An image shows weight loss drugs being smuggled in a pair of shoes.
The Friendship Bridge, connecting Brazil and Paraguay near the iconic Iguazu Falls, has long been a route for smugglersmoving cheap, illicit goods, like cigarettes and electronics. But in recent years, Brazilian authorities say smugglers have found a far more lucrative product: weight-loss drugs
As demand for GLP-1 based medications explodes in Brazil, seizures of unauthorized weight-loss drugs have soared along the Brazilian-Paraguay border. More than 76,000 pens,nd tirzepatide were seized at the border in the first half of 2026 — nearly three times the number confiscated during all of last year, according to data from Brazil’s Federal Revenue Service
The surge has turned weight-loss drugs into one of the most valuable categories of contraband seized in the region, as smugglers capitalize on soaring demand in Brazil and significantly lower prices across the border. Experts say the trade is increasingly attracting organized criminal groups because the products are highly profitable and relatively easy to transport
But health workers are warning of the adverse consequences of purchasing these drugs through an informal seller. Consumers may have no reliable way of knowing exactly what they are injecting into themselves
Yet the drugs now rank second in value among goods seized by Federal Revenue officials in the region encompassing the southern states of Paraná and Santa Catarina, behind only cell phones, according to federal tax auditor Flávio Bernardino de Carvalho
“They come on public buses, in cars, in trucks, with tourists. Every possible way,” Carvalho told CNN Brasil. “There’s organized crime and there are individuals. It’s very dispersed.”
At peak times, Brazilian authorities estimate more than 100,000 people and 45,000 vehicles cross the Friendship Bridge each day, creating an enormous challenge for customs officials trying to identify illicit cargo. For that reason, the bridge has long been one of South America’s busiest smuggling corridors
The provenance of the smuggled weight-loss jabs is often impossible to trace. Some are legally sold in Paraguay before being stolen from local pharmacies and smuggled across the border, while police have also uncovered clandestine operations producing counterfeit versions of the drug in the country
A shoe was used to smuggle the drugs.
Carlos Dure, Commissioner of the Tripartite Command, a police alliance between the authorities of Argentina, Brazil and Paraguay, which share a border in the area, told Organized Crime and Corruption Reporting Project that Chinese imports of the drug were also found
Mounjaro, the only authorized tirzepatide medication in Brazil, by American pharmaceutical Eli Lilly and Company, can cost upwards of 1,400 reais (about $280). In Paraguay, an ampoule of locally manufacturedtirzepatide sells for about 340 reais (about $68), according to Brazil’s Federal Revenue Service
Public security expert José Ricardo Bandeira told CNN Brasil that those economics are changing the incentives for criminal groups that have historically profited from cigarette smuggling
“Organized crime is migrating. There’s a logic to it,” Bandeira said. “Cigarette smuggling requires enormous logistics. You need trucks to transport the cigarettes and a series of measures to get the contraband into Brazil.”
The small size of weight-loss drugs makes logistics easier and significantly more cost effective. While a pack of cigarettes costs about 850 times less than a
“Because of their small size and high value, the pens are much more attractive,” Bandeira said. “With a few boxes of pens, you can make the same profit you would smuggling a truckload of cigarettes.”
Authorities say smugglers are also taking advantage of routes and infrastructure that already exist
“Organized crime has reach,” Bandeira said. “They share routes, storage centers. They use the same routes they use to smuggle weapons, drugs and ammunition.”
Smugglers have resorted to creative methods to conceal the products. Brazilian customs officers have found weight-loss drugs tucked beneath the soles of boots, stuffed inside shampoo bottles, hidden in containers of massage gel and stashed in secret compartments in cars
Other shipments bypass the bridge altogether,in which boats are used to transport cargo across the Paraná River that forms part of the border between Brazil and Paraguay
Those methods pose a problem beyond the illegality of the trade: Injectable GLP-1 medications require specific storage conditions
Dr. Alexandre Hohl, a professor of endocrinology and metabolism at the Federal University of Santa Catarina and a director of the Brazilian Association for the Study of Obesity and Metabolic Syndrome, has long advocated against the illicit use of medications
The Friendship Bridge spans over the Parana river along the border of Brazil, right, with Paraguay, left, Wednesday, Oct. 13, 2021.
