What to know about "gas station heroin"

• The letter — signed by Reps. Jeff Jackson, Rich McCormick, John Rose, Lauren Boebert and Wiley Nickel — calls for the FDA to share what research it has already conducted on the substance and whether the agency has taken action to consider reclassifying it under the Controlled Substance Act, among other requests.
• "We believe that more action on tianeptine use is needed to ensure the health and well-being of the American people," the lawmakers wrote, noting that the FDA has issued several warnings about tianeptine in the past few years."

What is tianeptine?

The antidepressant has been associated with severe side effects and even death, per the Centers for Disease Control and Prevention.

• Abuse of, and withdrawal from, the substance can closely resemble opioid toxicity and withdrawal, per the CDC.
• Tianeptine has not been approved for "any medical use" by the FDA, according to a 2022 warning issued by the agency.

Many tianeptine users are taking the substance because they believe it's a safer alternative to opioids like heroin and fentanyl or because they're trying to wean themselves off these other drugs, the New York Times reported.

• "Some people have turned to tianeptine as an opioid alternative, or to self-treat anxiety or depression," the FDA wrote in its 2022 warning.
• There were 11 tianeptine exposure calls to U.S. poison control centers between 2000 and 2013, per the FDA. In 2020 alone, there were 151 such calls.
• At least three U.S. deaths were linked to tianeptine as of September 2018, studies show. No data on deaths since 2018 was readily available.

What are its effects?

The use of tianeptine by itself or in combination with other substances can cause a slew of side effects, including nausea, high blood pressure, vomiting, coma, slowed or stopped breathing, and death, per the FDA's 2022 warning.

• The misuse of tianeptine can lead to "euphoric, opioid-like highs" that, with continued use, can lead to dependence and tolerance for the drug, according to a July 2023 study published in the journal Pain and Therapy.

Where is tianeptine available?

Tianeptine is legally available in several countries in Europe, Asia and Latin America, per the CDC.

• Globally, it is often marketed under the names Coaxil, Stablon and Tatinol, according to the National Institutes of Health.

• However, it's not available for medical use in Australia, Canada, New Zealand, the U.K. and the U.S., per the NIH.
• Nine U.S. states — Alabama, Michigan, Mississippi, Tennessee, Georgia, Indiana, Ohio, Florida, and Kentucky — have taken action to restrict or ban the sale of tianeptine, according to a press release from Jackson's office.

How is tianeptine sold in the U.S.?

Despite being unapproved by the FDA, tianeptine remains accessible to Americans, often sold as a dietary supplements or "cognitive enhancers," according to the Pain and Therapy study.

• Tianeptine got its "gas station heroin" nickname because of its potential for opioid-like effects, the study noted.
• It's among other so-called "gas station drugs" that are sold at convenience stores, bodegas, smoke shops and gas stations. Tianeptine can be found on store shelves under the names "Zaza" and "Tianna Red" or bought online without a prescription, per the study.
• The FDA said in 2022 that it had sent warning letters to companies illegally selling and marketing products with tianeptine, as well as import alerts to halt substance shipments at U.S. borders.

Of note: The FDA issued a new warning last November telling consumers not to use or purchase products from the supplement brand Neptune's Fix or any other products with tianeptine.

• A number of users had experienced severe reactions to Neptune's Fix products, including seizures and loss of consciousness that led to hospitalization, the FDA said.

Reality check: The FDA has said that tianeptine does not meet the definition of a dietary supplement.