States are moving fast to clamp down on tianeptine, a drug sold openly at convenience stores and gas stations that can produce opioid-like effects. Lawmakers, health officials and clinicians warn it can be highly addictive and even lethal, prompting recent scheduling changes and outright bans.
Fourteen states now classify tianeptine as a Schedule I controlled substance, reflecting the spike in concern among regulators and emergency room doctors. That designation puts it in the same legal bucket as drugs judged to have high abuse potential and no accepted medical use at the federal level.
Connecticut is the latest state to act, banning the sale and use of tianeptine effective Wednesday. Officials there say the move is needed to curb addiction and protect vulnerable people from products that were being sold like snacks.
HEALTH OFFICIALS WARN OF DANGEROUS SUBSTANCE AVAILABLE IN STORES ACROSS THE NATION
The U.S. Food and Drug Administration has flagged tianeptine because, at higher doses, it can produce euphoria and has been reported to be more potent than morphine in certain effects. The Drug Enforcement Administration adds that misuse can lead to respiratory depression, severe sedation and death, creating a clear public health risk.
Manufacturers and retailers have marketed the substance as a fix for pain, anxiety or to sharpen mental alertness, packaging it as pills, powders, salts or liquids. Retailers have stocked these products at gas stations, convenience stores and vape shops, and they’ve been sold under brand names such as Tianaa, ZaZa, Neptune’s Fix, Pegasus and TD Red.
That easy availability and often candy-like flavors are exactly why Connecticut’s leadership pushed for restrictions. “With false marketing that led consumers to believe these are safe products, and with candy-like flavor options, these substances posed a clear threat to those battling substance-use disorder and our youngest residents,” she added.
Alongside tianeptine, Connecticut moved several other substances into its controlled schedule, including Mitragyna speciosa (kratom), 7-hydroxymitragynine, Bromazolam, Flubromazolam, Nitazenes and Phenibut. The list underscores a broader push to rein in novel psychoactive products that have slipped through regulatory cracks.
FDA Commissioner Martin Makary sounded a national alarm in a recent letter, calling attention to spread and risk. “I am very concerned,” Makary wrote. “I want the public to be especially aware of this dangerous product and the serious and continuing risk it poses to America’s youth.”
Clinicians who treat overdoses warn the pharmacology is troubling: tianeptine can act on serotonin pathways at low doses and opioid receptors at higher doses. “The euphoria at low doses is primarily due to increased serotonergic activity from its serotonin reuptake effects. With increasing doses, the mu-opioid receptor stimulation may become lethal,” said Robert Schwaner, M.D.
“As with heroin and other opioids, significant mu-opioid receptor stimulation ultimately results in a loss of respiratory drive and subsequent cardiac arrest,” he added, driving home the comparison between this substance and classical opioids. Schwaner also noted that the FDA has never approved tianeptine as a dietary supplement, a detail that undercuts claims of safety.
Experts argue the drug’s ability to produce tolerance and withdrawal makes it a candidate for stricter national oversight. “Acting at the same receptor as opioids, tianeptine has the potential for an individual to develop tolerance, subsequent dependence and withdrawal from its use,” he cautioned.
As states tighten rules and awareness grows, buyers and sellers of these products face a changing legal landscape. For clinicians, the message is clear: expect to see more cases and plan accordingly, because what looks like a harmless shelf product can behave like a potent opioid in the body.