“Whenever you look for medicine outside a pharmacy, you’re taking risks,” Hohl said
He explained that legitimate drugs pass through a carefully controlled supply chain before reaching patients. Drugs such as semaglutide and tirzepatide are peptides, molecules that require controlled conditions during transportation and storage. Those conditions are unlikely to be met when illicit products are carried across the border concealed in vehicles, shoes, or against a person’s body, he said
Hohl said peptide drugs can lose stability when exposed to temperatures above 30 degrees Celsius (86 degrees Fahrenheit) or below 0 degrees Celsius (32 degrees Fahrenheit)
The likely outcome of improper storage, he said, is reduced effectiveness — meaning consumers may pay less for a medication that ultimately does not work as intended
But the consequences can potentially be far more serious
Hohl said the greater concern involves products, which origins and contents cannot be verified. “We don’t know where it came from. They’re not originals,” he said. “They’re copies manufactured in places we also don’t know.”
Producing peptide medications is technically complex. If the manufacturing process isn’t properly controlled, Hohl said, impurities can remain in the final product
Nausea, constipation and diarrhea are among the known side effects of approved semaglutide and tirzepatide, he said. But symptoms that are persistent or unexpected should be taken seriously when the provenance of the drug is uncertain
Dr. Hohl told CNN he has attended to patients who reported abnormal side effects after taking smuggled
One of his patients ended up in intensive care after using a product sold as tirzepatide from Paraguay. The woman, who was at a normal weight and had purchased the drug without a prescription or medical indication, developed lactic acidosis, a potentially serious buildup of acid in the blood
In another case, Hohl had prescribed a patient an authorized version of tirzepatide, but after the first month, the patient switched to a product his father had bought in Paraguay. Soon afterward, he developed nausea, vomiting, diarrhea and sought medical treatment. Despite the symptoms, he continued using the Paraguayan product and even increased the dose, causing him to end up in emergency care
“Persistent nausea, abdominal pain, headache, skin reactions are some of the symptoms that I’ve seen,” he said, adding that adverse reactions can become difficult to predict with medication that is not carefully regulated and manufactured. “Immune system reactions, effects that we didn’t see when the original drug was studied, more severe side effects… those are things that could potentially happen.”
Online orders associated with GLP-1 medications increased 149.3% in Brazil during the first half of 2026, according to a survey by Serasa Experian, a private Brazilian data and credit services company that analyzed GLP-1 orders through its anti-fraud technology. Requests climbed from 547,249 in the previous six-month period to more than 1.36 million between January and June, representing more than 2.3 billion reais (about $460 million) in purchases
As demand increases for weight-loss drugs, Brazilian authorities are now stepping up cooperation with Paraguay in an effort to tackle the growing illicit market
The injectable drug Ozempic is shown Saturday, Dec. 30, 2023, in Houston.
Brazil’s health regulator Anvisa signed an agreement last Thursday with Paraguay’s National Directorate of Health Surveillance, or Dinavisa, to strengthen oversight along the border between the two countries
But the illicit market may already be moving beyond the current generation of weight-loss drugs
Hohl said one of his patients reported using a product sold as retatrutide, an experimental weight-loss drug being developed by Eli Lilly
Retatrutide has not been approved by the US Food and Drug Administration — or by any other regulatory agency in the world — and is legally available only to participants in Lilly-sponsored clinical trials. The company, which has reported positive results from several Phase 3 trials this year, says it plans to submit the drug to the FDA for approval in the first quarter of 2027
Yet products marketed as retatrutide are already being sold in Paraguay. Hohl said he has seen such products marketed in the country and has already encountered a patient in Brazil who told him she had used one
In Paraguay, advertisements for weight-loss medications are widespread in its second-largest city Ciudad del Este Semaglutide and tirzepatide can also be purchased there without the prescription required through Brazil’s regulated system
Carvalho, the federal tax auditor, said authorities are increasingly confronting not only physical smuggling routes but also online sales and social media, where sellers can advertise the products and users can exchange information about how to bring them across the border
For Brazilian health officials and doctors, that may be one of the most troubling aspects of the boom: The illicit market is moving almost as quickly as the pharmaceutical one
“Access is very easy,” Hohl said. “Today, you can buy it online. You can buy it anywhere. But people need to be careful about what they put in their bodies.”
See all topics
