Tianeptine, a tricyclic antidepressant used abroad but unapproved in America, has emerged as an unlikely drug of abuse right under our noses. Brands like Zaza Red and Tianna Red containing potent doses of tianeptine are now easily bought at gas stations and stores nationwide. Yet deceitfully, it is often marketed as a supplement. Make no mistake - improperly used, tianeptine poses the same serious risks of addiction and overdose as unlawfully taking opioids. The opioid epidemic continues devastating families—the last thing we need is more addictive substances flooding communities completely unregulated.
So how did we get here? This complex question demands a thoughtful, nuanced response. I hope you’ll join me as I explain the details of this emerging threat as supplements containing tianeptine flood our markets.
What Exactly is Tianeptine (Zaza Red or Za Za)?
Tianeptine is a drug approved for medical use in Europe, Asia and Latin America to treat major depressive disorder. It has never been approved by the U.S. Food and Drug Administration. It is sold under the name Stablon and Coaxil. This drug is now being dangerously sold under the table at gas stations and stores nationwide. Instead of blocking the reuptake of serotonin like elective serotonin reuptake inhibitor (SSRI) medications, or norepinephrine like serotonin–norepinephrine reuptake inhibitor (SNRI) medications, tianeptine produces antidepressant and anxiolytic effects by acting like opioids at the μ-opioid receptors in the brain and modulating glutamatergic neurotransmission. Studies reveal that tianeptine decreases plasma serotonin levels.
Make no mistake - this is an imminent public health crisis. When abused recreationally, tianeptine acts on the brain's opioid receptors just like OxyContin or heroin, carrying risks of overdose and addiction. This unregulated distribution of tianeptine fuels opioid misuse.
Brands like Zaza Red and Tianna Red contain massive doses of tianeptine but are deceptively labelled as "supplements". Independent testing reveals the actual concentrations vary wildly. Therapeutic doses of tianeptine is 12.5-50mg. However, a single 15-capsule bottle of Zaza Red contains between 200-250mg of tianeptine sodium and cost around $25. Tianna Red is similar but generally contains 125mg of tianeptine sulfate per capsule. However, independent testing has found wildly varying actual tianeptine concentrations from bottle to bottle, ranging from nothing to over triple the labeled dosage.
With such loose oversight, it's far too easy for Americans seeking a high to get these potent preparations - essentially prescription-free opioid pills. We must take urgent action before this ticking time bomb claims more lives.
Is Tianeptine Use Legal in the United States?
Tianeptine is not FDA approved. It is not illegal or federally scheduled substance in most of the United States. Tianeptine products are unregulated and access is largely uncontrolled. However, some states are passing laws to make it illegal.
The FDA has released warnings about the dangers and addictive potential of tianeptine while continuing to confiscate illegally marketed products entering the U.S.
Alabama became the first state to classify tianeptine as a Schedule II controlled substance in March 2021, carrying criminal penalties for illegal use. Michigan enacted an emergency ban of the drug in 2018. A few other states have also begun implementing sales restrictions, but regulation overall remains extremely inadequate so far.
The FDA, DEA, legislators and state governments need to become more aware of the risks so that access can be limited, especially for youth. However, banning tianeptine outright could simply drive the issue underground, leading dependent users to seek out more hazardous street replacements.
How Did Tianeptine End Up As "Gas Station Heroin"?
Despite never getting U.S. approval, unscrupulous merchants are exploiting regulatory loopholes to sell unapproved tianeptine products openly at gas stations and convenience stores nationwide.
Patients battling chronic pain, addicts, even teenagers and other vulnerable groups are able to easily buy bottles of this addictive antidepressant. In most states, tianeptine is totally unregulated. Its availability to drug addicts have gained it the street name of "gas station dope" and "gas station heroin."
To prevent worsening the opioid epidemic devastating America, the spread of these hazardous tianeptine products labeled as "supplements" must be stopped. Concerted action is urgently needed to close loopholes and educate against this threat before more lives are lost.
