‘Gas Station Heroin’ growing health concern in the U.S.

NATION — The rise in the use of tianeptine, a drug widely known as “gas station heroin,” has sparked a growing health concern across the United States. Marketed under various brand names such as Neptune’s Fix, Za Za Red, and Tianaa, this substance, which was originally developed as an antidepressant, is now increasingly being abused for its opioid-like effects.
Tianeptine is a synthetic drug that is legally sold in some countries as a prescription medication for treating depression. However, in the U.S., it is not approved by the Food and Drug Administration (FDA) and has been a subject of significant concern due to its potential for abuse, addiction, and serious health consequences. Despite this, it is readily available over the counter in many convenience stores, gas stations, and smoke shops, often disguised as a dietary supplement.
The FDA has been warning against the use of tianeptine since 2022, categorically stating that it does not meet the criteria for a dietary ingredient and is considered an unsafe food additive. This classification comes in the wake of reports that link the drug to severe health risks, akin to those associated with well-known opioids such as fentanyl and heroin. The primary danger of tianeptine lies in its ability to stimulate the same receptors in the brain as these potent opioids, leading to euphoric effects, addiction, and severe adverse reactions including slowed or stopped breathing, psychosis, seizures, kidney damage, and even death.
The health risks associated with tianeptine are compounded by the lack of regulation in its sale and manufacturing. As a product not approved by the FDA, tianeptine escapes the stringent quality controls imposed on pharmaceutical drugs. This means that products containing tianeptine may vary widely in their composition, including the possibility of containing harmful contaminants like heavy metals, or other undisclosed drug ingredients. This unpredictability in potency and composition significantly increases the risk of overdose and other adverse health effects.
Poison control centers across the nation have reported a noticeable uptick in calls related to tianeptine, often involving cases of dangerous side effects and withdrawal symptoms. The most common adverse reactions include agitation, confusion, addiction, drowsiness, nausea, vomiting, rapid heartbeat, and severe respiratory issues. Alarmingly, there have been several instances of overdose deaths attributed to tianeptine, which is often found in concentrations much higher than what would be considered therapeutically appropriate.
Despite the mounting evidence of its dangers, tianeptine remains accessible to the public under various guises. It is often marketed as a dietary supplement, a classification that allows it to circumvent the stringent regulatory requirements imposed on pharmaceuticals. This lack of regulation poses a significant challenge in controlling its distribution and use. The labeling of tianeptine products is frequently misleading, with some manufacturers highlighting their ‘natural’ composition, despite the fact that tianeptine is a synthetic, lab-produced drug with no natural ingredients. The misconception that ‘natural’ equates to ‘safe’ further exacerbates the problem, leading consumers to underestimate the potential risks of these products.
The challenges in regulating tianeptine are also evident in its varied nomenclature and forms. Consumers may encounter tianeptine under different names such as Coaxil, Pegasus, Red Dawn, Stablon, Tianaa, Tianna, and Za Za Red, and in different forms like powder and pills. This variety in branding and presentation adds to the difficulty in tracking and controlling its use. Furthermore, the lack of standardization in the manufacturing process means that even products from the same brand may contain inconsistent amounts of the active ingredient, making it difficult for users to gauge the safety of their consumption.
In response to the growing crisis, several states have taken the initiative to ban tianeptine. Alabama, Georgia, Indiana, Kentucky, Michigan, Mississippi, Ohio, and Tennessee have all prohibited the sale of tianeptine products. This state-level action reflects a growing recognition of the drug’s dangers and a proactive approach to mitigating its impact on public health. The bans represent a critical step in limiting access to tianeptine and reducing the potential for abuse and adverse health effects.
For individuals struggling with tianeptine dependence or addiction, there are resources available to assist in recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA) operates a helpline that offers confidential, 24-hour support for those seeking treatment and support options. This helpline is an essential resource for those impacted by opioid use disorders, including those related to tianeptine.
The issue of tianeptine overdose is a critical aspect of the broader opioid crisis. If an overdose is suspected, it is imperative to call 911 immediately. Naloxone (Narcan), an over-the-counter medication that can reverse opioid overdose, should be administered right away if available. Recognizing the signs of opioid overdose, such as blue lips or fingernails, gurgling noises, inability to wake up, limp body, pale or clammy skin, slow or stopped breathing, and vomiting, can be life-saving.
Healthcare professionals are increasingly concerned about athe widespread use of tianeptine and its impact on public health. The challenge lies not only in its addictive potential but also in the lack of awareness among consumers about the true nature of the drug. Many users are unaware that they are consuming a substance with effects similar to potent opioids. This ignorance is partly due to deceptive marketing strategies that promote tianeptine as a harmless supplement rather than a dangerous synthetic opioid. The healthcare community emphasizes the need for greater public education on the risks associated with tianeptine to prevent unintentional misuse and potential health hazards.
The role of healthcare providers is crucial in combating the tianeptine crisis. Physicians, psychiatrists, and other healthcare professionals are encouraged to inquire about supplement use during patient consultations. This practice is particularly important as some patients may not voluntarily disclose the use of over-the-counter supplements, including those containing tianeptine. By actively discussing supplement use, healthcare providers can identify potential risks and advise patients appropriately, thereby preventing adverse health outcomes associated with tianeptine use.
The issue of tianeptine abuse also highlights the broader challenge of regulating dietary supplements in the United States. The FDA’s limited authority over dietary supplements means that many such products, including those containing tianeptine, can reach consumers without adequate safety testing or approval. This regulatory gap poses a significant public health risk, as seen in the case of tianeptine. Advocates for public health are calling for stricter regulations and oversight of dietary supplements to ensure consumer safety and prevent the distribution of potentially harmful substances like tianeptine.
The rise in tianeptine use, known colloquially as “gas station heroin,” represents a significant public health concern. Its availability as a dietary supplement, despite its opioid-like effects, has led to increased cases of misuse, addiction, and severe health complications. The response to this crisis must involve a combination of regulatory action, public education, healthcare provider awareness, and broader efforts to address the underlying issues contributing to substance abuse in the United States.
— Jeremy Webb