‘Gas station heroin’ sold as a dietary supplement alarms health officials

The young father crossed the parking lot to join the other parents and meet their children’s new kindergarten teachers. After a few steps he started sweating and shaking. As the air wavered, he staggered back to the car, desperate to lie down in the backseat and breathe, hidden by tinted windows.

“Did you bring anything?” his wife, Anne, yelled at him as he called 911. Eric, 26, had completed rehabilitation earlier this summer.

“The shot! The shot!” he groaned, just before he hit the ground and passed out.

In the emergency room of a nearby hospital in southern New Jersey, doctors tried to revive him with a defibrillator.

“What’s he doing?” they shouted at Anne.

She showed them a bottle of the cherry-flavored elixir she had fished from the car. It was called Neptune’s Fix, which Eric bought at a local supermarket.

“What the hell is that?” a doctor asked.

Neptune’s Fix contains an ingredient called tianeptine, colloquially known as gas station heroin.

Often sold as one food supplement and promoted by retailers as a mood enhancer and focus aid, tianeptine belongs to a growing, unregulated class of potential addictive products available at gas stations, convenience stores, smoke shops and via the Internet. They typically include synthetic pharmaceuticals and plant-derived substances.

Some, like kratom And phenibut, can be addictive and in rare cases fatal. They often come from other countries, including Indonesia and Russia, where they are commonly used and even prescribed for mood management. But the Food and Drug Administration has not approved them as a drug in the United States.

“Tianeptine is an emerging threat,” said Kaitlyn Brownclinical director of The US Poison Centers, which represents and collects data from 55 centers nationwide. “We have people who can be given a substance that is not well regulated, that has abuse potential and that, in high doses, can cause similar effects to opioids, which can lead to really harmful outcomes.”

At least nine states have banned or severely restricted tianeptine, including Florida, Michigan and Ohio. In late November, the FDA published a national alert about Neptune’s Fix in particular and tianeptine in general, telling people not to use it and warning that it was linked to overdoses and deaths.

Tianeptine, which also occurs as a concentrated powder or as an ingredient in products such as Tianaa, Zaza and Pegasus, “is sold illegally with claims that it improves brain function and treats anxiety, depression, pain, opioid use disorder and other conditions,” the agency said. warning said.

The FDA loosely oversees it nutritional supplements, an expanding universe of some 50,000 products containing minerals, vitamins and compounds like melatonin. But the agency doesn’t evaluate supplements for safety or effectiveness; it can only prohibit manufacturers from marketing them as medical treatments. It requires product labels with health claims to list ingredients and include standard disclaimers, such as stating that the product has not been evaluated by the FDA. The agency does not review those labels before a product is released.

Because the FDA’s enforcement powers are limited by law, many products containing tianeptine have lengthy labeling requirements. For example, although the FDA has explicitly said that tianeptine is not eligible as a dietary supplement, the labels of some brands, such as Tianaa, still make that claim.

“There are now at least a dozen different products that are foreign drugs that are openly marketed as dietary supplements, right under the eyes of the FDA, with no way to stop sales,” says Dr. Pieter Cohen, associate professor at Harvard Medical School. studies the regulation of supplements.

Tianeptine is a drug developed by French researchers in the 1960s as an antidepressant. It is approved for that use in low doses in many European, Asian and Latin American countries.

But at higher doses it also works much like an opioid, providing a short-lived euphoria. In the United States, many people use tianeptine under the widespread, incorrect belief that it is a safe alternative to street opioids such as fentanyl or heroin, or even a way to reduce their use. On social media sites such as Reddit, its benefits are hotly debated, with more than 5,000 people subscribing to a ‘Quitting Tianeptine’ forum.

“People develop a tolerance very quickly, so they quickly start increasing the dosage,” said Dawn Sollee, a clinical toxicologist and director of the Poison Control Center in Jacksonville, Florida. “They will set an alarm to wake themselves up every two hours to take tianeptine pills so they don’t get into trouble. intake. And then they have to keep taking more and more to stay functional.

