side effects expected from the name-brand Ozempic, like nausea and diarrhoea.
Then, one patient, who’d been injecting the liquid with the unusual bright red colour, started having an odd tingling sensation in their hands and feet.
The condition, known as peripheral neuropathy, can be serious, and cause permanent loss of sensation. The patient ended up in hospital.
As well as semaglutide, the label on the red vials said they also contained vitamin B12 and L-carnitine.
But tests revealed the sick patient had very high levels of something else, vitamin B6. Doctors determined the compounded semaglutide was the likely cause, even though B6 wasn’t listed on the label.
“That threw a lot of doubts in our head about, where this is coming from and what else might be in there or not in there,” Dr Fox said.
The surgery advised patients to stop taking the medication and reported the incident to the Therapeutic Goods Administration (TGA) last year.
Another patient at the clinic was surprised when the pharmacy offered to sell her more of the drugs before her first order even arrived.
She lost weight but within weeks of starting the compounded semaglutide injections she had severe diarrhoea and vomiting. Then her mouth wouldn’t stop bleeding.
She stopped taking the medication but the pharmacy kept messaging, offering her more without a script:
“Dear [name redacted] if you need more supply of your Weight Loss Injection semaglutide (known as Ozempic/Wegovy) Professional Strength prescribed by your doctors, simply SMS “Y” back”
She replied:
“F*** off you rip-off pieces of shit”
The service selling the red vials was what’s called a ‘compounding pharmacy’.
Compounding pharmacies are meant to fill a gap in the market – providing one-off medications for people when there’s no commercial product available.
But with the popularity of Ozempic and Mounjaro exploding, some have started mass producing replica versions of the drugs – something regulators were totally unprepared for. It’s also lured unscrupulous players looking to cash in on the growing market for weight-loss drugs.
When Dr Fox and his colleagues tried to raise the alarm about the red vials, they discovered regulators like the TGA don’t check compounded medications.
“It seems like there’s a real hole in the way we look after these medications and how they’re managed and make sure that they’re produced safely,” Dr Fox said.
He also tried to contact the pharmacy without success. Without a specific pharmacist to complain about, there was nothing the pharmacy board could do either.
‘Mimickers science’
Dr Fox’s surgery wasn’t the only one getting the faxes. Doctors’ surgeries, GP clinics and specialists around the country were being bombarded.
Four Corners spent months speaking to dozens of medical practitioners, patients and pharmacists, collecting a trove of documents that tell a strange story.
While the faxes appeared to be from different pharmacies, the wording on them was very similar.
They listed the same prices and dosage guides. The semaglutide always had the same additives as the red vials in Tasmania, B12 and L-carnitine.
Multiple ads contained the same spelling mistakes, stating they’re part of a “Compommdding Pharmacy Alliance” or declaring that Ozempic’s class of drug (GLP-1) “mimickers science”.
They also falsely claimed to be accredited by real, and fake industry bodies.
There was never a phone number, or a physical address, different pharmacies appeared to share fax numbers and there was usually just a Gmail to contact.
One business name kept coming up: Total Compounding Pharmaceuticals, or TCP.
‘These are cowboys’
Pharmacist Adam Reinhard is sick of hearing about TCP.
For years he’s been fielding angry calls from people who’ve mistaken his Sydney pharmacy (which is called TCPA) for TCP. At one point he was receiving up to 20 calls a day from customers demanding answers.
“They kept talking about the weight loss injections and I was like, ‘We don’t even do that’,” he said.
Some said they’d paid money and never been sent the drugs. One patient, who had received a red vial, just like those sent to Tasmania – sent Adam a photo.
“Straight away I was like, my brain says that is not sterile at all … I said, ‘Do not inject that because that is not sterile’, Adam said.
“We don’t know what is actually in there, let alone if it is the drug and then how it was made.
“I said, ‘These are cowboys, expect the worst’.”
He reported TCP to the NSW Pharmacy Council, the Australian Health Practitioners Regulation Agency (AHPRA) and the police. He said he was told that without the name of an actual pharmacy or pharmacist there was little they could do.
“All the information led, to me, that someone in the compounding world is part of this,” Adam said.
“The way they’ve set up the operation, only someone with the intricate detail in compounding would understand how to do.”
The order
To get to the bottom of who was behind the fax operation, Four Corners purchased some replica Ozempic from TCP.
We messaged the number that was texting the customers in Tasmania, asking how to place an order.
“Thank you for your reply, could you kindly send me how many supplies you would like to get, your name, email and delivery address. … Have a lovely day. The Specialist Compounding Pharmaceuticals Group.”
