As a physician, I am accustomed to patients asking me about new treatments they have seen online. Lately, those conversations include peptides, chains of amino acids that work as messengers in the body to affect blood sugar, healing, weight loss, or even aging.
Some peptides are legitimate, important medicines. Insulin is a peptide, and GLP-1-based drugs have transformed the treatment of obesity and diabetes.
But alongside those medical breakthroughs, a dangerous market has exploded online with people buying unapproved injectable peptides from websites and social media, sometimes shipped directly from overseas, without knowing with certainty what is actually inside the vial. It’s not dissimilar to buying a bottle of pills from a stranger on the street. Inside each pill could be a contaminated substance that makes the stakes life or death. Every online purchase of unregulated, foreign-manufactured peptides is effectively a game of Russian Roulette for American lives.
That concerns me. It should concern every physician, and it should concern President Donald Trump.
And where does some of this supply chain lead? A 2026 investigation by blockchain analytics firm Chainalysis found that some Chinese chemical manufacturers selling peptides to Americans had previously supplied fentanyl and amphetamine precursors to transnational drug traffickers. Chainalysis estimates that the cryptocurrency-based gray-market peptide economy has grown to an annual run rate exceeding $100 million.
In other words, parts of the infrastructure that helped supply the synthetic-drug trade have found another U.S. market. This time, the product can arrive looking like wellness.
Peptides including BPC-157, TB-500, and ipamorelin are promoted online for everything from injury recovery to physical enhancement. Retatrutide, an experimental obesity drug, has become particularly concerning. It has produced remarkable results in clinical trials, but it remains investigational and has not been approved by the Food and Drug Administration. Yet products claiming to contain retatrutide are already being sold online.
That’s not innovation. It’s an uncontrolled experiment on American consumers.
The phrase “research use only” doesn’t make these products safe or legal for human use. The FDA has explicitly warned sellers marketing supposed research peptides while simultaneously making claims about their effects on the human body. In August alone, the agency issued warning letters to companies selling unapproved injectable products including retatrutide, semaglutide, and other peptides. The FDA itself warns that injectable products pose particular risks because they bypass many of the body’s defenses against toxins and microorganisms.
We already know these products are entering the country.
Earlier this year, Customs and Border Protection officers in Cincinnati reported intercepting more than 5,000 shipments of unapproved peptides originating in China. The products had been packed inside more than 300 larger cartons and falsely described on shipping documents.
And this isn’t merely theoretical harm. Federal prosecutors in Utah indicted a physician in April, alleging that he obtained unapproved peptides from China, including retatrutide, BPC-157, TB-500, and ipamorelin, and sold them to more than 200 patients.
The FDA has taken action, but warning letters are not enough. Public Citizen found that of 14 FDA warning letters sent to companies selling retatrutide since 2024, 11 recipients were still advertising retatrutide or other unapproved peptides as of May, and eight were still selling retatrutide.
We cannot regulate a rapidly expanding international drug market one warning letter at a time.
This should not become a debate about whether peptides themselves are good or bad, nor should it become a fight over protecting pharmaceutical companies from competition. There are legitimate debates to have about drug prices, compounding, and access to emerging treatments.
But access without safety is not progress.
Americans shouldn’t inject substances manufactured by unknown or unaccountable suppliers, purchased through cryptocurrency, promoted by influencers, and shipped into the country under misleading labels. And Chinese chemical companies with documented connections to the fentanyl-precursor trade should not be allowed to simply pivot to the next lucrative American market.
Trump has made stopping the flow of fentanyl and confronting China central priorities of his administration. The emerging peptide market sits directly at the intersection of both.
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The administration should aggressively target illegal imports, pursue sellers knowingly distributing unapproved drugs for human use, strengthen cooperation among the FDA, Customs and Border Protection, and the Justice Department, and scrutinize overseas manufacturers connected to illicit drug networks.
We learned through fentanyl what happens when dangerous chemical supply chains are allowed to grow faster than our government responds. We shouldn’t have to learn that lesson twice.
Dr. Anahita Dua is a vascular surgeon and the founder and chairwoman of Healthcare for Action.