‘Gas-station heroin’ sold as dietary supplement, health officials worried

'Gas-station heroin' sold as dietary supplement, health officials worried

The young father walked with other parents to the parking lot to meet their children’s new preschool teachers. After walking a few steps, he started sweating and having cramps. As the sky darkened, he staggered back to the car, desperate to lie down in the back seat and breathe, hidden by the blackened windows.

“Did you take anything?” His wife, Anne, yelled at him while dialing 911. Eric, 26, completed rehab at the beginning of the summer.

“Shot! Shot!” Just before falling to the ground he groaned and became unconscious.

In the emergency room of a nearby hospital in southern New Jersey, doctors tried to revive him with a defibrillator.

“What’s he doing?” They yelled at Anne.

He showed them a shot-sized bottle of cherry-flavored elixir that he had taken out of the car. It was labeled Neptune Fix, which Eric had purchased at a local convenience store.

“What the hell is that?” A doctor asked.

Neptune Fix contains an ingredient called tianeptine – popularly known as gas-station heroin.

often sold as dietary supplement And promoted by retailers as a mood booster and focus aid, tianeptine is one of a growing, unregulated class of potentially drug addiction The products are available at gas stations, convenience stores and smoke shops, and on the Internet. These generally include synthetic pharmaceuticals and plant-Derived substances.

something like this Kratom And phenibut, can be addictive and, in rare cases, even fatal. They often originate in Indonesia and other countries, including Russia, where they are commonly used, 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 Managing Director of America’s Poison Center, which represents and collects data from 55 centers across the country. “We have people who are able to obtain a substance that is not well regulated, that has the potential for abuse and that can cause effects similar to opioids in high doses, which can lead to really harmful outcomes. “

At least nine states, including Florida, Michigan, and Ohio, have banned or severely restricted tianeptine. In late November, the FDA issued a Alert across the country Regarding Neptune’s Fix specifically and tianeptine in general, it told people not to take it and warned that it has been linked to overdoses and deaths.

Tianeptine, which also appears as a concentrated powder or an ingredient in products such as Tiana, Zaza and Pegasus, is “illegally used to improve brain function and treat anxiety, depression, pain, opioid use disorder and other conditions.” “Sold with claims,” ​​the agency says in a warning.

FDA monitors loosely dietary supplements, an expanding universe of approximately 50,000 products that include minerals, vitamins, and compounds such as melatonin. But the agency does not evaluate supplements for safety or effectiveness; This may simply prevent manufacturers from marketing them as medical treatments. It requires product labels making 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 those labels before the product is released.

Because the FDA’s enforcement powers are limited by statute, many products containing tianeptine have longstanding labeling requirements. However, for example, the FDA has clearly stated that tianeptine is not eligible As a dietary supplement, the labels of some brands, such as Tiana, still make this claim.

Dr. Peter Cohen, an associate professor at Harvard Medical School, said, “There are now at least a dozen different products, which are foreign drugs, being marketed openly as dietary supplements under the eyes of the FDA, without To stop their sale.” studies the regulation of complements,

Tianeptine is a drug developed by French researchers in the 1960s as an antidepressant. It is approved in lower doses for use in several European, Asian, and Latin American countries.

But in large doses, it works similarly to opioids, providing a short-term euphoria. In the United States, many people take tianeptine under the widespread, mistaken belief that it is a safe alternative to street opioids like fentanyl or heroin, or even a way to reduce their use. On social media sites such as Reddit, its merits are hotly debated, with over 5,000 people subscribing to the “Quitting Tianeptine” forum.

“People develop tolerance very quickly, and so they start increasing the dose rapidly,” he said. Don Solly, A clinical toxicologist and director of the Poison Control Center in Jacksonville, Florida. “They would set an alarm to wake themselves up every two hours to take tianeptine pills so they wouldn’t go in.” withdrawal, And then they have to keep taking more and more to remain functional.

