When semaglutide’s popularity exploded following FDA approval for weight management in 2021, so too did a wave of calls to poison control centers.
At the time, Jordan Miller ’25 was a UT San Antonio undergraduate student. She set out to discover if the spike in calls was a result of the U.S. Food & Drug Administration’s expanded approval or simply a coincidence.
Originally developed to treat type 2 diabetes, Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) became a cultural phenomenon after the FDA first approved them for chronic weight management in 2021. As sales soared, poison control centers across the country were also experiencing a massive increase in incoming calls — and there was a clear category that stood out.
“One of them was this quite odd category of semaglutide,” said David Han, Miller’s research mentor and Romo Endowed Professor in the UT San Antonio Department of Statistics & Data Science. “We suspected that the call volume was skyrocketing because of the misuse and mishandling of this drug and that it may be attributed to the FDA approval of this drug for weight management.”
Under Han’s guidance and supported by the Provost’s Undergraduate Research Fellowship, Miller and Long School of Medicine colleagues Robert S. Miller, Pharm.D, senior specialist in poison information, and Shawn M. Varney, MD, professor in the Department of Emergency Medicine and medical director of the South Texas Poison Center, studied the data.
Jordan Miller later presented the team’s findings at UT San Antonio’s Los Datos conference, where she took home first prize.
Prior to 2021, poison control centers nationally received roughly 1,000 to 1,500 cases per year. After mid-2021, these volumes nearly doubled, and by 2023 poison centers logged more than 8,000 GLP-1RA-related calls.
Most cases stemmed from unintentional dosing or therapeutic errors rather than deliberate misuse, but the UT San Antonio researchers found the massive increase jarring nonetheless.
“In that figure that tracks the increase by specific drug, I wasn’t expecting semaglutide to be so incredibly dominant,” Jordan Miller recalled. “I figured that it would lead the pack, but it was staggering. On the other hand, it makes sense with all the media attention.”
Han says the research is a living example of what data science is meant to do — moving beyond numbers and into the world.
“This work demonstrates the quantified impact of these drugs on public health,” he said. “Statistics, data science, analytics, machine learning and AI are meant to help people. We use them to transform data from any field into meaningful insight and informed action. Without that focus, it becomes hollow – numbers without real impact.”
The project by Miller, now a UT San Antonio graduate student in mathematics, began with a simple question she almost didn’t ask.
“You lose nothing by asking,” she said. “If you have a professor, you really get along with or admire, you lose nothing by asking them what they’re working on or if they have space for a research assistant. I got really lucky with Dr. Han saying, ‘I’m here to help — you pick what you want to work on.’”
Miller’s research confirmed that the FDA’s semaglutide approval was a clear inflection point. The volume and nature of calls before and after approval told two very different stories. The pool of people using GLP-1RA drugs to treat diabetes is one thing; the population now using them for weight loss is an entirely different scale.
“When the GLP-1[RA] drugs are being sold to diabetic patients, that’s a completely different story versus when the drug is used for weight management,” Han explained. “So, we had to quantify this evidence to show that it stemmed from the FDA approval and how to contain the risk. We need to better educate the public because how this drug behaves in our body and its long-term safety are not yet fully understood.”
The errors driving the spike in calls to poison control centers were, in many cases, preventable. Semaglutide is a weekly injection, not a daily one. Patients are also supposed to begin at a low dose before gradually increasing their use. Two of the most common mistakes were captured in the data. Patients were injecting daily instead of weekly, and they were starting at the full dose immediately.
“Can you imagine something you’re supposed to trickle up to, and you’re going full blast and seven times more often than you’re supposed to?” Jordan Miller said.
The solution, both Miller and Han agree, lies in education—from the prescriber’s office to the pharmacy counter.
The team’s research was featured as the cover story in Significance, a flagship magazine of the Royal Statistical Society and the American Statistical Association. It is also published in the Journal of Medical Toxicology, the official journal of the American College of Medical Toxicology.
Journal
Journal of Medical Toxicology