Tianeptine - A so-called supplement with dangerous consequences. Our #expert weighs in on 'gas station heroin' warnings

Jan 29, 2024

5 min

C. Michael  White, Pharm.D., FCP, FCCP

Since 2022, the U.S. Food and Drug Administration has been actively urging consumers to avoid purchasing or consuming tianeptine -- a synthetic drug commonly called "gas station heroin" that can mimic the actions of opioids like fentanyl.



Now, the FDA is upping the urgency of it's warnings as vendors continue to market the drug as a so-called "dietary supplement." UConn's C. Michael White, a Distinguished Professor of Pharmacy Practice, spoke with The Conversation about the problem with tianeptine in a must-read Q-and-A:


What is tianeptine and why is it risky?

Tianeptine stimulates the same receptors as well-known opioids such as fentanyl, heroin and morphine. When these drugs make their way from the blood to the brain, they bind to the “mu” type opioid receptor that triggers the sought-after pain relief and euphoria of those drugs as well as the dangerous effects like slowed or stopped breathing.

High doses of tianeptine can bring euphoric effects similar to heroin and can also bring about the dissociative effect – the perception of your mind being disconnected from your surroundings and body – that is reminiscent of ketamine, an anesthetic that has a role in treating post-traumatic stress disorder and depression but has also commonly been abused as a street drug.

Products containing tianeptine are often called “legal high drugs” – sometimes dubbed “gas station drugs” – a term used for all non-FDA-approved synthetic drugs that are sold casually in gas stations, online and elsewhere.



What are the major adverse effects that people can experience?

Data from clinical trials, case reports and poison control centers shows that tianeptine commonly induces agitation. This is typically accompanied by a fast heart rate and high blood pressure, confusion, nightmares, drowsiness, dry mouth and nausea, among other conditions. The most serious adverse events are slowed or stopped breathing, coma, heart arrhythmia and death. When long-term users try to stop tianeptine use, they often experience withdrawal symptoms reminiscent of opioid withdrawal.

Consumers need to be aware that products containing tianeptine may not adhere to good manufacturing practices. This means they could contain lead or have other heavy metal contamination or be contaminated by microorganisms such as salmonella or mold. They could also contain other drug ingredients that are not disclosed. Knowingly or unknowingly combining active ingredients can increase the risk of adverse events.

Additionally, the amount of the active ingredient contained in the product can vary widely, even with the same manufacturer. So past use does not guarantee that using the same amount will provide the same effect.

How are these drugs sold in the US if they are not FDA-approved?

If a drug product is not FDA-approved for prescription or over-the-counter-use, it is the Drug Enforcement Agency that is responsible for controlling market access.

Before the DEA can ban an active ingredient in a drug product, it must be designated Schedule I, meaning the drug has no legitimate medical purpose and has high abuse potential. Manufacturers do not have to alert the DEA before selling their products to U.S. citizens. This means the DEA must detect an issue, identify the products causing the issue, identify the active ingredients in the product in question and do a full scientific review before designating it as Schedule I.

Tianeptine came to market masquerading as a dietary supplement in gas stations and smoke shops, even though it is a synthetic compound. Tianeptine is also sold online allegedly for research purposes and not for human consumption. Tianeptine is undergoing clinical trials for the treatment of pain and depression, but sellers do nothing to make this type of labeling clear to consumers or to restrict purchases to researchers.



What can people do to protect themselves and their families?

Non-FDA-approved products containing synthetic drugs are very risky to use and should be avoided. FDA-approved drugs are available by a prescription from a health professional or over the counter with active ingredients on an approved list.

If someone in a gas station, smoke shop or over the internet touts the benefits of a non-FDA-approved drug product – for pain or anxiety relief, to increase energy or for a buzz – be aware. It could be dangerous the first time you use it, but using it successfully once also doesn’t mean the experience will be the same the next time, and continued use can cause addiction.

