The young father headed across the parking lot to join other parents meeting their children’s new preschool teachers. After a few steps, he began to sweat and twitch. As the sky raced, staggering back to the car, desperate to lie in the back seat and breathe, hidden by tinted windows.
“Did you get anything?” His wife, Anne, called out to him while calling 911. Eric, 26, had completed rehab earlier in the summer.
“The shot! The shot!” he groaned, just before he hit the ground and blacked out.
In the emergency room of a nearby hospital in southern New Jersey, doctors tried to revive him with a defibrillator.
“What’s on;” they shouted at Anna.
He showed them a shot-sized bottle of the cherry-flavored elixir he had fished out of the car. It was called Neptune’s Fix. Eric had bought it at a local tobacco shop.
“What the hell is this?” asked a doctor.
Neptune’s Fix has an ingredient called tianeptine – popularly known as gas station heroin.
Often sold as a Dietary Supplements and promoted by retailers as a mood enhancer and focus aid, tianeptine is in a growing, unregulated class of potentially addictive products available at gas stations, convenience stores and tobacconists and online. They usually include synthetic pharmaceuticals and plant-derived substances.
Some like kratom and phenibut, can be addictive and, in rare cases, fatal. They often come from other countries, including Indonesia and Russia, where they are commonly used, even by prescription, to manage mood. But the Food and Drug Administration has not approved them as drugs in the United States.
“Tianeptine is an emerging threat,” he said Caitlin Brownits clinical managing director Poison Centers of America, which represents and collects data from 55 centers nationwide. “We have people who can take a substance that is not well regulated, that has potential for abuse, and that, at high doses, can cause opioid-like effects, leading to really harmful effects.”
At least nine states have banned or severely restricted tianeptine, including Florida, Michigan and Ohio. In late November, the FDA issued a nationwide alert about Neptune’s Fix specifically and tianeptine in general, telling people not to take it and warning that it had been associated with overdoses and deaths.
Tianeptine, which also appears as a concentrated powder or ingredient in products such as Tianaa, Zaza and Pegasus, “is sold illegally with claims that it improves brain function and treats anxiety, depression, pain, opioid use disorder and other conditions.” , the organization reports. warning he said.
The FDA oversees loosely food supplements, an expanding universe of approximately 50,000 products that includes minerals, vitamins and compounds such as melatonin. But the agency doesn’t evaluate supplements for safety or effectiveness. it can only prohibit manufacturers from marketing them as medical treatments. It requires product labels that make health claims to list ingredients and include boilerplate disclaimers, such as noting that the product has not been reviewed by the FDA. The agency does not review these labels before releasing a product.
Because the FDA’s enforcement powers are limited by law, many tianeptine products have long-term labeling requirements. Although the FDA has specifically said, for example, that tianeptine does not meet the requirements As a dietary supplement, the labels of some brands, such as Tianaa, still support this claim.
“There are now at least a dozen different products that are foreign drugs that are openly marketed as dietary supplements right under the eyes of the FDA, without being able to stop sales,” said Dr. Peter Cohen, an associate professor at Harvard Medical School. studies supplement regulation.
Tianeptine is a drug developed by French researchers in the 1960s as an antidepressant. It is approved in low doses for this use in many countries in Europe, Asia and Latin America.
But at higher doses, it also works like an opioid, offering a short-lived euphoria. In the United States, many people take tianeptine under the widespread, mistaken belief that it is a safe alternative to street opioids such as fentanyl or heroin, or even a way to reduce their use. On social media sites like Reddit, its benefits are hotly debated, with more than 5,000 people signing up on a “Tianeptine Entry” forum.
“People develop a tolerance very quickly and so they quickly start to progress the dose,” he said. Dawn Sollee, clinical toxicologist and director of the Poison Control Center in Jacksonville, Florida. withdrawal. And then they have to keep getting more and more to stay functional.”
Expenses can add up quickly, along with the risks. At a grocery store in Montclair, NJ recently, 15 capsules of Tianaa Red cost $34. A bottle of Neptune’s Fix, available in lemon, tropical, cherry or chocolate-vanilla flavors, costs about $16. A salesman at a roadside tobacco shop further west said customers usually bought cases of 12 bottles. A salesman at another roadside shop said a customer was buying 10 boxes each week — whether for resale or personal use, he didn’t know.
