Over-the-Counter Opioid: The Dangers of Unregulated Tianeptine Use

Overdoses from tianeptine—also known as “gas station heroin”—are on the rise as the FDA calls for a crackdown.
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Tianeptine was developed decades ago to treat depression and anxiety, but today, this drug is earning a far more nefarious reputation as “gas station heroin.”

While this substance was intended to help, its accessibility and opioid-like high have fed an addiction epidemic spreading coast to coast. Sold openly under countless brands and formulations, tianeptine poses grave health risks, yet its use continues to proliferate in the regulatory abyss.

The Rise of Tianeptine Abuse

Tianeptine is an antidepressant sold under brands like Stablon and Coaxil. Though not approved for any medical use by the U.S. Food and Drug Administration (FDA), the drug is approved to treat depression and anxiety in other countries. Still, its use is limited due to inconsistent results and high abuse potential.

In the United States, tianeptine is often sold over the counter as a supplement. Its widespread availability at gas stations and convenience stores—where it is often sold in capsule form and used as an ingredient in energy drinks—has fueled misuse. Tianeptine provides euphoria and relieves opioid withdrawal.

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In January, the FDA warned about Neptune’s Fix drinks containing tianeptine, which is linked to seizures, unconsciousness, and death.

Similar to what’s happening with other “gas station drugs,” the increasing incidence of people experiencing harmful effects has brought attention to the use of tianeptine within the medical community, Dr. Nima Majlesi, director of medical toxicology at Staten Island University Hospital in New York, told The Epoch Times.

Recently, in Alabama, tianeptine was associated with 1,000 poison control calls and three deaths. “Those involved in the recent outbreak included teenagers who could legally buy tianeptine-containing drugs,” said Dr. Majlesi.

Deceptive Marketing and Legal Loopholes

Deceptive marketing exacerbates issues, touting improved mood, energy, and sexual performance as well as cognitive benefits, Dr. Majlesi said. Worse, companies making the drug exploit the opioid crisis, he added.

“The manufacturers have even gone so far as to claim that they can reduce the symptoms of opioid withdrawal,” Dr. Majlesi noted.

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Though not banned, the FDA advises avoiding tianeptine. Several states have prohibited or restricted sales due to mounting misuse. Still, legality implies safety to many buyers, Dr. Majlesi added. “Many people have purchased these drugs under the assumption that they are safe simply because they are legal to buy in stores.”

Manufacturers evade bans by tweaking chemical structures or mislabeling. Lack of oversight also allows erratic dosing, heightening toxicity risks.

“Other methods to avoid removal from the market include labeling the products’ not for human consumption’ and smuggling the products into the country as misbranded imports,” Dr. Majlesi said.

Health Dangers of Tianeptine Abuse

Despite its reputation as a “legal high,” tianeptine abuse poses the following serious health risks:
  • Addiction: With prolonged, high-dose use, tianeptine can cause physical dependence and addiction. Users build tolerance, requiring more for desired effects, thus increasing overdose and withdrawal risks. Its opioid-like potential for abuse is how it earned the nickname “gas station heroin,” Dr. Majlesi said.
  • Heart problems: Tianeptine abuse has been tied to hypertension, rapid heart rate, and heart attacks. All of these are especially dangerous for those with preexisting conditions.
  • Psychiatric symptoms: Chronic abuse may trigger or worsen psychiatric disorders like anxiety, depression, and psychosis. Stopping suddenly can also cause withdrawal symptoms, including agitation, insomnia, and dysphoria.
  • Death: Tianeptine overdose can lead to respiratory depression, seizures, coma, and even death. Risk heightens when combined with other depressants like alcohol or opioids.
Safer opioid withdrawal treatments exist, so tianeptine products should be avoided, Dr. Majlesi said. Given its high abuse potential, tianeptine warrants tight regulation and medical oversight to prevent misuse, addiction, and harm, he added.

Tianeptine and the Opioid Crisis

Tianeptine is contributing to the opioid crisis, which impacts nearly 3 million people aged 12 and above in the United States.

“Exposure to these types of substances increases the risk of opioid use disorder developing,” Dr. Majlesi said. “People who need treatment should seek out a provider who can prescribe buprenorphine.” Additionally, supervised methadone use is a safer alternative.

In support of the FDA’s efforts to restrict tianeptine distribution, the U.S. Department of Justice, in collaboration with the FDA’s Office of Criminal Investigations and the U.S. Postal Inspection Service, is taking enforcement actions against individuals and entities distributing tianeptine-containing products.

Although tianeptine is banned in only 12 states, according to the FDA, it remains readily accessible by traveling to states where it is legally available.

George Citroner
George Citroner
Author
George Citroner reports on health and medicine, covering topics that include cancer, infectious diseases, and neurodegenerative conditions. He was awarded the Media Orthopaedic Reporting Excellence (MORE) award in 2020 for a story on osteoporosis risk in men.
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