Ways Tianeptine is Being Recreationally Abused
While the recommended prescription dosage range for tianeptine is just 10-50mg taken once or twice daily, individuals abusing this drug for euphoric effects are taking up to 100 times that amount. At those amounts, it produces effects similar to opioids. Chronic recreational users report regularly consuming up to 2,500mg daily, though doses may range from 100mg to over 5,000mg per day.
Some initially start taking tianeptine as directed but soon begin escalating their dosage searching for an increasingly intense high. Others intentionally misuse the drug from the outset for its psychoactive and addictive properties by intentionally exceeding the recommended dosage.
Oral ingestion in pill or capsule form is the most common route of recreational tianeptine abuse. Though never intended for injection, there are concerning reports of users dissolving the pills to inject the drug intravenously or intramuscularly as a more direct and dangerous method to achieve a faster, more powerful high.
Those consuming tianeptine for non-medical purposes also often combine it with other substances like opioids, benzodiazepines, alcohol or stimulants, increase their risk of overdose through drug synergy.
Alarmingly, the DEA has reported the presence of tianeptine in over 80% of Alabama forensic cases involving fentanyl or other illicit drugs, demonstrating just how embedded its recreational use has already become in the addiction and overdose crisis impacting the country.
Why Tianeptine Addiction Is an Emerging Public Health Threat?
While tianeptine is not yet a widely recognized drug of abuse in the United States, certain factors have allowed this prescription antidepressant to quietly emerge as a fast-growing public health threat that demands attention:
It's Available at Gas Stations
Lack of regulation has permitted the proliferation of highly concentrated tianeptine products with the brand names Zaza Red and Tianna Red in gas stations, head shops, and online. Purchasing tianeptine illicitly could not be easier currently.
Low Public Awareness
Tianeptine is not a federally scheduled substance or a well-known street drug. Most people using tianeptine are unaware that they can become addicted and that taking too much tianeptine can cause overdose especially in young users.
High Potential for Addiction
The euphoric opioid-like high triggered by mega-doses and dopamine release makes dependence, compulsive use, and withdrawal nearly inevitable over time.
Often Used With Other Drugs
Tianeptine is often misused with other substances too, dangerously enhancing effects like respiratory depression.
Difficult to Recognize and Treat
Few addiction specialists are familiar with tianeptine abuse or are aware that tianeptine use can lead to addiction. Using too much tianeptine leads to serious health conditions including respiratory depression and overdose. Drug screens do not detect it. Regulating and providing treatment remains challenging.
Increasing Emergency Department Visits
As use rises, ER visits related to cases of tianeptine toxicity, overdose, and withdrawal have surged over the past few years, alarming healthcare providers.
No FDA-Approved Medications for Treatment
Research is still lacking on medications proven through clinical trials that can relieve tianeptine cravings and withdrawal symptoms long-term.
Without proper education and control measures implemented soon, our lack of readiness to deal with this drug could allow heavy tianeptine abuse to silently spread much further.
What are the Dangers of Tianeptine Substance Use Disorder?
While tianeptine is generally well tolerated with a low side effect profile when taken for depression at recommended therapeutic doses under medical care, recreational abuse of high dose tianeptine poses serious health hazards including:
Addiction and Dependence
Frequent abuse of high tianeptine doses can lead to addiction and other serious health issues. The reinforcing euphoric effects drive intense drug-seeking behavior.
Both physiological and psychological withdrawal symptoms emerge with discontinued use - anxiety, panic attacks, sweating, goosebumps, muscle aches, insomnia, nausea, diarrhea, vomiting, and more. These symptoms can be indistinguishable from opioid withdrawal.
Side Effects of Tianeptine
Common side effects of misusing tianeptine include severe constipation, abdominal pain, headache, dizziness, heart palpitations, chest pain, kidney pain, shortness of breath, and coughing up blood.
High doses of tianeptine can lead to hypomania, suicidal ideation, seizures, liver damage, rapid heart rate, high blood pressure, and irregular heart rhythms.
