In recent months, US health authorities have increasingly voiced concerns over the drug tianeptine, commonly known as “gas station heroin” following a spike in its use and its associated health risks. Tianeptine is an unauthorised drug in the US, and has been increasingly found in over-the-counter supplements sold at gas stations and convenience stores under names like “Zaza,” “Tianaa,” “Pegasus,” and “TD Red.”

Tianeptine is a psychoactive drug originally developed as an antidepressant, and can act as an opioid receptor agonist at high doses, which can produce euphoric effects similar to opioids. Earlier in May, the FDA issued a formal warning in the U.S., referring to tianeptine “a dangerous and growing health trend” and urging the government to take action to prevent a potential opioid-style crisis. In addition, the agency reported a significant and sharp increase in adverse events, including deaths, particularly among young people. Specifically, symptoms linked to tianeptine include seizures, low blood pressure, rapid heartbeat, and severe distress.

“There is an urgent need for comprehensive regulation, public education, and enforcement to mitigate risks associated with widely available synthetic and semi-synthetic drugs,” wrote Dr. Mark Gold in his opinion article in Psychology Today. He also noted that due to its effects, which are comparable to heroin and prescription opioids, tianeptine causes severe withdrawal symptoms. This includes anxiety, tremors, depression, vomiting, and insomnia. In addition, tolerance to tianeptine develops rapidly. Moreover, the drug can also cause respiratory depression, seizures, and death, particularly when mixed with other CNS depressants.

Moreover, urine drug screens currently fail to detect tianeptine, while naloxone can be used to treat withdrawal symptoms. “Clinicians seldom screen for nootropic use. With the widespread and online availability of these substances, patients may not view them as medications or drugs at all and so may not report use,” wrote Dr. Gold. “Very few people are familiar with the term “nootropics,” so clinicians should always ask patients if they are taking OTCs to enhance memory or boost energy levels.”