Tiffinne Perkins, a nurse practitioner who ran an Ohio-based weight-loss clinic called Enbody, appeared on the local news and lifestyle morning show "New Day Cleveland."

"How many people got skinny thanks to you lately?" asked the host, in a segment sponsored by Enbody.

"Oh, boy, all of them," Perkins replied. "Hundreds."

A little over a year after that 2024 TV appearance, inspectors from the Ohio State Board of Pharmacy arrived at Perkins's clinic. They found more than 400 vials of illicit weight-loss drugs, including retatrutide, a next-generation weight-loss drug that Eli Lilly is developing but isn't yet approved. The clinic's license was suspended within days.

Perkins denied the clinic sold retatrutide. Her lawyer said they wouldn't appeal the board's decision or the $300,000 fine.

Clinics and medspas, promising people transformational weight loss, have figured out how to procure and sell an experimental drug that hasn't gotten through the government's drug approval process, prompting serious safety concerns from authorities.

Social media has amplified interest, with influencers promoting Eli Lilly's retatrutide-often called "reta"-as a superior weight-loss solution. The black-market compound makes its way to the U.S. through a robust and loosely regulated peptide industry fueled by Chinese suppliers.

Regulators are trying to come to grips with this underground system. States like Ohio have started to crack down in the past year. While approved pharmaceuticals are subject to rigorous vetting, the same standards don't apply to the black market, raising fears of potential contamination, mislabeling and unknown ingredients that could cause dangerous side effects.

Other states, including Oregon and Iowa, have put out notices warning patients and medical professionals about using retatrutide.

It looks like a game of whack-a-mole.

"They shut down a company, and it pops up again under a slightly different name with a new website," said Tenille Davis, a pharmacist and chief advocacy officer for the Alliance for Pharmacy Compounding, a compounding-pharmacy trade group.

Between March 2025 and August 2026, Ohio's board conducted 1,102 proactive inspections of wellness clinics and medical spas across the state, leading to 54 immediate emergency shutdowns of businesses that posed a "danger of immediate and serious harm."

Inspections in Ohio jumped 56% since fiscal year 2024, when regulators started seeing illicit retatrutide and other peptides, board data show.

The Food and Drug Administration has sent warning letters to telehealth companies marketing retatrutide, distributors for selling it and outsourcing facilities for repackaging it. But critics say the federal regulators either don't have or aren't fully using the limited authority they do have to stop this influx of illicit drugs.

An FDA spokeswoman said that the agency would continue to take action to remove illegal drugs from the market and that it urges consumers not to use retatrutide unless they are part of an official study.

The explosion in use of compounded versions of weight-loss drugs has "really exposed these gaps in our regulatory structure," said John Hertig, board chair of the advocacy group Collaborative for Evidence-Based Medicines.

"Warning letters don't work in black markets," said Dan Burke, who previously led illegal online pharmacy investigations at the FDA and is now director of intelligence and investigations at the U.S. Anti-Doping Agency. "If I'm running an illegal online pharmacy and I get a letter in the mail, if they can locate me at all, I can just simply ignore it because there's no sanction."

Burke said consumers have no idea what they are injecting when they buy drugs like these online. "We've worked cases where the vial is just tap water and mold and nothing more."

Reports to poison-control centers about retatrutide increased 164% from January to July 2026, according to America's Poison Centers, a nonprofit that oversees them. There have been more than 1,000 reports since the organization started tracking them in September last year. Reports to webPOISONCONTROL, an online reporting tool, show a similar increase, from 18 cases in 2025 to 124 cases so far this year, according to co-director Dr. Michael Chary.

Consumers are drawn to retatrutide because the early data is compelling. Patients on the highest dose in a big study lost an average of 28.3% of their body weight, Eli Lilly reported in June. That is notably higher than the roughly 21% average weight loss on the highest doses of approved injectables like Zepbound and Wegovy.

Obesity-medicine doctor Dr. Angela Fitch recalled a time when she overheard prospective patients discussing the drug over breakfast. "I heard them all talking about retatrutide and whether they should buy it on this site or that site," she said. "We didn't see that when patients would sit at a table before Ozempic came out."

This summer, as Eli Lilly began preparing its application for approval of retatrutide, it also filed six lawsuits against a medspa, compounding pharmacy and peptide sellers accusing them of illegally selling black-market versions of the drug. But that is just a tiny fraction of the broader illicit market.

Retatrutide is getting into the U.S. from overseas suppliers, often based in China or India and marketed through social-media platforms such as Facebook and TikTok. It arrives by mail as a powder, and users are supposed to turn it into injectable liquid using sterile water.

The nature of the black market makes it unclear how many people are using it or experiencing side effects. There have been 50 adverse events involving retatrutide reported to the FDA so far this year, up from 10 in 2025. More than half were classified as serious, and one was linked to a death. This is likely to be a substantial underestimate-compounders aren't required to report adverse events, and doctors might not know their patients are using these drugs.

Grace Flower, a 46-year-old woman in Strongsville, Ohio, who works as a nanny, started taking retatrutide in early 2025 from an online supplier. Flower said she has lost roughly 95 pounds since starting the drug-though at times she has also combined it with another weight-loss drug.

She has also been to the emergency room three times since then. The first visit was after she decided to double her dose of another GLP-1 that she was taking at the same time as reta, leaving her unable to eat or drink and leading to dehydration. She also went to the ER for dizziness and a suspected transient ischemic attack, or mini-stroke, which she said doctors didn't believe to be connected to the retatrutide.

Flower said aside from the neurological symptoms, the pain in her knee has gone away since she started losing weight.

"It's helping in so many different ways," said Flower, the mother of two adult children. "My kids do tease me all the time, though, and say that it's going to kill me."

Ultimately, the dizziness didn't subside so she stopped the drug. She has been feeling better since. An Eli Lilly spokesman declined to comment on her case.

Chinese suppliers ship directly to patients like Flower and sell bulk packages to clinics like Enbody. When investigators inspected Enbody in 2025, they found ingredients imported from Chinese suppliers that weren't registered with the FDA, including a box labeled retatrutide, public records show.

In the three months before Enbody shut down, 1,308 patient visits were logged.

Ohio's laws allow the pharmacy board more power to crack down than most states. They can inspect without advance notice, and they have authority over medical spas and clinics, which isn't the case in most states.

The border continues to be a challenge, though. Retatrutide powders are slipping through U.S. customs in large boxes falsely labeled as consumer goods, like snacks or T-shirts, supply-chain experts said.

In March, U.S. Customs and Border Protection officers at the port of Cincinnati identified roughly 5,000 shipments of unapproved peptides, including retatrutide, shipped through large cartons. These boxes often contain pre-addressed shipments of peptides that are unpacked and sent directly to clinics or medspas. Millions of low-value shipments arrive at U.S. ports of entry each day, making it that much harder to trace.