Determining the number of cases of tianeptine abuse is difficult because hospitals do not test for it. Reports to poison centers they are voluntary, usually done by a concerned relative, so officials say the numbers represent a drastic undercount.
But case reports are increasing. In 2013, only four cases of exposure to tianeptine were reported nationwide. In 2023, 391 cases were registeredaccording Poison Centers of America. New Jersey, which typically has one report a year, received 27 in 2023, with patients aged 20 to 69.
“Some people apparently think it can help with chronic pain instead of having to use an opioid, which may explain the older demographics,” he said. Dr. Diane Calellomedical director of the New Jersey Poison Control Center.
As with many illegal drugs, tianeptine is often sloppily mixed with unlabeled ingredients such as potent synthetic cannabinoids. That’s one reason why overdose symptoms seem to range widely, poison control medical directors said, including bleeding, nausea, low blood pressure and fainting, as well as seizures and severe convulsions. in the stomach.
Sometimes naloxone, a drug that reverses opioid overdoses, can be effective in reviving patients, they said — and sometimes not. At least four deaths have been associated with tianeptine.
About a year ago, Dr. Raymond Pomm, an addiction psychiatrist at Gateway Community Services in Jacksonville, saw his first patient on tianeptine. To treat the patient’s withdrawal symptoms, he tried buprenorphine, an opioid-reducing drug. He said he found it helped patients manage tianeptine withdrawal and maintain abstinence.
Last summer, after Eric completed rehab for kratoma potentially addictive herb from Southeast Asia that is readily available in convenience stores and tobacconists, doctors have prescribed drugs for anxiety and depression. But Eric, a corporate salesman from a South Jersey suburb, was determined to stay away from the mood-altering prescriptions he had become addicted to in the past.
In a tobacco shop, he spotted Neptune’s Fix. A salesman said he could help with his disposition and wouldn’t hook him up.
“Since it was being sold in stores, I thought it can’t be that bad,” said Eric, who, like Ann, asked to be identified by his middle name to protect his family’s privacy. “You know, some kind of energy drink.”
After throwing back a shot, he felt better almost immediately: more talkative, happy, confident.
But soon, Eric said, “I couldn’t stop taking it.”
Within weeks, he was up to five bottles a day, spending over $400 a week. His energy was flagging. Although he was a former college athlete who still used to work out every day, now he couldn’t even go to the gym.
When he tried to quit cold turkey, withdrawal hit him with cold sweats, muscle aches, restlessness and irritability.
Weeks after he collapsed in the preschool parking lot, doctors from the New Jersey Poison Control Center tested the contents of the Neptune’s Fix bottles. Results included synthetic cannabinoids and other unlisted ingredients as well as tianeptine.
FDA sent warnings in 2021 and 2022 to two companies he said were “trafficking in illicit tianeptine products as dietary supplements and unapproved drugs’.
But enforcement requires huge resources, in part because manufacturers and suppliers can be difficult to locate. A New York Times inquiry to the makers of Neptune’s Fix submitted through its website did not receive a response. The Sheridan, Wyo., location listed on the company’s bottles is an address for one registration agent for many companies.
Regulatory experts disagree about how the FDA should effectively address with tianeptine and other supplements. Some say the agency should create a strict registry of approved supplements.
In interviews, some poison center managers did not support a complete ban on tianeptine, saying it could lead to dangerous underground trafficking. Educating emergency officials and consumers about the dangers inherent in such products would be a more effective course, they said.
Pulling tianeptine off store shelves, they added, would not only be a daunting task but also of limited utility because customers could simply buy it from the most convenient outlet of all — the Internet.
While Eric was recovering from tianeptine poisoning, Anna broke into the local tobacco shop where she had bought it.
“My husband is in the hospital because of this product and you’re still going to keep it on the shelves?” she shouted.
“Yes,” the owner replied, “because people want it and we need to make money.”
The sound is produced by Tally Abecassis.