It then sent through an invoice, with a “pay now” button for $150 plus shipping.
They never asked for a script.
While we waited for the medication to arrive the company texted multiple times offering more.
When it did arrive, it was a red vial like the others. One of the warm ice packs had broken, leaking liquid through the package. There was a barcode with number 31,044 on it. Usually in compounding this would reflect the number vial produced.
The paperwork that came with the medication, the label on the vial and the packaging included the names of four different pharmacies, none of which are registered pharmacies or actual company names.
The postage location: “Brisbane Queen Street Mall, Toowoomba” didn’t make sense either.
Another lead also came to a dead end.
The bank transaction for our order listed the seller as yet another company: Biopharmacy.
That company was once licensed to operate a compounding pharmacy in south-west Sydney.
The address is now a tyre shop, but neighbouring tenants say there was a compounding pharmacy at the site years ago. The sign bears the name of yet another defunct pharmacy.
They said the tenants stopped paying rent and suddenly disappeared, leaving all their equipment including a pill press in the property and a pile of unopened mail.
Mail for the owners of the compounding pharmacy still arrives here, addressed to even more companies and pharmacy names. It’s strewn in the gutter covered in debris.
A Kansas City clue
The breakthrough came from the other side of the world.
Total Compounding Pharmaceuticals wasn’t just selling to patients here, it also illegally exported weight loss drugs overseas.
We found patients in Alabama, Texas and Missouri.
The complaints from American customers online are extensive:
“Product was shipped and was not temperature [controlled].”
“They list an address on their website making it look like their company is in Wyoming, United States, but it is NOT. … They are really located in Australia.”
“I received a product from Australia. It was hot and unusable, no numbers to be able to talk with anyone. Lost $800.”
When one unhappy customer in Kansas City demanded a refund, PayPal told her to return the medicine to the seller. The address it provided was a suburban brick house in Sydney’s south-west.
The owner of the house is registered pharmacist Emad Azzer.
Neighbours said there had been a constant stream of delivery trucks backing into the driveway and they’d seen Mr Azzer unloading large boxes and pallets of equipment into his garage.
Mr Azzer’s NSW license to practice is restricted — it states he is not allowed to compound drugs or have a financial interest in any compounding pharmacy.
Despite his ban, Mr Azzer’s underground business has been able to operate for years unchecked, obscured through a complex web of fake pharmacy names.
At least one bank account he used to take money from customers under the name “TCP compound” is now part of an AUSTRAC investigation and has been closed.
Four Corners shared the details of our investigation with the TGA last week. Within 48 hours, TGA officers descended on his house searching for evidence.
Mr Azzer was nowhere to be seen. But inside the house officers found tiny red vials just like those Four Corners discovered had been sent around the world. They were taken away in an esky for forensic testing.
After months, a TGA warning
The Kansas City customer submitted a formal written report to the TGA in October last year about Total Compounding Pharmaceuticals, stating:
“I wanted to ensure you were aware of this company … I have serious concerns about the safety & efficacy of the shipment I received.”
She said she received no response.
Five weeks after Dr Michael Fox reported the adverse patient reaction to the TGA last year, he was asked to send vials for testing.
He said he hadn’t heard from the TGA since.
Last Thursday, after being contacted by the ABC, the agency put out a safety alert about the red compounded semaglutide vials Dr Fox had provided.
The TGA described the vials as “substandard semaglutide” and revealed testing found the vials contained 10 times the amount of vitamin B12 on the label. It’s not known what else they contained.
In recent months the TGA has become concerned about established compounding pharmacies making replica semaglutide more generally.
Compounding versions of medications is allowed when it’s done by a registered pharmacist in a licensed pharmacy, but even in that case, there’s no one independently checking what’s being made.
TGA Chief Medical Advisor Robyn Langham says that’s because compounded medications are exempt from the agency’s usual checks and balances.
“We can’t tell you exactly what they are. We can’t tell you if they work and we can’t tell you if they’re safe. And we have no oversight of the quality of these medications at all,” she said.
In recent months, the regulator has proposed banning the broader compounding pharmacy industry from making weight loss drugs at all.
Professor Langham denied the proposed ban showed current regulation wasn’t working.
“This is how regulation works … recognising that there is activity that is not in keeping with the safety of the community and taking action to address it.”
The TGA says its investigations are ongoing.
Emad Azzer has not responded to multiple requests for comment from the ABC.
Watch Four Corners’ The Ozempic Underground on ABC iview.
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