Washington, D.C. — Authorities are raising alarms over tianeptine, a substance frequently marketed as a dietary supplement that has gained notoriety on the streets as “gas station heroin.” Linked to numerous overdoses and fatalities, this unregulated compound is readily available at convenience stores, smoke shops, and various online platforms, despite its lack of FDA approval for any medical application in the United States.
Tianeptine originated in France during the 1960s and was introduced as an antidepressant in the late 1980s. Although it shares structural similarities with tricyclic antidepressants, its pharmacological effects differ significantly. Unlike standard antidepressants that increase serotonin levels, tianeptine appears to influence the brain’s glutamate system, which plays a critical role in memory and learning processes. While prescribed as a legitimate treatment in several countries across Europe, Asia, and Latin America, it has also been found to activate mu-opioid receptors, the same targets for opioids like morphine and heroin.
At therapeutic doses, tianeptine’s effects are mild. However, individuals seeking a stronger experience may ingest doses that far exceed medical recommendations, triggering euphoric sensations that can lead to dependence. In the United States, the substance is often promoted as a wellness product or nootropic—purported to enhance cognitive functioning—though it lacks any oversight required for pharmaceuticals. Misleading packaging, which mislabels the drug as a dietary supplement, has enabled vendors to bypass regulatory scrutiny, placing consumers at risk for adverse health effects.
Recent data indicates a staggering increase in poison control calls related to tianeptine, with cases rising over 500% between 2018 and 2023. In 2024 alone, it was involved in more than 300 incidents of poisoning, prompting the FDA to issue warnings about products containing the substance and to recommend recalls. Users have taken to online forums, sharing both the highs and the challenging withdrawal experiences they face, with some reporting dangerously high daily dosages that resemble patterns seen in classic opioid addiction.
A significant challenge for healthcare providers is that tianeptine does not appear in standard toxicology tests, potentially leading to misdiagnosis in patients presenting with seizures or unusual cardiac symptoms. Reports of withdrawal symptoms strikingly similar to those of opioids—such as anxiety, tremors, sleep disturbances, and gastrointestinal issues—have surfaced, with some requiring hospitalization due to severe reactions.
In the United Kingdom, tianeptine occupies a legal gray area. While it remains unlicensed for medical use and is not categorized as a controlled substance, it is still available for purchase from overseas vendors online. Currently, evidence of its prevalence in the UK is limited; only one sample has been officially documented in national drug testing. Despite this, the absence of targeted testing protocols means that tianeptine could be present in the community without being recorded.
Given its unique chemical properties, the potential for misdiagnosis in emergency medical settings is high. Tianeptine may mimic the effects of a tricyclic antidepressant overdose or be dismissed as recreational drug use, complicating appropriate medical intervention. Authorities warn that, should the drug gain more widespread use, especially among individuals seeking alternatives to opioids or those searching for a legal high, a similar emergence pattern to past psychoactive substances could unfold.
As tianeptine’s online availability and addiction potential continue to pose risks, the urgency for increased awareness and regulation grows. Addressing this complex public health issue will require coordinated efforts from health professionals, regulators, and communities to mitigate the harmful impacts before they escalate.