Tianeptine is an atypical tricyclic antidepressant, commonly referred to as Gas Station Heroin or Za Za. Its use, linked to serious harm and death, has been making headlines. Tianeptine is not approved in the United States but is legal in other countries to treat depression or anxiety. Reports in the United States about severe harm due to tianeptine have been increasing, leading the FDA to issue a formal warning about the drug¹.   

The clinical effects of tianeptine are very similar to opioids, leading some opioid users to switch to tianeptine as an opioid alternative1. Other users have turned to tianeptine to self-treat depression or anxiety. Tianeptine users experience dependence, withdrawal, and overdose when used at concentrations above the therapeutic doses prescribed in other countries¹. However, when tianeptine is used in small doses consistent with therapeutic treatments, no negative side effects have been reported. Several case studies have shown that tianeptine toxicity mimics that experienced from opioids and that naloxone is an effective therapy^2,3. 

The Centers for Disease Control reports that tianeptine use is on the rise. From 2000 to 2014, there were 11 calls to poison control regarding tianeptine, but from 2014-2017, there were over 200 calls⁴. Nationally, tianeptine is not scheduled, though Alabama and Michigan have added the drug as a Schedule II substance. Tianeptine is readily available online, typically in tablet or powder form⁵. 

References:

1. Tianeptine Products Linked to Serious Harm, Overdoses, Death | FDA 
2. Acute Toxicity From Intravenous Use of the Tricyclic Antidepressant Tianeptine – PubMed (nih.gov) 
3. Amitriptyline and tianeptine poisoning treated by naloxone – PubMed (nih.gov) 
4. Characteristics of Tianeptine Exposures Reported to the National Poison Data System — United States, 2000–2017 | MMWR (cdc.gov) 
5. Tianeptine (usdoj.gov) 

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