WASHINGTON – Health officials are urging consumers to think carefully before buying those small, colorful bottles you often see at gas stations, convenience stores, and smoke shops.
Commonly referred to as “gas station heroin,” these products are marketed as energy shots or cognitive supplements but actually contain tianeptine, an unapproved and highly addictive substance known for its severe side effects.
The U.S. Toxicology Control Center has noticed a consistent uptick in related calls over the past ten years. Just last month, the Food and Drug Administration issued a warning to healthcare providers about the significant risks posed by these products.
So, what exactly should you know about gas station heroin?
How are these products sold in the US?
Tianeptine is formally recognized as an antidepressant and is typically prescribed as a low-dose tablet taken three times daily. However, it has never received FDA approval for any medical purposes in the U.S.
Moreover, it’s illegal to put tianeptine into food or beverages, and it cannot be sold as a dietary supplement. The FDA has repeatedly cautioned companies about this. Still, some businesses operate in the shadows, marketing tianeptine under names like Zaza, Teana, Pegasus, and TD Red. The FDA doesn’t proactively inspect these products for ingredients prior to sale.
“This area of consumer products, or supplements, exists in a gray zone, where contents aren’t scrutinized or tested as they would be for pharmaceutical drugs,” explains Dr. Diane Carrero from the New Jersey Poison Information and Education System.
Last year, Callello and colleagues published findings on a string of emergency calls in New Jersey connected to a flavored elixir known as Neptune’s Fix. Individuals who consumed it experienced severe symptoms including pain, rapid heartbeat, and even seizures. Out of 20 patients, more than half required hospitalization for intensive care.
Why use these products?
Many tianeptine products claim they can address medical issues like addiction, pain, and depression — claims that lack solid evidence or FDA approval.
In 2018, the FDA issued a warning to the makers of a product called Tianna, which claimed to be a “unparalleled solution to cravings for opiates.”
Though tianeptine is not classified as an opioid, it can trigger similar receptors in the brain, producing temporary effects akin to those of opioids like oxycodone. Tianeptine also presents risks typically associated with opioids, including potentially fatal breathing suppression.
“We’ve encountered numerous cases connected to these products,” says Dr. Hannah Hayes from National Children’s Hospital in Columbus, Ohio. “Many use it for its opioid-like effects to ease withdrawal, which can lead to issues like slow breathing.”
For individuals grappling with opioid addiction, pain, depression, anxiety, or similar conditions, Hayes advises consulting a healthcare professional for FDA-approved treatments.
Is tianeptine use rising?
While it’s unclear, data suggest a significant rise in emergency calls involving this substance.
An analysis published this year revealed a staggering 525% increase in calls to poison control centers from 2018 to 2023; in roughly 40% of these instances, medical assistance was necessary.
One reason behind this surge may simply be an increase in the consumer base.
However, experts also argue that as these products become stronger and more hazardous, they spark more emergencies. Researchers in New Jersey have found that some of these elixirs contain not just tianeptine but also synthetic cannabis and other substances.
“You really have no way of knowing what’s in that bottle,” warns Carrero. “It’s crucial for people to understand that even if they’ve used these products before, they might end up with something entirely different in whatever bottle they pick up.”
Are there any policies that can reduce the use of tianeptine?
Tianeptine isn’t listed among the federal controlled substances that ban or limit drugs without medical use, like heroin or LSD. Nevertheless, around 12 states have enacted laws to restrict or ban tianeptine, including Alabama, Georgia, Michigan, Minnesota, Ohio, and Tennessee.
In some cases, these regulations have led to increased withdrawal symptoms among users, which is a testament to its addictive nature. However, state-level data indicates some success in mitigating drug-related harm.
Interestingly, Alabama recently had the highest rate of tianeptine-related emergency calls in the Southern U.S., with calls spiking by over 1,400% between 2018 and 2021.