Harmful Drug Interactions
Those abusing tianeptine frequently take other substances too like opioids, benzodiazepines, alcohol, or stimulants. Combined central nervous system depression exacerbates overdose risk.
Pregnancy and Neonatal Risks
Use during pregnancy can lead to neonatal abstinence syndrome where the newborn suffers severe withdrawal symptoms - crying, fever, vomiting, diarrhea, seizures, etc.
Psychiatric Effects
Case reports link high-dose tianeptine abuse to onset or exacerbation of psychosis, mania, delusions, hallucinations, suicidal thoughts and other adverse mental health effects.
Legal Penalties
Getting caught buying, selling or possessing unregulated tianeptine products could potentially lead to legal consequences depending on the state, though regulation remains inadequate.
Signs of Tianeptine Drug Abuse and Addiction
For those ingesting tianeptine recreationally, addiction can develop rapidly. Concerning signs of abuse or dependency include:
Needing increasingly higher or more frequent doses to get the same pleasurable effect (tolerance)
Experiencing painful flu-like withdrawal symptoms if dosage is lowered or drug is stopped
Spending excessive time, energy and money trying to obtain more tianeptine
Failed attempts to control or reduce tianeptine use on one's own
Using it compulsively despite physical, mental, social or interpersonal harm
Giving up important social, occupational or recreational activities to keep using
Using the drug while alone or in physically hazardous situations
Hiding extent of tianeptine use from family, friends and healthcare providers
Dangers of Withdrawing from Tianeptine
Because individuals dependent on high doses of tianeptine quickly develop tolerance, abruptly stopping use often causes severe and unpleasant withdrawal effects. Medically supervised detox is ideal to safely discontinue heavy tianeptine abuse.
Attempting to quit “cold turkey” often fails due to the agonizing physical and psychological withdrawal symptoms that emerge within 24 hours of last use. These may include:
Drug cravings
Anxiety, panic attacks or depression
Sweating and chills
Insomnia and vivid nightmares
Nausea, vomiting, diarrhea
Muscle aches, tremors, restless legs
Rapid heart rate and high blood pressure
Suicidal thoughts
Without medical help, many find the withdrawal effects so intolerable that they quickly resume tianeptine use, becoming trapped in a cycle of addiction. Research shows that gradually tapering tianeptine dosage under medical supervision can help mitigate issues like depression, anxiety, body aches, nausea, diarrhea and drug cravings.
Some dependent users try managing withdrawal symptoms themselves by substituting alcohol, benzodiazepines or other opioids like kratom. However, this usually leads to more severe addiction issues down the road. Early research shows that buprenorphine therapy could be effective for treating tianeptine dependence, helping manage withdrawal discomfort.
Tianeptine Overdose
Signs of tianeptine overdose include:
Drowsiness, confusion, inability to stay awake
Shallow, slowed breathing
Low blood pressure and slowed heart rate
Unconsciousness, coma
Death from respiratory failure
The major risk with tianeptine overdose is inadequate oxygen reaching the brain due to severely decreased respiratory drive. Death can occur quickly without intervention.
Combining tianeptine with other CNS depressants like alcohol or benzodiazepines dramatically increases overdose risk. Never mix these substances.
If a tianeptine overdose is suspected, call 911 immediately. Timely medical care can save a person's life. Tianeptine overdose is treated by:
Administering oxygen and performing intubation if breathing is impaired
Giving IV fluids and electrolytes to stabilize blood pressure
Monitoring heart rate and rhythm
Providing respiratory support until the drug is naturally metabolized
Medication-Assisted Treatment for Tianeptine Addiction
Battling tianeptine addiction is challenging, but know that help is available. Though unapproved in the U.S., some medications can aid recovery when this antidepressant is misused.
Case reports reveal options like buprenorphine, methadone, or naltrexone may lessen withdrawal symptoms and cravings:
Buprenorphine, used to treat opioid addiction, can relieve tianeptine withdrawal given their similar opioid receptor action.