The costs can quickly add up, as can the dangers. At a grocery store in Montclair, NJ, 15 capsules of Tianaa Red recently cost $34. A bottle of Neptune’s Fix, available in lemon, tropical, cherry, or chocolate vanilla flavors, costs about $16. A salesperson at a roadside smoke shop, further west, said customers typically purchased cases of 12 bottles. A salesperson at another roadside store said a customer was buying 10 boxes every week — whether for resale or personal use, he didn’t know.

Determining the number of cases of tianeptine abuse is challenging because hospitals do not test for it. Reports to poison control centers are voluntary, usually made by a concerned family member, so officials say the numbers represent a drastic undercount.

But the number of cases is increasing. In 2013, only four cases of tianeptine exposure were reported nationwide. By 2023, 391 cases were reportedaccording to The US Poison Centers. New Jersey, which typically has one report per year, received 27 in 2023, with patients ranging in age from 20 to 69.

“Some people seem to think it can help with chronic pain instead of having to use an opioid, which could explain the older demographic,” said Dr. Diane Calellomedical director of the New Jersey Poison Control Center.

Like many illegal drugs, tianeptine often is sloppily mixed with unlabeled ingredients, such as powerful synthetic cannabinoids. That’s one reason why overdose symptoms appear to be widespread, poison control medical directors said, including clamminess, nausea, low blood pressure and unconsciousness, as well as seizures and severe stomach cramps.

Sometimes naloxone, a drug that reverses opioid overdoses, can be effective in reviving patients, they said — and sometimes not. At least four deaths have been associated with tianeptine.

About a year ago, Dr. Raymond Pomm, an addiction psychiatrist at Gateway Community Services in Jacksonville, saw his first tianeptine patient. To treat the patient’s withdrawal symptoms, he tried buprenorphine, a drug that eases opioid cravings. He said he found it helped patients manage tianeptine withdrawal symptoms and maintain abstinence.

Last summer, after Eric completed rehabilitation kratoma potential addictive herb from Southeast Asia, which is readily available in convenience stores and smoke shops, doctors recommended medications for anxiety and depression. But Eric, a corporate salesman from suburban South Jersey, was determined to abstain from mood-altering prescriptions to which he had been addicted in the past.

At a tobacconist he saw Neptune’s Fix. One salesperson said it could improve his mood and he wouldn’t care.

“Since it was sold in stores, I figured it couldn’t be that bad,” said Eric, who, like Anne, asked to be identified by his middle name to protect his family’s privacy. “You know, some kind of energy drink.”

After putting back a shot, he felt better almost immediately: more talkative, happier and more confident.

But soon Eric said, “I couldn’t stop.”

Within a few weeks, he was consuming five bottles a day, spending more than $400 a week. His energy was waning. Even though he was a former college athlete who was still used to training daily, he now couldn’t even make it to the gym.

When he tried to quit cold turkey, he developed cold sweats, muscle aches, restlessness and irritability.

Weeks after he collapsed in the kindergarten parking lot, doctors at the New Jersey Poison Control Center tested the contents of his Neptune’s Fix bottles. The results include synthetic cannabinoids and other unlisted ingredients, as well as tianeptine.

The FDA sent warnings in 2021 and 2022 to two companies said to be “illegally marketing tianeptine products as nutritional supplements and unapproved medications.”

But enforcement is required enormous resources, partly because manufacturers and suppliers can be difficult to trace. A question submitted via the website from The New York Times to the makers of Neptune’s Fix yielded no response. The Sheridan, Wyo., location listed on the company’s bottles is an address for one registration agent for numerous companies.

Regulatory experts disagree on how the FDA should act effectively with tianeptine and other supplements. Some say the agency should establish a strict registry of approved supplements.

In interviews, some poison center directors have not endorsed a complete ban on tianeptine, saying it could lead to dangerous underground trade. Educating first responders and consumers about the inherent risks of such products would be a more effective approach, they said.

They added that taking tianeptine off store shelves would not only be a mind-boggling task, but also of limited use because customers could simply buy it from the most convenient store of all: the Internet.

While Eric was recovering from tianeptine poisoning, Anne stormed to the local smoke shop where he had bought it.

“My husband is in the hospital because of this product and you are still leaving it on the shelves?” she screamed.

“Yes,” she said, the owner replied, “because people want it and we have to make money.”