When you walk into a gas station or convenience store, you don’t expect to find an addictive drug on the shelf. But in most states, you might. And you wouldn’t even know it from looking at the package.
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This drug, known as tianeptine or “gas station heroin,” is an opioid, like heroin and morphine. And like other opioids, it’s addictive and potentially deadly. Yet it can be found on store shelves, labeled as a dietary supplement, and anyone can walk in and buy it — including minors.
Addiction psychiatrist Akhil Anand, MD, explains the facts about this dangerous substance.
Gas station heroin, or tianeptine, is an antidepressant that was developed in France in the 1960s. It doesn’t contain heroin, but it earned the nickname for its similar effects on the brain.
“When tianeptine was first discovered, it was believed to be an effective tetracyclic antidepressant,” Dr. Anand says. “But tianeptine doesn’t really improve mood like other antidepressants. It enhances a person’s mood by binding to the brain’s opioid receptors — just like heroin, morphine and other narcotics. Experts quickly discovered that it was highly addictive, as patients began doctor-shopping for more and were developing withdrawals after abruptly stopping it.”
Providers in Europe can still legally prescribe tianeptine, but only as a controlled substance.
“Newer medications are safer and more effective than tianeptine,” Dr. Anand adds.
The U.S. Food and Drug Administration (FDA) has never approved tianeptine to treat depression or any other condition. Tianeptine also never earned a Generally Recognized as Safe (GRAS) designation, a label the FDA puts on some chemicals and food additives.
But some companies found a legal loophole that allowed them to put tianeptine in products labeled as “dietary supplements.” That’s why you can still find it on store shelves today.
Tianeptine appears in various so-called supplements, often those sold at convenience stores and gas stations.
“Tianeptine supplements are sometimes labeled as a ‘nootropic,’ claiming to boost brain function,” Dr. Anand notes, “or they might say they treat asthma, pain, opioid use disorder or anxiety. But it’s not safe or effective for any of these uses.”
You also can’t be sure what’s actually in tianeptine products.
“These supplements aren’t subject to the same FDA regulations as other pharmaceutical medications,” Dr. Anand warns. “There could be other dangerous ingredients, and its potency isn’t regulated. We just don’t know.”
And don’t let the claims on any supplement label fool you.
“Tianeptine is a pharmaceutical drug that is synthesized in a lab,” he says. “There’s nothing natural about it.” And the word “natural” doesn’t necessarily mean safe, anyway.
Poison control centers have noted an uptick in tianeptine-related calls in the last several years. Many of these calls are due to dangerous side effects and withdrawal, and several people have died from tianeptine overdose.
Side effects of tianeptine include:
“A lot of these commercial tianeptine products contain 100 times the normal therapeutic dose, and because it’s not regulated, people are unknowingly taking high doses that can lead to dangerous side effects,” Dr. Anand explains.
Tianeptine goes by many different names, so read your labels carefully before you take any supplement. Look for “tianeptine,” “tianeptine sodium” or “tianeptine sulfate” listed in the ingredients or supplement facts. And it comes in both powder and pill form.
Common names for tianeptine products include:
The FDA doesn’t strictly regulate dietary supplements or approve them before they’re sold. But they have tracked down and sent warning letters to companies that sell tianeptine products. And some states have banned tianeptine, including:
“More people are becoming aware of the dangers of tianeptine, and my hope is that all states will ban it,” Dr. Anand reflects. “There’s no reason for people to take it. We have safe and effective treatments for mood and anxiety.”
If you’re experiencing dependence on tianeptine or other opioids, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline at 1.800.662.HELP (4357). This is a free, confidential, 24-hour service that can help you find local treatment and support options.
If you or a loved one is overdosing on tianeptine or another opioid, call 911 immediately. If you have Narcan® (naloxone), administer it right away. This nasal spray is available over the counter and can reverse opioid overdose.
Signs of opioid overdose include:
Tell your primary care provider about any supplements you take, including vitamins, nootropics and herbs. Certain supplements could be unsafe for you.
“Whenever you’re trying any online product, please first talk to your family doctor or psychiatrist,” Dr. Anand advises. “I’ve seen patients take supplements with good intentions but end up having serious complications.”