If a product is being sold “not for human consumption” or “for research purposes only,” you are at a high risk if you take it. Before you take any dietary supplement, make sure you check the active ingredient to be sure that it is, in fact, a natural product and not a synthetic chemical. If someone you know has bags with unmarked powder, a product labeled for research use or not for human consumption, or tablets or capsules not in standard drug bottles, that is a sign of a potentially dangerous situation.

Standard drug tests sold over the counter are not designed to pick up tianeptine. One of the main reasons that people use these alternative substances of abuse over regular opioids, cannabis or amphetamines is that they are much harder to detect through work- or at-home drug screens by parents, schools, employers, probation officers and so on.

If the DEA is not responding to emerging threats quickly enough, individual states can also act to ban sales of dangerous active ingredients in products. As of January 2024, at least 12 states have banned the sale of tianeptine, according to the FDA, although people in those states can still illegally procure it from the internet. So contacting your state legislators could be a place to start exercising your power to help prevent the harms from these products.



This is an important piece, and if you are looking to know about tianeptine and the threat it poses to consumers in America, then let us help.


Dr. C. Michael White is an expert in the areas of comparative effectiveness and preventing adverse events from drugs, devices, dietary supplements, and illicit substances. Dr. White is available to speak with media -- click on his icon now to arrange an interview today.


Connect with:
C. Michael  White, Pharm.D., FCP, FCCP

C. Michael White, Pharm.D., FCP, FCCP

Head and Distinguished Professor, Department of Pharmacy Practice

Dr. White’s research interests are in drug, dietary supplement, and illicit drug safety, quality, and cost

DietCBDDrug CostsDietary SupplementsCardiovascular Drugs

You might also like...

Check out some other posts from University of Connecticut

3 min

Moths in the Mojave, with UConn's David Wagner

Did you know that there are approximately 180,000 moth and butterfly species living in California’s Mojave Desert? Moths, the winged insects famous for eating sweaters and flocking to lights at night, are a mysterious and captivating species for entomologists like UConn's David Wagner. He was part of a research study that was documented recently in The Washington Post. Each night in the desert, vast clouds of sphinx moths, some spanning the palm of your hand, speed between night-blooming flowers, sipping nectar. Ethmia, tiny black moths with spots shaped like musical notes, emerge from the dark like fairies. Thousands of geometrid moths, no bigger than your fingernail, slip by cloaked in desert hues from rusty reds to pale green. To witness them, I traveled deep into the Mojave Desert this spring with a team from the California Academy of Sciences working to ensure the survival of lepidoptera. For two days, we beat bushes, placed traps and collected thousands of moths to see what lives there — and what can be saved. Moths have inhabited our planet for at least 200 million years. But the conservation status of about 99 percent of moth species remains unknown. Some, like sphinx moths, remain abundant. Many others are probably being pushed to the brink by development, land-use changes, pesticides and pollution, and rising temperatures. “It’s not this unseen force,” says David Wagner, an entomologist at the University of Connecticut. “It’s humans.” Over two nights in the desert, I discovered just how easy it is to fall in love with an unloved insect. And why “mothing” may be the best way to discover the miracle of biodiversity in your own backyard. On the arid western edge of the Mojave, where the desert floor rises to meet the San Bernardino Mountains, sits the 306-acre Burns Piñon Ridge Reserve. We venture out in the morning with beating sticks. Hitting the branches of small oaks and rabbitbrush deposits a treasure trove of insect life into collectors made out of fabric: Crane flies, green lacewings, spiders, walking sticks and caterpillars that will one day grow into moths. Wagner and Chris Grinter, an entomologist and collection manager at the California Academy of Sciences, will catalogue the most interesting ones. The academy houses a collection of 18 million insects, 700,000 of which are butterflies and moth specimens. Many are still waiting for scientists to identify and name them. The plight of moths and caterpillars has fascinated Wagner since childhood. After 20 years, he is no less enthusiastic — or worried. Wagner traveled to Burns Piñon to help finish his magnum opus, the successor to his 500-page guide to eastern North America’s caterpillars. The guide for the west will probably run more than 1,500 pages, a testament to the region’s remarkable biodiversity. As the sun sets, the mood is anticipatory. We head out into the desert to set our traps and see what moths we’ll discover. “The nice thing,” says Grinter, “is moths will come to you.”  The article is an amazing read - and the link is above. And if you are interested in knowing more about moths, insects, or the fascinating field of entomology, then let us help. Dr. David Wagner is an expert in caterpillars, butterflies, moths, and insect conservation, and he's commented extensively on the current decline of insects worldwide. Click his icon to arrange an interview today.

