If you’ve never heard of tianeptine, a.k.a. gas station heroin, you’re not alone.
It’s one of a new breed of substances readily available through various retail sources – like gas stations. They’re commonly sold as dietary supplements marketed to improve mood, enhance mental clarity, reduce anxiety, or induce effects common to recreational drugs like cannabis and others.
One substance that’s reached national notoriety is tianeptine. Here’s the basic information on tianeptine:
- It’s an antidepressant medication approved for the treatment of major depressive disorder in several European, Asian, and Latin American countries
- In countries where it’s approved for medical use, brand names include Coaxil, Stablon, and Tatinol
- It’s classified as an atypical tricyclic antidepressant
- It may also help people with anxiety and irritable bowel syndrome (IBS)
- Tianeptine is not approved by the U.S. Food and Drug Administration for any use, medical or otherwise
- Tianeptine is an opioid receptor agonist
Currently, tianeptine is banned in the following states:
- Alabama
- Florida
- Georgia
- Indiana
- Kentucky
- Michigan
- Mississippi
- Ohio
- Tennessee
There are several reasons tianeptine is on our radar now. News reports like this one and this one discuss the potential dangers and increasing frequency of serious medical problems associated with tianeptine. Before we go further, the reason it’s possible to buy the substance at all is that it’s not sold as a medication – and therefore doesn’t need FDA approval – and it’s not classified as a controlled substance, which means the Drug Enforcement Agency (DEA) has no role in policing its sale – yet.
Lawmakers Urge FDA to Address the Tianeptine Problem
First of all, we need to define the problem.
A report from the Centers for Disease Control (CDC) describes an increase in complications surrounding tianeptine. From 2000-2013, the report indicates, the National Poison Data System (NPDS) recorded a total of 11 calls for tianeptine exposure. From 2013-2017, they recorded a total of 207 calls for tianeptine exposure, with five (5) calls in 2014 rising to 81 in 2017, an increase of 1,520 percent.
The problems associated with tianeptine revolve around the adverse side effects of taking the drug and the negative consequences of discontinuing use of the drug. In a letter to the FDA, five members of the U.S. House of Representatives outlined the issues they see with tianeptine. Rep. Jeff Jackson of North Carolina, the chief author of the letter, included the following warnings:
“Recent reporting indicates that tianeptine is extremely addictive and that tianeptine withdrawal symptoms are strikingly similar to opioid withdrawal symptoms, including nausea, chills, and insomnia. Recent medical research indicates that tianeptine can cause fatal overdoses.”
That’s the problem in a nutshell: addiction, withdrawal, and complications up to and including death. In addition, reports include people in treatment for opioid use disorder (OUD) taking tianeptine because they believed it was safe. However, many quickly experienced negative consequences, such as addiction, coupled with extreme difficulties discontinuing use. An individual interviewed in an article in Consumer Reports magazine describes quitting tianeptine:
“Withdrawal and detox [were] 10 times more severe than any opiate withdrawal.”
In the same article, the Director of the Alabama Poison Control Center, Dr. William Rushton, states:
“Very few of the patients I have encountered are starting tianeptine to get a recreational high but rather are truly trying to help themselves under a mistaken concept of its safety.”
Whether people take the tianeptine for a recreational high or to help themselves in some way is immaterial when we consider the consequences, which are serious. Let’s take a closer look at the negative effects associated with tianeptine, and learn why tianeptine earned the nickname gas station heroin.
Tianeptine: The Details
The article “Tianeptine, an Antidepressant with Opioid Agonist Effects: Pharmacology and Abuse Potential, a Narrative Review” offers a comprehensive review of the important facts about tianeptine. We’ll preface the information from that review by reiterating that tianeptine is an opioid receptor agonist, meaning it binds – or attaches – to the same receptors in the brain as opioids, and causes some of the same effects.
That’s where the nickname gas station heroin comes from.
With that said, the effects of tianeptine include:
The effects of tianeptine include:
- Euphoria
- Sedation
- Muscle relaxation
- Stimulation
Common side effects of tianeptine include:
- Headache
- Dry mouth
- Dizziness
- Constipation
- Nightmares
- Stomach problems
Less common side effects include:
- Muscle pain
- Tremors
- Seizures
- Hot flashes
- Blurred vision
- Painful urination
- Cardiovascular complications
Tolerance to the effects of tianeptine occurs rapidly, which can cause recreational users to escalate the frequency and dosage of tianeptine. Since most users are completely unaware that tianeptine is an opioid receptor agonist, they’re also completely unaware that discontinuing use can lead to a withdrawal syndrome similar to opioid withdrawal syndrome (OWS).
