A few years ago, Ozempic was a diabetes drug whose name most Canadians had not heard. Today, semaglutide and the broader class of GLP-1 receptor agonists are among the most-prescribed medications in the country. The legal questions surrounding their use have caught up with the prescribing.
For patients who have been prescribed Ozempic, Wegovy, or another GLP-1 drug and have experienced serious harm, the question is rarely about the drug itself. The drugs work. The question is about the care that surrounded the prescription: the assessment that should have been done, the contraindications that should have been identified, the side effects that should have been monitored, and the follow-up that should have been arranged.
How we got here
Ozempic was approved by Health Canada in 2018 for adults with type 2 diabetes. Its active ingredient, semaglutide, mimics a gut hormone (glucagon-like peptide-1, or GLP-1) that helps the pancreas release insulin in response to food, slows gastric emptying, and acts on the brain to suppress appetite. Within a few years, the appetite-suppression effect, combined with significant weight loss in clinical trials, drove explosive off-label use of Ozempic for weight management.
In November 2021, Health Canada approved Wegovy, a higher-dose formulation of semaglutide specifically indicated for chronic weight management in adults with obesity (BMI 30 or greater) or overweight (BMI 27 or greater) with at least one weight-related comorbidity. Wegovy did not actually launch in Canada until May 2024, after the manufacturer worked through global supply constraints.
Since then, the approved indications have continued to expand. In November 2024, Health Canada approved Wegovy to reduce the risk of non-fatal myocardial infarction in adults with established cardiovascular disease and a BMI of 27 or higher, based on the SELECT trial. In December 2025, Wegovy received conditional authorization for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH), a serious liver condition. Health Canada has also approved generic semaglutide and authorized Rybelsus, the oral form, to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes.
The point is that GLP-1 drugs are no longer a fringe weight-loss product. They are an established class of medications with multiple approved indications, multiple formulations, and millions of Canadian users. With that scale of prescribing comes a corresponding scale of prescribing decisions, and with that, the legal questions.
When prescribing goes wrong: the 2023 Nova Scotia case
In April 2023, the College of Physicians and Surgeons of Nova Scotia suspended the licence of a Halifax-area physician alleged to have issued thousands of Ozempic prescriptions over a three-month period. The prescriptions were reportedly filled by two British Columbia pharmacies and mailed to American patients. The College’s concerns included the volume of prescriptions, the absence of a meaningful clinical relationship with patients, and the cross-border distribution arrangement.
The case attracted attention because it was an early and unusually visible example of mass online prescribing of a GLP-1 drug. It was not the last. The same patterns, prescriptions issued at scale, with limited assessment, often through telehealth platforms, often without meaningful follow-up, have continued to attract regulatory scrutiny across the country.
For patients who have been harmed in this kind of arrangement, the legal question is whether the prescribing physician met the standard of care.
Off-label prescribing is not, by itself, malpractice
It is acceptable medical practice in Canada for physicians to prescribe medications for purposes not authorized by Health Canada. This is known as off-label prescribing. Many widely accepted treatments are prescribed off-label, and a physician who does so is not, on that basis alone, negligent.
What matters is whether the prescribing physician met the standard of care that a reasonable physician would have met in the circumstances. For GLP-1 drugs in particular, that standard has several recognizable elements.
What the standard of care looks like
A reasonable physician prescribing Ozempic, Wegovy, or another GLP-1 drug will, at minimum:
Take an adequate history. This includes the patient’s medical history, current medications, allergies, and a meaningful assessment of the indication being treated. For weight management, that means evaluating the patient’s BMI, comorbidities, and whether non-pharmacological options have been tried.
Identify contraindications. GLP-1 drugs are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2. They should be used with caution in patients with a history of pancreatitis, severe gastrointestinal disease, or diabetic retinopathy. Pregnancy is a contraindication, and Health Canada specifically directs patients to stop semaglutide at least two months before a planned pregnancy because of the long half-life.
Order baseline investigations where appropriate. Depending on the indication, this can include HbA1c, lipid panel, renal function, and pancreatic enzymes.
Counsel the patient on side effects and warning signs. The most common side effects, gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain, constipation), are usually mild but can be severe enough to warrant dose adjustment or discontinuation. Less common but more serious adverse events include pancreatitis, gallbladder disease (cholecystitis, cholelithiasis), severe gastroparesis or ileus, kidney injury, vision changes (particularly in patients with diabetic retinopathy), and serious allergic reactions.
Arrange appropriate follow-up. GLP-1 drugs are not a one-time prescription. Dose escalation, tolerability assessment, and monitoring for adverse effects require continuing clinical contact. A prescription written today and never followed up is not consistent with the standard of care, particularly at higher doses.
The telehealth and online prescribing question
The single most fertile area for malpractice in this category is the gap between what is convenient for the patient (a brief online consultation, an automatic prescription, mail-order delivery) and what the standard of care requires (an adequate assessment, identification of contraindications, ongoing follow-up).
Online weight-loss clinics have proliferated. Many of them deliver good care. Some do not. The recurring concerns are: assessments that consist of a brief patient-completed form rather than a real clinical evaluation; prescriptions issued by a physician the patient has never met and may not be able to identify; insufficient screening for contraindications; no meaningful follow-up arrangement; and reliance on the patient to self-report adverse events through asynchronous messaging.
A serious adverse event arising from a prescription issued in those circumstances is the kind of case that increasingly appears in malpractice files.
When prescribing crosses into malpractice
A patient who develops a serious adverse event on a GLP-1 drug does not, by that fact alone, have a malpractice claim. These drugs have well-documented risks that are accepted as part of treatment.
The legal question is whether the prescribing physician took reasonable steps to assess, counsel, and monitor the patient, and whether reasonable steps would have prevented or mitigated the harm. The most common patterns in claims involve:
- A serious complication (pancreatitis, gallbladder disease, severe gastroparesis, or vision loss) where the patient was never warned of the risk or counselled on the warning signs
- A serious complication in a patient with a contraindication that was identifiable from the medical history but was not asked about
- A patient who reported significant symptoms (severe vomiting, persistent abdominal pain, neurological changes) and was not assessed in person or referred onward in a timely way
- A pregnancy that occurred in a patient who was not counselled about the need to stop semaglutide before conceiving
What patients should do
If you believe that improper prescribing of Ozempic, Wegovy, or another GLP-1 drug contributed to a serious injury or death, the most useful first step is to obtain a complete copy of the medical records: the prescribing physician’s chart, any online platform’s records, the pharmacy’s records, and any subsequent treating provider’s chart. Reviewed by a malpractice lawyer and the right medical experts, those records will usually answer whether there is a viable claim.
For more on how medication errors and prescribing claims are handled, see the Medication Errors practice page. For the legal process more broadly, see Suing for Medical Malpractice in Ontario: What You Need to Know.
The first conversation is free and strictly confidential. The earlier we look at the records, the better.
