This Week’s Focus: Tianeptine

This week’s NDEWS Weekly Briefing focuses exclusively on tianeptine, an atypical antidepressant that is increasingly sold in the United States under names like "ZaZa", "Neptune’s Fix", and "Tianna Red". Tianeptine has been linked to serious health outcomes, particularly when used at doses far exceeding the therapeutic range or when combined with other substances. US Federal agencies including the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), and Department of Justice (DOJ) have issued warnings and taken enforcement actions, while multiple states have banned the substance.

NDEWS is monitoring the national scope of tianeptine-related harms through its biospatial and web monitoring reports, and the Early Warning Network. Multiple new peer-reviewed studies, public alerts, and surveillance reports are helping to clarify the scale and characteristics of this emerging threat.

To view the entire Special Report from our Weekly Briefing, click here.
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What is Tianeptine? Tianeptine is an atypical tricyclic antidepressant sold under brand names Stablon, Tatinol, and Coaxil. While it's used medically in some countries for treatment of major depressive disorder, anxiety, asthma, and irritable bowel syndrome, it has gained popularity as a recreational substance due to its opioid effects. In the US, it's commonly found in gas station/smoke shop products.

Public Health Impacts: FDA warnings and recent research highlight escalating concerns over tianeptine products sold at gas stations and smoke shops. Reddit discussants mention experiencing withdrawal symptoms worse than traditional opioids, significant financial burden, and limited awareness of harm reduction strategies beyond pharmaceutical interventions for withdrawal management.

How is it being discussed? Tianeptine's effects are frequently compared to traditional opioids across Reddit. Reddit commentors report that the intensity of these effects makes it appealing to those with prior opioid experience. Commenters also mention that the convenience of purchasing at gas stations and smoke shops makes tianeptine more accessible than illicit substances for many individuals who use. Discussants seek information about tianeptine's legal status in different locations, including speculation about future regulatory actions.

Commenters note the high price of maintaining regular use creating financial stress. Reddit users who have ingested tianeptine for a longer period of time share strategies for maintaining affordable access. Severe withdrawal symptoms are a common discussion theme. Discussants report negative experiences when attempting to quit, including seizures requiring emergency medical intervention. Harm reduction strategies mentioned in discussions tend to focus on withdrawal management. Discussants share experiences with helper medications, some report switching to kratom to manage tianeptine withdrawal, while others report seeking formal medical detoxification.

Drug interactions are a point of concern for some Reddit users, with some expressing concern over the lack of knowledge available. Reddit users who are new to ingesting tianeptine frequently seek dosage advice and experience reports.

Drug Terms: Tianeptine, Zaza, ZaZa Red, Neptune's Fix, Neptune's Elixir, Stablon, Coaxil, Tatinol, gas station heroin

Click here to read more about NDEWS Online Monitoring.

A new study in Drug and Alcohol Dependence by Dr. Fitzgerald (NIDA T32 alum and NDEWS colleague), Dr. Palamar, and Dr. Cottler (NDEWS Co-Directors) analyzed data from 6,039 adults surveyed in 20 US cities via the NDEWS Rapid Street Reporting study (2022–2023) and found 4.3% reported past 12 month new psychoactive substance (NPS) use. Synthetic cannabinoids were most common (2.5%), followed by novel opioids and synthetic cathinones (0.6% each). Individuals who use synthetic cannabinoids were more likely male, with lower education, and concentrated in the South and Northeast—highlighting the need for rapid, localized surveillance to capture emerging drug trends.
Read the report here.

The Drug Enforcement Administration published a fact sheet in April 2025. It is linked here. Additionally, a recently released 2025 National Drug Threat Assessment by the DEA highlights the growing public health threat posed by tianeptine—often referred to as “gas station heroin”—a non-FDA-approved antidepressant with mu-opioid receptor agonist activity that is increasingly sold in convenience stores under names like "Neptune’s Fix", "ZaZa", and "Tianna Red". Though not currently scheduled at the federal level, DEA reports note that tianeptine is often marketed as a supplement or nootropic and has been detected in counterfeit pills and bulk powders seized by law enforcement, sometimes alongside fentanyl or other opioids.
Read the report here.

A recently published systematic review in Current Addiction Reports co-authored by NDEWS collaborators Drs. Kirsten Smith and Oliver Grundmann analyzed 26 US-based clinical case reports (2016–2024) involving tianeptine products. Following PRISMA guidelines, the authors identified 28 patients, primarily young adult males, who used tianeptine for its anxiolytic, euphoric, or opioid-like effects. Morbidities included dependence (46.4%), withdrawal (46.4%), and toxicity (25%).
Read the report here.

A May 2025 Food and Drug Administration (FDA) alert from Commissioner Dr. Martin Makary highlights increasing adverse events linked to tianeptine. Tianeptine is marketed as a supplement or nootropic but used at doses far exceeding the therapeutic range (up to 10,000 mg/day). Reported effects include respiratory depression, withdrawal, coma, and death. A 2024 New Jersey outbreak tied to Neptune’s Fix revealed co-adulteration with synthetic cannabinoids. FDA advises clinicians to warn patients and report adverse events via MedWatch.
Read the report here.

Media Coverage:
- FDA issues warning against "gas station heroin" tianeptine - CBS News
- FDA says ‘dangerous’ substance known as ‘gas station heroin’ poses major risk to young people - Fox News
- What is tianeptine? Is 'gas station heroin' banned in Texas? See what experts say - Yahoo News
- FDA issues warning on ‘gas station heroin’ tianeptine - Medscape

A new case series in the Journal of Medical Toxicology by Dr. Counts et al., including NDEWS Scientific Advisory Group (SAG) members Dr. Krotulski and Dr. Logan, describes 41 tianeptine exposures reported to the New Jersey Poison Information and Education System (NJPIES) from June 2023–February 2024. Among 34 unique patients, 43% were intubated and 65% required intensive care unit (ICU) admission. Product testing confirmed tianeptine.
Read the study here.