Signs of tianeptine withdrawal include:
- Agitation
- Nausea
- Vomiting
- Elevated heart rate
- Diarrhea
- Insomnia
- Suicidal thoughts
- Depression
- Confusion
- Sweating
- Depressed breathing
- Restless legs
- Cold and flu-like symptoms
As we mention in the introduction to this article, tianeptine joins other substances that tiptoe around rules established by the FDA and the Drug Enforcement Agency (DEA). It’s possible to buy tianeptine at sold at retail stores such as:
- Gas stations
- Corner stores
- Bodegas
- Mini marts
- Smoke shops
- Online
Note: We have nothing against corner stores, gas stations, minimarts, or bodegas. Here, we join the chorus of health providers who encourage them to take dangerous products – like tianeptine – off the shelves, and be careful about new products that make any kind of health claims.
How Do I Recognize a Product That Contains Tianeptine?
Companies market products containing tianeptine as dietary supplements, brain enhancers, energy supplements, mood enhancers, appetite suppressors, or pain relievers. Other products considered gas station drugs include:
- Kratom
- Spice
- ISO (isopropyl nitrate)
- K2 (synthetic cannabis)
- Phrenze Red
- Delta 8 Gummies
In many cases, manufacturers design these drugs in both legal and illegal laboratories/factories. Despite the advertising language on their labels, casual outside observers are likely to conclude the purpose of these products is to create subjective effects similar to common substances of misuse/disordered use/addiction, including substances such as cannabis, cocaine, amphetamine, opioids, and others. However, if we take the manufacturers and many users at face value, the purpose of these drugs is to gain some sort of perceived benefit, such as relaxation, mental clarity, or stress relief.
It’s possible to find tianeptine sold under the following names:
- Zaza
- Zaza Red
- Tianna Red
- Neptune’s Fix
- Red Dawn
- Pegasus
Based on the data on the addictive properties of tianeptine and the potential for serious side effects and a difficult withdrawal, we encourage anyone interested in taking the substance to have a detailed discussion with a physician, psychiatrist, or qualified health care provider before initiating use. Ask a provider why it’s tianeptine is called “gas station heroin.”
Research on Tianeptine, a.k.a. Gas Station Heroin: Why Do People Use It?
Because of its position as an unregulated supplement, verified quantifiable data on tianeptine in the U.S. population is scarce. However, one group of researchers analyzed posts from online forums and social media sites to gather information on tianeptine.
Here’s what they found:
- People who use tianeptine were likely to engage in polysubstance use (taking more than one drug at a time)
- Most people who use tianeptine considered the drug an opioid/opiate
Tianeptine users cited the following reasons for taking the substance:
- Improve mood
- Increase energy
- Increase productivity
- Improve focus/clarity
- Pain relief
- Reduce anxiety
- Prevent opioid withdrawal
- As a buprenorphine substitute
- Enhance effects of cannabis, kratom, and/or amphetamines
- Enhance libido
The Mayo Clinic offers this brief, accurate summary of our knowledge of tianeptine:
“While tianeptine may help treat depression, anxiety and irritable bowel syndrome, the risks often outweigh the benefits. Tianeptine can have ill effects and can even lead to death.”
We agree wholeheartedly. Our review of the evidence indicates the risks far outweigh the benefits. And although we cannot give medical advice in this context, our message is simple. We encourage people to listen to the experts at the CDC and the Mayo Clinic, and make a rational, informed decision on any substances they choose to ingest.
Tianeptine, Dietary Supplements, Gas Station Heroin: Takeaways
We encourage anyone experiencing mental health challenges to seek support from a qualified mental health professional. For people with opioid use disorder (OUD) seeking addiction support with a medication for opioid use disorder (MOUD) – which some users cite as a reason for taking tianeptine – we advise avoiding any substance that’s not approved as a medication by the FDA for that purpose, avoiding any substance or medication with no evidence base for treating SUD, and avoiding any substance the FDA – and reputable sources of medical information, like the CDC and the Mayo Clinic – warns can increase likelihood of serious complications, up to and including death.
In other words, if you need help or support for a physical, mental health, addiction-related, or emotional issue, please go to the doctor, not the gas station. We understand the desire to handle problems independently, but in this case, all the available evidence shows that tianeptine has a negative, rather than positive, effect on overall health and wellbeing.
Finding Help: Online Resources
If you, a friend, or loved one needs support discontinuing tianeptine use, or needs support for substance use disorder (SUD), alcohol use disorder (AUD), and/or opioid use disorder (OUD), please call us at Pinnacle Treatment Centers.
You can also use these free treatment locators:
- The National Institute on Drug Abuse (NIDA) Treatment and Recovery Page
- The Substance Abuse and Mental Health Services (SAMHSA) Find Help Page
- U.S. Department of Health & Human Services Search for Treatment Page
Remember: the sooner a person who needs treatment for SUD receives treatment for SUD, the better the outcome.