Yet another dangerous substance is raising concern in the public health community.

Earlier this year, the Centers for Disease Control and Prevention sounded the alarm on products containing tianeptine, linking them to several severe illnesses. Ominously nicknamed “gas station heroin,” this substance can be found in smoke shops, convenience stores, and online, and it has been growing in popularity in recent years.  

And with growing popularity comes growing danger. The Food and Drug Administration (FDA) reported that poison control center cases involving tianeptine jumped from 11 total from 2000 to 2013 to more than 150 cases in 2020 alone. Consumer Reports used FDA data to find at least four individuals who died after using the drug.  

What is tianeptine?  

Tianeptine is an antidepressant, approved for medical use in many countries (though not in the United States). It increases production of serotonin and dopamine, two neurochemicals related to happiness and mood. Users say it creates feelings of euphoria and relaxation, alleviates pain, and can improve mental clarity.  

Tianeptine is mainly consumed in two forms when used recreationally: as a liquid and as pills. Several brands sell the substance, including Neptune’s Fix, Tianaa and ZaZa.  

Additionally, the FDA found synthetic cannabinoids, human-made chemicals that mimic the psychoactive chemicals in cannabis and can result in serious side effects, in some bottles of Neptune’s Fix. 

Is tianeptine legal?  

Like many other substances, tianeptine exists in a legal gray area. The FDA cautions consumers against using it and has issued warnings to some companies that sell tianeptine products. Additionally, federal legislation was introduced in February 2024 that would designate tianeptine a Schedule III substance, making it illegal to sell without a prescription. Tianeptine is banned in some states, but not in Virginia. 

Tianeptine’s current categorization as a dietary supplement rather than a drug makes it difficult to enforce regulations or restrictions, and it remains widely available. That is also why it’s easy for kids and teens to access – unlike alcohol, tobacco, and controlled substances, it has no minimum age requirement.  

Is tianeptine dangerous?  

The potential effects and dangers of recreational tianeptine use are still being researched. However, the drug has been linked to severe illness, painful side effects, and even death. Risks include seizures, nausea and vomiting, irregular heartbeat and cardiac events, and loss of consciousness.  

Recreational users of tianeptine report painful withdrawals with symptoms similar to opioid withdrawal, such as nausea, chills, insomnia, and agitation.  

Tianeptine also poses high potential for misuse. It binds to the brain’s opioid receptors, meaning it has similar behavior and effects as substances like heroin and fentanyl. That means tianeptine users can easily develop dependencies, especially those with a history of or predisposition to substance use disorder.  

While tianeptine can be used safely and effectively to treat depression (not in the US), recreational users take exponentially higher doses of the substance than what would be prescribed.  A tianeptine prescription typically would have a user take about 38 milligrams per day, while over-the-counter tianeptine products found in the states have upwards of 150 milligrams in a single capsule. Many over-the-counter tianeptine products don’t list the dosage, so users may not even know how much they are taking.  

Are youth at risk? 

The uncontrolled dosage of recreational tianeptine points to another major danger of these products. Since tianeptine is unregulated, there is no way for users to know exactly what they are consuming or in what quantities.  

Tianeptine’s true danger lies in its accessibility. Its designation as a “supplement,” over-the-counter availability, and lack of an age restriction all make it easy for children and teens to buy, putting youth at risk.