3 min

Every Voice and Vote Matters

It's the right of every citizen - and with a presidential election less than two weeks away, a team of social workers from UConn are working to make sure every voice is heard as the U.S. choses a new leader on Nov. 5. Voting Is Social Work - a campaign led by Tanya Rhodes Smith, director of the Nancy A. Humphreys Institute for Political Social Work at the UConn School of Social Work - is getting a lot of attention for its work engaging social workers to help empower some of the most vulnerable and disenfranchised groups to get registered and cast their ballots in local elections. “Voting is complicated, and it’s intimidating, especially for vulnerable populations, like the unhoused, the formerly incarcerated, or those living in congregate care,” says Rhodes Smith. “We know that being a non-voter is a very isolating space, because voting is highly relational. Campaigns generally ignore non-voters— you don’t get campaign materials, or someone knocking on your door. Information on candidates in state and local elections in communities with low turnout can be very hard to find or even nonexistent.” That’s where social workers, explains Rhodes Smith, can play an important role in helping disenfranchised voters understand their rights – and register to vote. Money, Power, and Resources As co-founders since 2015, UConn’s Humphreys Institute has been the institutional home for Voting Is Social Work. Also known as the National Social Work Voter Mobilization Campaign, Voting Is Social Work supports nonpartisan voter engagement as central to social work’s mission, ethical mandate, and impact. “We’ve always believed that social work has the power to transform democracy,” says Rhodes Smith, “and we believe every social worker – and social service agency – should include nonpartisan voter engagement into their practice and work. Because we reach non-voters – those who are least likely to vote.” October 16 - UConn Today It's an initiative catching attention across the country. Research has linked voting to higher earning and education, better health outcomes, and lower rates of recidivism. But education is key, particularly for individuals with special circumstances, like the formerly incarcerated, people living in congregate care, and the unhoused. Homelessness comes with a new, unique set of challenges during an election cycle. However, homeless residents have protections, including voting rights. Nationwide, only 10% of unhoused people vote each year, according to the Institute of Political Social Work at the University of Connecticut. Many social workers in Connecticut are working to educate unhoused residents about their voting rights, according to UConn Social Work professor Tanya Rhodes Smith, director of the Nancy A. Humphreys Institute for Political Social Work. “When you ask somebody if they would like to check their voter registration, they may say, ‘I'm not eligible,’ or ‘I've never voted,’ and that's really important information for you to know,” Rhodes Smith said. “It really tells a story about them.” About 60% of eligible voters turnout in presidential election years, but increasing voting rates is important for local elections as well, Rhodes Smith said. “When you have 10% to 15% [voter turnout], that's not an accountable government, that's a government that's accountable to the 10% to 15%,” Rhodes Smith said. “We've seen it over and over in Bridgeport, that nothing changes because that turnout rate doesn't go up, and so there is no accountability when you have an unhealthy democracy.” October 10 - WNPR Looking to know more about this important work? If so, let us help. Tanya Rhodes Smith specializes in policy development, nonprofit administration, voter engagement and legislative advocacy. She's available to speak with media about this important topic - simply click on her icon now to arrange an interview.