Methadone’s effects on these receptors also made it effective for some patients.
For others, naltrexone’s opioid blocking properties reduced tianeptine cravings.
But responses vary - no single medication works for all. This complex issue demands nuance and care. Treatment must be tailored to the individual with medical guidance.
Tianeptine addiction recovery is possible, especially when medication-assisted therapy is thoughtfully combined with counseling, social support and healthy lifestyle changes.
Raising Awareness to Combat Rising Tianeptine Addiction
Because tianeptine is not a recognized drug of abuse by most Americans, there is an urgent need for public health campaigns that can spread awareness about its addiction potential and hazards.
Educating the Public
We need to reach at-risk populations and Correct the misperception that products like Zaza Red provide just harmless mood enhancement without serious side effects.
Counseling Young Adults
Parents, teachers, school counselors, nurses, and physicians should specifically counsel teens and young adults about tianeptine risks as use rises among youth.
Warning Current Users
Substance abuse programs must inform addicted individuals that tianeptine can cause life-threatening interactions with other drugs.
Informing Healthcare Providers
Doctors, nurses and addiction counselors should receive up-to-date information to recognize symptoms of tianeptine abuse and overdose.
Training First Responders
Paramedics, EMTs and police must be educated about the risks of tianeptine and equipped with naloxone to counteract overdoses.
Researching Treatment Options
Ongoing medical research needs to identify medications and psychosocial treatments that can best treat tianeptine addiction long-term.
Spreading Awareness on Social Media
Posting on Facebook, Instagram, Twitter, TikTok and Reddit can rapidly increase public understanding about tianeptine among key demographics.
Properly educating those at risk, current recreational users, parents, educators, healthcare providers, first responders, law enforcement and others across the country will be crucial to stemming the tide of tianeptine addiction.
The Necessity of Better Tianeptine Regulation and Control
Simply providing information without also implementing tighter regulations and improved addiction treatment resources would be insufficient to tackle the issue. Some essential policies that experts argue are needed at state and federal levels include:
Explicitly scheduling tianeptine as a controlled substance alongside other prescription opioids.
Mandating that pharmacies track tianeptine sales.
Prohibiting retail sales of pure tianeptine powders.
Enforcing maximum legal dosing caps on supplement products.
Comprehensive labeling of risks on packaging.
Restricting online sales channels & volume.
Setting age restrictions for purchases.
Providing towns with authority to restrict local sales.
Increasing criminal penalties for unlawful distribution.
Ensuring insurers cover evidence-based tianeptine addiction treatment.
Funding more medication-assisted treatment programs.
Implementing prescription drug monitoring for tianeptine.
A comprehensive approach including both education campaigns and improving regulations and treatment options provides the only promising way to curb the expansion of tianeptine addiction and revert it back into a medication for depression used exclusively under medical supervision.
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Conclusion and Key Takeaways
In review, here are the key facts covered about the risks associated with recreational tianeptine abuse:
Tianeptine has a high potential for abuse and addiction due to its opioid-like effects at mega-doses.
Buying tianeptine online and at gas stations and vape shops is currently very easy.
Taking up to 100 times the recommended antidepressant dose provides a temporary stimulant high but high risk of addiction to tianeptine.
Withdrawal from prolonged tianeptine misuse can be severely painful without medical help.
Overdose and adverse effects are much more likely when misusing tianeptine, especially combined with other drugs and alcohol.
Most recreational users are unaware just how hazardous abusing "gas station heroin” can be.
Education is badly needed among youths, parents, educators, healthcare providers and others.
Stricter state and federal regulations must be implemented around the manufacturing, sales and use of tianeptine products.
The FDA has not approved tianeptine for medical use and its unregulated sale as a supplement makes this opioid-like drug too easily available and dangerously addictive when misused. All stakeholders must take action through tightened restrictions and widespread public awareness campaigns before tianeptine addiction can spread further within vulnerable communities.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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