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Various flavors of Neptunes Fix Elixir, a product labeled to contain tianeptine. (FDA's Office of Regulatory Affairs, Health Fraud Branch/Flickr)
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The Centers for Disease Control and Prevention (CDC) issued a warning about the prevalence of tianeptine, also called “gas station heroin,” throughout the country.
This month, CDC officials reported that tianeptine products being sold in gas stations, convenience stores and online, may also contain synthetic marijuana.
The “Neptune’s Fix” brand is one tianeptine product that can be purchased as an elixir bottle with flavors ranging from cherry, lemon and chocolate.
The Food and Drug Administration (FDA) issued a report last week specifically urging consumers to not buy Neptune’s Fix, or other tianeptine-related products, citing “serious” health risks associated with ingestion.
Reports related to the use of the sedative have described symptoms including confusion, nausea and increased blood pressure. Seizures, loss of consciousness and death have also been linked to the substance.
While used in other countries, tianeptine is an antidepressant that is not approved by the FDA. However, the drug can easily be bought online.
Besides Neptune’s Fix, similar dietary supplements have incorporated tianeptine into its ingredient list, such as “ZaZa” and “Pegasus Silver.”
Tianeptine is often marketed as a supplement that can address anxiety and chronic pain. Its effects can mimic the sedation similar of opioid use — thus, incorrectly considered a “safer” alternative.
“The drug itself does have weak opioid effects, which is probably what’s led to the term ‘gas station heroin,’ and that may be driving some of the use behind it,” said Christopher Counts, a toxicologist at the New Jersey Poison Control Center at Rutgers New Jersey Medical School. “And unfortunately, since you can purchase it so easily this gives the impression that it’s safe, which it absolutely is not.”
Since June, there have been an estimated 38 tianeptine exposures in New Jersey. Even though that number appears miniscule, cases have almost doubled from the baseline of two or fewer exposure calls since November.
But tianeptine isn’t new to the medical community.
In 2018, poison control centers across the U.S. had been flooded with calls related to the misuse of tianeptine — over 200 cases of users between 21 to 40 years old.
These numbers are consistent with the current trend, Counts said. The New Jersey Poison Control Center has seen the age range even expand between ages 19 to 69.
“Many states receive calls and reports about tianeptine,” he said. “It’s become particularly prominent in New Jersey over the past few months because we’ve had a sharp spike in the number of calls that we receive at the Poison Center regarding tianeptine, and part of that may be due to adulteration of this product with other other drugs.”
The presence of tianeptine is also something to monitor in Philadelphia, said Robert Bassett, associate medical director of the Poison Control Center at Children’s Hospital of Philadelphia (CHOP).
“In mild to moderate cases, there can just be subtle to moderate changes and level of consciousness and awareness. However, in extreme cases, it could be so deeply sedating that it could cause people to not be able to breathe,” he said.
The Poison Control Center at CHOP could not verify how many cases of exposure were in Philadelphia, but it’s a situation that’s being closely looked at, Bassett said.
“One of the limitations to the poison control center is that data is voluntary reporting,” he said. “There’s no mandatory reporting to us.”
Individuals exposed to tianeptine are recommended to call the National Poison Control Center at 1-800-222-1222. The New Jersey Department of Health is also urging people to call 911 if they need immediate medical attention.
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If you or someone you know is struggling with substance use, SAMHSA’s National Helpline is a free, confidential, 24-hour hotline that offers referrals to local treatment facilities, support groups, and community-based organizations. Call 1-800-662-HELP for more information.