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The answer: largely through compounding pharmacies and gray-market suppliers

Gross JB Jr, Ludwig J, Wiesner RH, McCall JT, LaRusso NF

BPC-157 administration in rat models of mesenteric artery ligation has been shown to restore NO bioavailability in ischemic tissue beds within timeframes as short as 30 minutes post-administration, an effect blocked by pre-treatment with L-NAME (a non-selective NOS inhibitor), confirming the NO-dependent mechanism

Cai Y, Fleming C, Yan J

Research chemicals are intended solely for laboratory experimentation and/or in-vitro testing

In models of NO-system disruption, BPC-157 appeared to rescue vascular and wound-healing responses