CHARLESTON, SOUTH CAROLINA — South Carolina public-health officials sanctioned Charleston doctor Craig Koniver in 2024 for failing to maintain his Drug Enforcement Administration registration while prescribing controlled substances and for neglecting to check patient vital signs before administering ketamine. Koniver paid a ten-thousand-dollar fine and agreed not to administer ketamine or testosterone for one year.

Koniver, who trained in family medicine, had built a wellness clinic offering Botox treatments, skin fillers, and intravenous drips marketed as slowing aging. Some CrossFitters were among his patients, part of a fitness community in which members were injecting themselves with peptides — short chains of amino acids that act as signaling molecules in the body. Many of those peptides had not been officially approved for use as drugs and had not been studied in humans.

Koniver began ordering peptides from compounding pharmacies that produce custom medications. He experimented with various peptide doses extrapolated from animal studies and tested some on himself. The clinic's electronic ordering system allowed him to request unapproved peptides in custom combinations. He also offered patients a complimentary drip of methylene blue, a chemical dye marketed for improving longevity and memory. Methylene blue is a last-resort blood-pressure drug that, at high doses, constricts blood vessels and can cause gangrene.

In 2023, the U.S. Food and Drug Administration added nineteen peptides, including BPC-157, to a restricted-compounding list due to potential safety risks such as immune reactions, pancreatitis, and accelerated growth of cancerous cells. In response, Koniver began offering a peptide variant that differs by a single amino acid from those on the FDA's list. Federal efforts to control peptides placed him at odds with public-health agencies.

Koniver said he attributed the regulatory lapses to charting issues and that no patients were harmed. New York State ordered him to surrender his medical license in that state.

The human body produces thousands of peptides, which are fragments of proteins that send messages or regulate body systems in ways not fully understood by scientists. Researchers have known about some peptides for decades, and dozens have been developed as safe and effective drugs. The peptide hormone insulin, for example, transports sugar from the bloodstream into cells, while GLP-1, or glucagon-like peptide-1, stimulates the pancreas to release insulin and slows the passage of food through the gut. Certain peptides were reported to enhance strength, energy, endurance, and recovery.

U.S. imports of gray-market peptides and hormones from China roughly doubled last year. Health Canada has warned the public against injecting unauthorized drugs marketed for anti-aging, weight loss, or wellness. The College of Physicians & Surgeons of Alberta advised that unauthorized injectable peptides carry serious health risks. South Carolina public-health officials and the DEA did not provide comment for this report.