'Gas station heroin': The dangerous drug sold as a dietary supplement causing overdoses and deaths

The US Food and Drug Administration (FDA) has issued a serious warning regarding tianeptine, a substance falsely marketed as a dietary supplement but colloquially known as "gas station heroin." Despite its intent for medicinal use, tianeptine is frequently sold illegally in the United States, often found at petrol stations, smoke shops, and online vendors, even though it has not received approval from the FDA. This drug has been linked to numerous cases of overdose and fatality.

Originally developed in France during the 1960s, tianeptine was approved for depression treatment in the late 1980s, marketed under brand names like Stablon or Coaxil. Structurally resembling tricyclic antidepressants, its mechanism of action diverges significantly. Unlike typical antidepressants that elevate serotonin levels, tianeptine modulates the brain’s glutamate system, which is involved in learning and memory.

In some countries across Europe, Asia, and Latin America, tianeptine is available as a prescription medication. However, research revealed a concerning property: it activates the brain’s mu-opioid receptors, similar to morphine and heroin. This discovery has earned it the nickname "gas station heroin."

At prescribed doses, tianeptine’s effects are mild, but when taken in large quantities, it can induce euphoria, sedation, and dependency. Individuals seeking a heroin-like high may consume doses far exceeding medical recommendations, increasing the risk of overdose. In the US, it is often sold as a "wellness" product or nootropic, purportedly to improve mood, mental clarity, or cognitive function, packaged misleadingly as dietary supplements.

This regulatory loophole allows producers to bypass extensive oversight, with some products containing unlisted or hazardous ingredients, including synthetic cannabinoids. Poison control data show a dramatic increase—over 500%—in calls related to tianeptine exposure between 2018 and 2023. In 2024 alone, there were more than 300 poisoning cases linked to the drug. The FDA has responded with product recalls and import bans.

Users on social media platforms, including Reddit, report both the euphoric effects and challenging withdrawal symptoms, which resemble opioid addiction. Many describe cravings, relapses, and taking hundreds of pills daily. Since standard drug tests often do not detect tianeptine, healthcare professionals may overlook its presence, complicating treatment in emergency situations.

Withdrawal symptoms can include anxiety, tremors, insomnia, diarrhea, muscle pain, seizures, and respiratory depression—serious conditions reminiscent of opioid overdose. Hospitals have seen patients presenting with unexplained seizures or cardiac issues, possibly due to undisclosed tianeptine use.

In the UK, tianeptine remains unlicensed for medical use and is not classified as a controlled substance under existing laws, which places it in a legal gray area. It can be purchased online from overseas, often labeled as "research chemicals." Though currently little evidence suggests widespread circulation within the UK, the emergence of this substance in the black market poses potential health risks, especially for individuals seeking legal highs or alternative opioids. Because of its structural similarity to other psychoactive substances, misidentification and misdiagnosis are concerns, complicating medical response and regulation.

Tianeptine's increasing presence highlights the challenge of regulating novel psychoactive substances that are accessible online. Without proactive monitoring, the drug’s dangerous effects and addiction potential could cause widespread harm before authorities can respond.