A recently published analysis in Drug and Alcohol Dependence Reports by Hershey et al. examined 50 tianeptine-involved emergency department (ED) visits, 6 fatal overdoses, and 19 law enforcement seizures of tianeptine in Tennessee from 2021 to 2023 using data from the Tennessee Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE), the State Unintentional Drug Overdose Reporting System (SUDORS), and the National Forensic Laboratory Information System (NFLIS). Despite its scheduling as a Schedule II substance in Tennessee in July 2022, half of the ED visits occurred after this date. All fatal overdoses involved polysubstance use, most often fentanyl. 
Read the study here.

A July 2024 NPR feature reports a sharp rise in US poison center calls and overdose cases involving tianeptine. Marketed as a nootropic or supplement, tianeptine is often consumed at doses far exceeding therapeutic levels, sometimes over 100 times higher, leading to severe withdrawal, dependence, and documented deaths. The DEA has found bulk tianeptine powder used to manufacture counterfeit hydrocodone and heroin baggies.
Read the article here.

You are invited to attend the NDEWS Summit at the College on Problems of Drug Dependence (CPDD) 87th Annual Scientific Meeting on Saturday, June 14th (06/14/2025) from 4:00 pm - 6:00 pm CT in Bayside Ballroom AB, 4th floor. The Summit will be open to all CPDD meeting attendees. 

We hope to see you there!

NDEWS Posters and Presentations at CPDD

In June, the NDEWS team will be traveling to attend the 87th College on Problems of Drug Dependence (CPDD) Annual Meeting in New Orleans, Louisiana. Along with posters, the NDEWS team will be presenting a late-breaking abstract, an oral presentation and two invited symposia. We invite you to join us for these presentations. Please find the presentation information below:

Sunday, June 15
3:30 pm - 4:45 pm CT Late-Breaking Abstract
Anesthetics (“-Caines”) Adulterate the Illicit Fentanyl Supply: A National Drug Early Warning System (NDEWS) Alert
Joseph Palamar, Joshua DeBord, Alex Krotulski, Bruce Goldberger

5:00 pm - 6:30 pm CT Poster Session 1 (Napoleon Ballroom CD, 3rd Floor)
Trends in Nonfatal Fentanyl Poisonings Involving Stimulants in the United States, 2015–2023
Nicole Fitzgerald, Joshua Black, Linda Cottler, Silvia Martins, Joseph Palamar

Monday, June 16
10:45 am - 12:15 pm CT Invited Symposium
Found in Translation: Coordinated Preclinical, Human Laboratory and Epidemiological Approaches to Understanding Polydrug Use
William Stoops, Lori Knackstedt, Linda Cottler, Christa Corley

3:30 pm - 4:30 pm CT Oral Session: Sex Matters: Translational Evaluations of Sex-Specific Factors in Substance Use
Sex Differences in Problematic Substance Use, Mental Health, and Social Determinants of Health among Middle-Aged and Older Adults in the All of Us Research Program
Vijaya Seegulam, Bia Whipp, Liva LaMontagne, Linda Cottler

5:45 pm - 7:15 pm Poster Session 2 (Napoleon Ballroom CD, 3rd Floor)
Natural Language Processing Analysis of 7-Hydroxymitragynine Reddit Discussion
Daniel Van Zant, Kirsten Smith, Oliver Grundmann, Catherine Striley, Elan Barenholtz, Christopher McCurdy, Linda Cottler

Tuesday, June 17
3:45 pm- 4:45 pm CT Oral Presentation at Mini Symposium: Prevalence and Characteristics of Recreational Ketamine Use among Nightclub Attendees and College Students in the New York Tristate Area.
The Current Landscape of Medical and Recreational Ketamine Use
Shahar Almog, Meredith Berry, Joseph Palamar 

5:30 pm - 7:00 pm CT Poster Session 3 (Napoleon Ballroom CD, 3rd Floor)
Reported Use of Recreational and Medical Cannabis, Delta-8, and Delta-10: Findings from NDEWS Sentinel Sites and Hotspots (2022–2023)
Tamara Millay, Vijaya Seegulam, Monica Bhargavi Kodali, Linda Cottler

Wednesday, June 18
2:00 pm - 3:30 pm CT Poster Session 4 (Napoleon Ballroom CD, 3rd Floor)
Alcohol Polysubstance Use among past 30-Day Opioid Users in Northern Florida: A Model for Back Translational Research
Christian Conger, Linda Cottler

Friday, June 20
3:00 pm - 5:00 pm CT Polysubstance Use: From Bench to Communities Session 2 Keynote (LSU Health Sciences Center, 411 S Prieur Street, New Orleans, LA 70112)
The National Drug Early Warning System Networks, Initiatives and Data: How can we help?
Linda Cottler

📅 Dates: May 29 - May 30, 2025

📍Location: UF Academic and Research Center at Lake Nona, Orlando, FL

Learn more here.

📅 Dates: June 2 - 4, 2025

📍 Location: University of Puget Sound, Tacoma, WA

Learn more here.

📅 Date: Thursday, June 12, 2025

🕑 Time: 12:00 pm ET

📍 Location: Online

Learn more here.

📅 Date: Friday, June 20, 2025

📍 Location: New Orleans

Learn more here.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

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     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
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The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), New York University (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.