Tianeptine doesn't actually contain heroin, but it does induce similar dangerous, opioid-like effects. Lawmakers and health regulators are now trying to get a handle on the alarming emerging threat.
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The Illinois Poison Center has been tracking a notable increase in calls involving tianeptine, and certified poison specialists have noted some of the calls come from emergency room physicians. These physicians report patients exhibiting symptoms similar to opioid addiction, withdrawal and toxicity.
"Got a call about a 40-something-year-old male who had been taking two supplements; tianeptine was found in both. Symptoms thought to be tianeptine withdrawal, so hallucinations, tremors, tachycardia," said Eric Schultz with Illinois Poison Control.
Nationally, tianeptine cases are steadily climbing. America's Poison Centers has been documenting increasing numbers of calls involving tianeptine over the past five years. There were 391 cases noted in 2023.
Tianeptine is not approved by the Food and Drug Administration for medical use, and the agency said it does not qualify as a dietary supplement. Overseas, it is sometimes prescribed by doctors as an antidepressant.
Dr. Michael Wahl, medical director for the Illinois Poison Center, said it's difficult to know how many people may be having issues right now, because most of the calls come from hospital ERs and not the general public.
"Anything that's over the counter that is marketed as a supplement, it's essentially unregulated. And there are some things that are not going to be safe and this would be one of those drugs," said Whal.
And tianeptine isn't hard to find. In liquid or pill form it's at smoke shops, gas stations, convenience stores and on websites. It's marketed in a variety of ways, including as a mood enhancer, claiming to help energy, anxiety and more.
Dr. Diane Catello has seen dozens of cases documented recently at the New Jersey Poison Control Center where she serves as medical director, as well as in her role as spokesperson for America's Poison Centers. She noted that less severe cases may go undetected.
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"There may be patients who don't feel well but never connect it to their tianeptine use," she said.
The I-Team didn't have to look far to find "gas station heroin." They shopped online and visited dozens of stores in Chicago and the suburbs looking for tianeptine. Many clerks claimed they were out, and then offered to order it. In a handful of stores, the supply was plentiful.
"Once the FDA has a number of cases then they can make a cause for regulating and removing supplements from the market. But it's a very long and arduous process," said Elisabeth Poorman, addiction specialist at UI Health.
Dr. Catello is also frustrated with the lack of regulation.
"They're sold in this kind of regulatory gray area and what we have found is these products contain all manner of other things, and that is dangerous," she said.
The FDA is now warning people not to buy any tianeptine products, including those sold under the brand name Neptune's Fix.
The manufacturer has since issued a voluntary recall, but added their "distribution channels have not reported any adverse events from the use of its products."
The FDA is now citing reports of serious health risks associated with tianeptine, including death.
In Northeastern Ohio, Lorain County Coroner Dr. Frank Miller confirmed that tianeptine contributed to the accidental death of 37-year-old Christopher Haggarty in November 2023.
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"It was a higher or pretty high level of tianeptine for people who should not have tianeptine in their system. And so it's my belief and opinion that he died of toxic effects of tianeptine," he said.
So far, only a handful of deaths nationwide are currently linked to the drug. Addiction experts suspect many reactions are underreported.
"In these cases, people are showing up with an opioid overdose but they're testing negative for the opioids that we typically test for," said Poorman.
U.S. House lawmakers recently sent a letter to the FDA commissioner citing the urgent need for action on tianeptine. In Illinois, newly filed legislation seeks to have tianeptine classified as a controlled substance.
"If it got scheduled as a drug it would need to be clearly labeled. And right now it's not scheduled at all." That's when we get into trouble because that's when the compounds can literally contain anything," said Calello
FDA officials said the agency evaluates reports of adverse effects from products sold as dietary supplements, trying to identify signs of safety risks to consumers early.
As federal agencies and lawmakers try to figure things out, a dozen states, including Indiana, are now regulating tianeptine by banning or restricting the drug locally. Tianeptine has been on the radar of health officials for years; the cause of the recent marked increase in dangerous side effects isn't fully known.
There are also people who are opposed to any controls who use tianeptine for pain control and relaxation, and who say when used carefully it's safe.
America's Poison Centers can answer questions about tianeptine or provide emergency assistance at 1-800-222-1222.