Emerging Drug Alert: Tianeptine

Tianeptine, popularly known as “gas station heroin” has been encountered in various forms including bulk powder and counterfeit pills mimicking hydrocodone and oxycodone. Tianeptine has been sold as “ZaZa”,. “Tiana”, “Neptune’s Fix” and other brand names. Poison Control Center cases involving tianeptine exposure increased nationwide, from 11 total cases between 2000 and 2013 to 151 cases in 2020. As an antidepressant, tianeptine is prescribed to treat depression and anxiety in some European, Asian, and South American countries, but it is not approved for medical use in the United States. Tianeptine-containing products are marketed as dietary supplements or as “smart drugs” that allegedly enhance cognitive function. Tianeptine induces euphoria at high doses via activation of mu-opioid and dopaminergic receptors. It is also alleged to be useful to manage opioid consumption, with claims that it reduces the effects of opioid withdrawal and craving. Unregulated tianeptine is at an increased risk of contamination with adulterants, which may cause additional or unexpected side effects. Tianeptine is not currently controlled under the Controlled Substances Act, but has been scheduled in several states.