4 min

Expert Opinion - The Undisclosed Risks of Off-brand Ozempic and Other Weight Loss Products

The popularity -- and price -- of brand-name injectable drugs like Ozempic, Wegovy, Mounjaro, and Zepbound has skyrocketed. But the soaring demand for these drugs -- used for weight loss as well as to control blood sugar levels and reduce the risk of heart disease -- and the limited supply as well as lack of generic options has also led to a flood of non-brand alternatives in the market. In a recent article for The Conversation, UConn expert C. Michael White, Distinguished Professor of Pharmacy Practice, issued a warning to consumers about the potential undisclosed risks of these off-brand products: High demand is driving GLP-1 wannabes The dietary supplement market has sought to cash in on the GLP-1 demand with pills, teas, extracts and all manner of other products that claim to produce similar effects as the brand names at a much lower price. Products containing the herb berberine offer only a few pounds of weight loss, while many dietary supplement weight loss products contain stimulants such as sibutramine and laxatives such as phenolphthalein, which increase the risk of heart attacks, strokes and cancer. The role of compounding pharmacies Unlike the dietary supplements that are masquerading as GLP-1 weight loss products, compounding pharmacies can create custom versions of products that contain the same active ingredients as the real thing for patients who cannot use either brand or generic products for some reason. These pharmacies can also produce alternative versions of brand-name drugs when official drug shortages exist. Since the demand for GLP-1 medications has far outpaced the supply, compounding pharmacies are legally producing a variety of different semaglutide and tirzepatide products. These products may come in versions that differ from the brand-name companies, such as vials of powder that must be dissolved in liquid, or as tablets or nasal sprays. Just like the brand-name drugs, you must have a valid prescription to receive them. The prices range from $250-$400 a month – still a steep price for many consumers. Compounding pharmacies must adhere to the FDA’s sterility and quality production methods, but these rules are not as rigorous for compounding pharmacies as those for commercial manufacturers of generic drugs. In addition, the products compounding pharmacies create do not have to be tested in humans for safety or effectiveness like brand-name products do. Proper dosing can also be challenging with compounded forms of the drugs. Companies that work the system For people who cannot afford a compounding pharmacy product, or cannot get a valid prescription for semaglutide or tirzepatide, opportunistic companies are stepping in to fill the void. These include “peptide companies,” manufacturers that create non-FDA approved knockoff versions of the drugs. From November 2023 to March 2024, my team carried out a study to assess which of these peptide companies are selling semaglutide or tirzepatide products. We scoured the internet looking for these peptide companies and collected information about what they were selling and their sales practices. We found that peptide sellers use a loophole to sell these drugs. On their websites, the companies state that their drugs are for “research purposes only” or “not for human consumption,” but they do nothing to verify that the buyers are researchers or that the product is going to a research facility. By reading the comments sections of the company websites and the targeted ads on social media, it becomes clear that both buyers and sellers understand the charade. Unlike compounding pharmacies, these peptide sellers do not provide the supplies you need to dissolve and inject the drug, provide no instructions, and will usually not answer questions. Peptide sellers, since they allegedly are not selling to consumers, do not require a valid prescription and will sell consumers whatever quantity of drug they wish to purchase. Even if a person has an eating disorder such as anorexia nervosa, the companies will happily sell them a semaglutide or tirzepatide product without a prescription. The average prices of these peptide products range from $181-$203 per month. Skirting regulations Peptide sellers do not have to adhere to the rules or regulations that drug manufacturers or compounding pharmacies do. Many companies state that their products are 99% pure, but an independent investigation of three companies’ products from August 2023 to March 2024 found that the purity of the products were far less than promised. One product contained endotoxin – a toxic substance produced by bacteria – suggesting that it was contaminated with microbes. In addition, the products’ promised dosages were off by up 29% to 39%. Poor purity can cause patients to experience fever, chills, nausea, skin irritation, infections and low blood pressure. In this study, some companies never even shipped the drug, telling the buyers they needed to pay an additional fee to have the product clear customs. If a consumer is harmed by a poor-quality product, it would be difficult to sue the seller, since the products specifically say they are “not for human consumption.” Ultimately, consumers are being led to spend money on products that may never arrive, could cause an infection, might not have the correct dose, and contain no instructions on how to safely use or store the product. Dr. C. Michael White is an expert in the areas of comparative effectiveness and preventing adverse events from drugs, devices, dietary supplements, and illicit substances. Dr. White is available to speak with media -- click on his icon now to arrange an interview today.

View all posts