'Gas Station Heroin' Thrives in a Legal Gray Area

Health officials want you to think twice before buying one of those brightly colored little bottles often sold at gas stations, convenience stores, and smoke shops. Sometimes called "gas station heroin," the products are usually marketed as energy shots or cognitive supplements but actually contain tianeptine, an unapproved drug that can be addictive and carries risks of serious side effects. US poison control centers have reported a steady rise in calls linked to the drug for more than a decade. And last month the Food and Drug Administration sent a warning to health professionals about "the magnitude of the underlying danger or these products." Details:

• Tianeptine is approved in a number foreign countries as an antidepressant, usually as a low-dose pill taken three times a day. But it has never been approved by the FDA for any medical condition in the US. Additionally, the drug cannot legally be added to foods and beverages or sold as a dietary supplement—something the FDA has repeatedly warned US companies about.
• Still, under-the-radar firms sell tianeptine in various formulas, often with brand names like Zaza, Tianaa, Pegasus, and TD Red. Although that is technically illegal, the FDA does not preapprove ingredients added to supplements and beverages.
• "It's kind of this gray area of consumer products, or supplements, where the contents are not regulated or tested the way they would be with a medication," said Dr. Diane Calello of the New Jersey Poison Information and Education System.
• While tianeptine is not an opioid, the drug binds to some of the same receptors in the brain, which can temporarily produce effects akin to oxycodone and other opioids. Tianeptine also carries some of the same physiological risks of opioids, including the potential to dangerously depress breathing.
• Calls to poison control centers increased 525% between 2018 and 2023, according to a data analysis published earlier this year. In about 40% of cases, the person had to seek medical care, with more than half of them needing critical care.

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