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WASHINGTON (AP) — Health officials want you to think carefully before purchasing one of the small, brightly colored bottles that are often sold at gas stations, convenience stores and smoke stores.
Sometimes called “gas station heroin,” the product is usually sold as an energy shot or cognitive supplement, but actually contains tianeptin, an unapproved drug that is addictive and has the risk of serious side effects.
The U.S. Toxicology Control Center has reported a steady increase in calls related to the drug for over a decade. And last month, the Food and Drug Administration sent a warning to healthcare professionals about “the underlying danger or the size of these products.”
Here’s what you need to know about gas station heroin:
How are these products sold in the US?
Thianeptin is usually approved as an antidepressant, as a low-dose tablet, usually taken three times a day. However, it has never been approved by the FDA for any medical condition in the US
Furthermore, the drug cannot be legally added to foods or drinks, nor can it be sold as a dietary supplement. This is what the FDA has repeatedly warned US companies.
Still, companies under the radar often sell cyaneptine in a variety of formulas with brand names such as Zaza, Teana, Pegasus, and TD Red. Although it is technically illegal, the FDA does not use any ingredients added to supplements or drinks in advance.
“This is like this grey area of consumer products, or supplements, where the contents are not regulated or tested in a way that is drug therapy,” says Dr. Diane Carrero of New Jersey Poison Information and Education System.
Last year, Callello and her colleagues published a study documenting a cluster of emergency calls in New Jersey tied to a flavoured elixir called Neptune’s Fix. People experienced pain, rapid heartbeat, hypotension and seizures after drinking it. Of the 20 patients, more than 12 had to be admitted to hospital for intensive care.
Why use these products?
Many tianeptine products claim that they can help users treat medical conditions such as addiction, pain, depression, and other diseases – without evidence or FDA approval.
In 2018, the FDA issued a warning letter to the manufacturer of a product called Tianna. It claimed to provide a “unparalleled solution to the cravings for opiates.”
Thianeptin is not an opioid, but drugs can bind to some of the same receptors in the brain and produce temporary effects similar to oxycodone and other opioids. Thianeptin also carries some of the same physiological risks of opioids, including the potential for dangerous inhibition of breathing.
“We’ve seen a lot of people who have had a lot of trouble with us,” said Hannah Hayes, PhD, of National Children’s Hospital in Columbus, Ohio. “They use it for opioid-like effects and for withdrawal of self-treatment opioids. It can lead to slow breathing and such problems.”
Those who deal with opioid addiction, pain, depression, anxiety and other conditions should see a healthcare professional to get a prescription for FDA-approved treatments, Hayes said.
Is tianeptine use rising?
Experts aren’t sure, but national figures show a massive increase in emergency calls that include the drug.
According to data analysis published earlier this year, calls to the poison control centres rose by 525% between 2018 and 2023. In about 40% of cases, the person had to seek medical care.
One explanation for the increase in call is simply that more Americans are using the product.
However, experts also say that as the product becomes more powerful and dangerous, the more emergency it causes. And researchers from New Jersey who analyzed Neptune’s modifications discovered that liquids also contain synthetic cannabis and other drugs.
“You have no idea what’s in that bottle,” Carrero said. “It’s important for people to know that even if people have used products before, they can still get a bottle that contains something very different than what they’re looking for.”
Are there any policies that can reduce the use of tianeptine?
Thianeptin is not included in the federal controlled substances law that prohibits or restricts drugs that are free of medical use, such as heroin, LSD, or PCP, or are likely to be abused. However, around 12 states have passed laws banning or restricting cyaneptine, including Alabama, Georgia, Michigan, Minnesota, Ohio and Tennessee.
In some cases, these laws have resulted in more cases of withdrawal among users of cyaneptine. This is chemically addictive. However, state data shows some success in reducing drug-related harm.
Until recently, Alabama had the highest tianeptin-related call rate in the Southern United States, increasing by more than 1,400% between 2018 and 2021.
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The Associated Press School of Health Sciences is supported by the Howard Hughes Medical Institution’s Science and Education Media Group and the Robert Wood Johnson Foundation. AP is solely responsible for all content.
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