The costs can rise rapidly along with the risks. At a convenience store in Montclair, NJ, recently, 15 capsules of Tiana Red cost $34. A bottle of Neptune Fix, which comes in lemon, tropical, cherry or chocolate-vanilla flavors, costs about $16. A salesman at a roadside smoke shop in the far west said customers usually buy 12-bottle cases. A salesman at another roadside shop said a customer buys 10 boxes every week – whether for resale or personal use, he doesn’t know.

Determining the number of cases of tianeptine abuse is challenging, because hospitals do not test for it. Report to poison-control centers are voluntary, usually made by a concerned relative, so officials say the numbers represent a huge undercount.

But the news of the case is increasing. In 2013, only four cases of tianeptine exposure were reported nationwide. In 2023, 391 cases were reportedAccording to America’s Poison Center. New Jersey, which typically has one report a year, received 27 in 2023, with patients ages 20 to 69.

“Some people clearly think it can help with chronic pain rather than using opioids, which may explain the older demographic,” said Dr. Dianne CalelloMedical Director of the New Jersey Poison Control Center.

Like many illicit drugs, tianeptine is often casually mixed With unlabeled ingredients, such as powerful synthetic cannabinoids. Poison-control medical directors said that’s one reason why overdose symptoms are so widespread, including stiffness, nausea, low blood pressure and fainting, as well as seizures and severe stomach cramps.

Sometimes naloxone, a drug that reverses opioid overdoses, can be effective in reviving patients, he said — and sometimes not. at least four deaths Has been associated with tianeptine.

about a year ago, Dr. Raymond PalmAn addiction psychiatrist at Gateway Community Services in Jacksonville, saw his first tianeptine patient. To treat the patient’s withdrawal symptoms, he tried buprenorphine, a drug that reduces opioid cravings. He said he found that it helped patients come off tianeptine and maintain abstinence.

Last summer, after Eric completed rehab Kratoma Presto addictive herb From Southeast Asia, which is readily available in convenience stores and smoke shops, doctors recommend the drug 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 been addicted to in the past.

At a tobacco shop, he saw Neptune’s Fix. A salesman said it would help his mood and keep him from getting upset.

“Since it was being 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, an energy drink type thing.”

After throwing back a shot, he began feeling better almost immediately: more talkative, happy, confident.

But soon, Eric said, “I couldn’t stop taking it.”

Within a few weeks, he was drinking up to five bottles a day and spending more than $400 a week. His energy was flagging. Although he was a former college athlete, he was so used to working out daily that he no longer even went to the gym.

When he tried to quit cold turkey, withdrawal left him with cold sweats, muscle aches, restlessness, and irritability.

A few weeks after her collapse in the preschool parking lot, doctors at the New Jersey Poison Control Center tested the contents of her Neptune Fix bottles. The results included synthetic cannabinoids and other unlisted ingredients as well as tianeptine.

FDA sent warnings For the two companies in 2021 and 2022, it said that “Illegal marketing of tianeptine products As dietary supplements and unapproved drugs.”

but requires enforcement vast resources, partly because manufacturers and distributors can be difficult to track down. Inquiries to the makers of Neptune Fix submitted by The New York Times through its website received no response. The Sheridan, Wyo., location listed on the company’s bottles is an address Registration agent for multiple companies,

regulatory specialist Disagree over how the FDA should effectively deal with 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 support a complete ban on tianeptine, saying it could lead to dangerous underground trafficking. He said a more effective approach would be to educate emergency responders and consumers about the risks inherent in such products.

He added, Removing tianeptine from store shelves would not only be a staggering task but would also be of limited utility since consumers can easily purchase it from the most convenient store – the Internet.

While Eric was recovering from tianeptine poisoning, Anne visited the local smoke shop where she had purchased it.

“My husband is in the hospital because of this product and you still have it on the shelves?” she shouted.

“Yes,” she said, the owner replied, “because people want it and we need to make money.”

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