Understand the Risks Associated with 'Black Market Heroin Sold at Gas Stations'

Walking into a Gas Station Convenience Store May Not Be as Safe as You Think

In most states, there's a hidden danger lurking on the shelves that you might not expect to find: "gas station heroin." This addictive drug, known as tianeptine, can be found in various so-called supplements marked as dietary products, and anyone, including minors, can buy it.

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Tianeptine, named for its hazardous resemblance to heroin, is an opioid with dangerous consequences. The U.S. Food and Drug Administration (FDA) advises consumers to avoid any product containing tianeptine[2]. Yet, it can still be found in stores, marketed as an antidepressant[1].

"People should know that, despite its marketing as an antidepressant, tianeptine isn't really concerned with improving mood," explains addiction psychiatrist Akhil Anand, MD[1]. "Rather, it binds directly to the brain's opioid receptors, much like heroin or morphine."

Origins of tianeptine

Developed in France in the 1960s, tianeptine was initially believed to be an effective antidepressant. However, it soon became clear that the drug was highly addictive. It wasn't long before addicts began visiting multiple doctors for more prescriptions and experiencing withdrawal symptoms when abruptly stopping its use[1].

Providers in Europe can still legally prescribe tianeptine as a controlled substance. However, in the U.S., the FDA has never approved tianeptine for any medical use[1]. Additionally, the drug has never earned a Generally Recognized as Safe (GRAS) designation, which is given to some chemicals and food additives by the FDA[1].

The FDA's reluctance to approve tianeptine stems from its addictive nature and lack of demonstrated effectiveness. Instead, some companies have exploited a legal loophole, enabling them to sell tianeptine as an unregulated dietary supplement.

Tianeptine products appear in various so-called supplements, frequently found at gas stations and convenience stores. Some of these supplements are marketed as nootropics and health-enhancing products, while others make claims to treat conditions like asthma, pain, anxiety, and opioid use disorder[1].

However, Dr. Anand warns that these supplements are not subject to the same scrutiny as other medicines and may contain additional harmful ingredients. "Without proper FDA oversight, there's no guarantee that these products contain consistent amounts of tianeptine or even what other substances they might include," he cautions[1].

Dangers of tianeptine use

Poison control centers have seen a sharp increase in tianeptine-related calls. These calls have often involved dangerous side effects and withdrawal, leading to several deaths from overdose[3].

In February 2024, the U.S. Centers for Disease Control and Prevention (CDC) published a report on 20 cases of tianeptine use that led to the need for medical care in New Jersey[3]. Thirteen of those individuals required admission to an intensive care unit, and while no deaths occurred in this case, the potential for further fatalities remains high.

Some of the most common side effects of tianeptine use include agitation, confusion, dependence (addiction), drowsiness, nausea and vomiting, rapid heartbeat, slowed or stopped breathing, and sweating[3]. In addition, Dr. Anand states that many of the commercial tianeptine products contain ten times the normal therapeutic dose, which can lead to severe adverse events, particularly when the products contain unknown ingredients[1].

Banned in Some States

Despite the dangers associated with tianeptine, it remains readily available in most parts of the country. However, some states have begun to take steps to ban its sale:

Alabama.
Florida.
Georgia.
Indiana.
Kentucky.
Michigan.
Mississippi.
Ohio.
Tennessee.

Dr. Anand urges further action to eradicate this hidden danger. "More people are becoming aware of the dangers of tianeptine, and my hope is that all states will eventually ban it," he says[1]. "There's no reason for people to take it when we have safer and more effective treatments available for mood and anxiety."

Addressing Opioid Use Disorder

If you or someone you know is experiencing dependence on tianeptine or any other opioids, help is available. You can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) Helpline at 1.800.662.HELP (4357). This free, confidential service is available 24 hours a day and can help you find local treatment and support options.

In the event of an opioid overdose—tianeptine or otherwise—call 911 immediately. If you have Narcan® (naloxone), administer it right away. This over-the-counter nasal spray can reverse opioid overdose effects. Signs of opioid overdose include blue lips or fingernails, gurgling noises, unconsciousness, a limp body, pale or clammy skin, slowed or stopped breathing, and vomiting[3].

Lastly, Dr. Anand advises communicating with your primary care provider about supplements. He reminds patients that supplements, including vitamins, herbs, and nootropics, can sometimes pose hidden risks. "Whenever you're trying a supplement, always talk to your family doctor or psychiatrist first," he says[1]. "There have been cases of individuals taking supplements with good intentions, only to encounter serious complications."

[1] Tianeptine: An Increasingly Popular, But Dangerous Dietary Supplement. https://clevelandclinicmeded.com/medication-management/psychiatry/treatment-guideline/tianeptine-gas-station-heroin-and-other-names/[2] FDA Issues Strong Warning Regarding Weight Loss and Sexual Enhancement Substances Sold as Dietary Supplements. https://www.fda.gov/consumers/consumer-updates/fda-issues-strong-warning-regarding-weight-loss-and-sexual-enhancement-substances-sold-dietary[3] Tianeptine Exposure—A Multi-poison Center Analysis. https://emergencymedicinepediatrics.com/2021/03/10/tianeptine-exposure-a-multi-poison-center-analysis/[4] H.R.3520: Tianeptine Control Act of 2023. https://www.govtrack.us/congress/bills/118/hr3520/[5] Tianeptine: A Case Report and Review of the Literature. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652825/

The dangers associated with the use of tianeptine, marketed as dietary supplements and often found in gas stations, raise concerns about health and wellness, particularly mental health and nutrition.
Despite its marketing as an antidepressant, tianeptine, a hidden danger found in convenience stores across many states, is not concerned with improving mood but rather binds directly to the brain's opioid receptors, leading to addiction and other health risks.
The FDA acknowledges the addictive nature and lack of demonstrated effectiveness of tianeptine, yet some companies sell it as an unregulated dietary supplement, possibly containing additional harmful ingredients, making health and safety a significant concern.
Considering the dangerous side effects and withdrawal symptoms associated with tianeptine use, which can lead to overdose and even death, it is crucial for mental health, healthcare providers, and government bodies to address this issue and prioritize the overall health and wellness of individuals.