The young father walked across the parking lot to join other parents who were meeting their children’s new preschool teachers. After a few steps, he started sweating and having contractions. As the sky turned, he staggered back to the car, desperate to lie in the back seat and breathe, hidden by the tinted windows.
“Did you take anything?” his wife, Anne, yelled at him while calling 911. Eric, 26, had finished rehab earlier this summer.
“The shot! The shot!” » he groaned, just before hitting the ground and passing out.
At the emergency room of a nearby hospital in southern New Jersey, doctors tried to revive him with a defibrillator.
“What is he doing?” they shouted at Anne.
She showed them a small bottle of cherry-flavored elixir that she had fished out of the car. It was Neptune’s Fix, which Eric had purchased at a local smoke shop.
“What is that?” » asked a doctor.
Neptune’s Fix contains an ingredient called tianeptine, commonly known as gas station heroin.
Often sold as dietary supplement and promoted by retailers as a mood enhancer and concentration aid, tianeptine is part of a growing and unregulated class of potentially dangerous substances. addictive products available at gas stations, convenience stores, smoke shops and on the Internet. They generally include synthetic pharmaceuticals and factory-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, and even prescribed, for mood management. But the Food and Drug Administration has not approved them as drugs in the United States.
“Tianeptine is an emerging threat,” said Kaitlyn Brownclinical general director of American poison control centers, which represents and collects data from 55 centers across the country. “We have people who can obtain a substance that is not well regulated, has the potential for abuse, and in high doses can cause opioid-like effects, leading to really harmful outcomes. “
At least nine states have banned or severely restricted tianeptine, including Florida, Michigan and Ohio. In late November, the FDA issued a national alert about Neptune’s Fix in particular and tianeptine in general, telling people not to take it and warning that it had been linked to 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 disorders and other conditions,” according to the agency. warning said.
The FDA loosely supervises food supplements, an expanding universe of some 50,000 products including minerals, vitamins and compounds like melatonin. But the agency doesn’t evaluate the safety or effectiveness of supplements; it can only prohibit manufacturers from marketing them as medical treatments. It requires labels on products making health claims to list ingredients and include boilerplate warnings, such as stating that the product has not been reviewed by the FDA. The agency does not review these labels before marketing a product.
Because the FDA’s enforcement powers are limited by law, many products containing tianeptine are subject to long-evaded labeling requirements. Although the FDA has explicitly stated, for example, that tianeptine does not qualify as a dietary supplement, the labels of some brands, such as Tianaa, still make this claim.
“There are now at least a dozen different products that are foreign drugs that are being openly marketed as dietary supplements in full view of the FDA, without it being able to stop the sales,” said Dr. Pieter Cohen, associate professor. at Harvard Medical School which 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 European, Asian and Latin American countries.
But at higher doses, it also acts like an opioid, causing short-lived euphoria. In the United States, many people take tianeptine in the mistaken belief that it is a safe alternative to street opioids like fentanyl or heroin, or even a way to reduce their dependency. consumption. On social networks like Reddit, its merits are hotly debated, with more than 5,000 people subscribing to the “Quit Tianeptine” forum.
“People develop a tolerance very quickly and so quickly start increasing the dosage,” said Dawn Sollée, clinical toxicologist and director of the poison control center in Jacksonville, Florida. “They will set alarms to wake up every two hours to take tianeptine pills so they don’t go into withdrawal. And then they have to keep taking more and more just to stay functional.
Expenses can add up quickly, and so can the dangers. Recently, at a convenience store in Montclair, New Jersey, 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 smoke shop further west said customers usually bought 12-bottle boxes. A salesman at another roadside store said a customer was buying 10 boxes every week – whether for resale or personal use, he didn’t know.
It is difficult to determine the number of cases of tianeptine abuse because hospitals do not test for it. Reports to poison centers are voluntary, usually done by a concerned parent, so officials say the numbers represent a drastic underestimate.
But reported cases are increasing. In 2013, only four cases of tianeptine exposure were reported nationwide. In 2023, 391 cases were reportedaccording to US Poison Control Centers. New Jersey, which typically releases one report per year, received 27 in 2023, with patients ranging in age from 20 to 69.
“Some people apparently think it can help with chronic pain instead of having to use an opioid, which could explain the fact that the population is older,” said Dr. Diane Calellomedical director of the New Jersey Poison Control Center.
Like many illicit drugs, tianeptine is often poorly mixed with unlabeled ingredients, such as powerful synthetic cannabinoids. That’s one reason why overdose symptoms appear to vary widely, poison control medical directors said, including clamminess, nausea, hypotension and loss of consciousness, as well as seizures. and severe stomach cramps.
Sometimes naloxone, a drug that reverses opioid overdoses, can be effective in resuscitating patients, they said — and sometimes not. At least four death have been associated with tianeptine.
About a year ago, Dr Raymond Pomm, an addiction psychiatrist at Gateway Community Services in Jacksonville, saw his first tianeptine patient. To treat the patient’s withdrawal symptoms, he tried buprenorphine, a medication that curbs opioid cravings. He said he found that it helped patients manage tianeptine withdrawal and maintain abstinence.
Last summer, after Eric finished rehab kratoma potentially addictive weed originating from Southeast Asia and readily available in convenience stores and smoke shops, doctors have recommended medications for anxiety and depression. But Eric, a corporate salesman from a South Jersey suburb, was determined to stay away from mood-altering prescriptions, which he had been addicted to in the past.
In a tobacco shop, he spotted Neptune’s Fix. One seller said it might improve his mood and wouldn’t hook him.
“Since it was sold in stores, I thought it couldn’t be that bad,” said Eric, who, like Anne, asked to be identified by his middle name to protect his family’s privacy. “You know, some kind of energy drink.”
After knocking back a shot, he felt better almost immediately: more talkative, happier, more confident.
But soon, Eric said, “I couldn’t stop taking it.” »
Within weeks, he was consuming up to five bottles a day, spending more than $400 a week. His energy is flagging. Even though he was a former college athlete still used to working out daily, he couldn’t even make it to the gym anymore.
When he tried to quit all at once, the withdrawal hit him with cold sweats, muscle pain, restlessness and irritability.
A few weeks after he collapsed in the preschool parking lot, doctors at the New Jersey Poison Control Center tested the contents of his Neptune’s Fix bottles. The results included synthetic cannabinoids and other unlisted ingredients as well as tianeptine.
The FDA sent warnings in 2021 and 2022 to two companies that she said were “illegally market tianeptine products as dietary supplements and unapproved medications.
But the application requires huge resources, in part because manufacturers and suppliers can be difficult to track down. A New York Times request to the creators of Neptune’s Fix, submitted via its website, received no response. The Sheridan, Wyo. location listed on the company’s bottles is the address of a registration agent for many companies.
Regulatory experts disagree on how the FDA should effectively fight with tianeptine and other supplements. Some say the agency should establish a strict registry of approved supplements.
In interviews, some poison center directors did not endorse a total ban on tianeptine, saying it could lead to dangerous clandestine trafficking. Educating first responders and consumers about the risks inherent in these products would be a more effective approach, they said.
Removing tianeptine from store shelves, they added, would not only be a daunting task, but also of limited use, because customers could simply purchase it from the most convenient store of all: the Internet.
While Eric was recovering from tianeptine poisoning, Anne rushed to the local tobacco shop where he had purchased it.
“My husband is in the hospital because of this product and you are still going to keep it on the shelves? ” she screamed.
“Yes,” she replied to the owner, “because people want it and we have to make money.”
