‘Gas station heroin’ alarms poison center officials in N.J. and beyond

New Jersey poison center physicians are raising new alarm about the drug tianeptine, which has been linked to seizures, cardiac arrest, and other adverse effects in at least 35 state residents since June.

Informally called “gas station heroin” because it is sold in gas stations and behaves chemically like an opioid, the drug is increasingly tainted with other substances that may be contributing to the toxic effects, the physicians reported in a new study.

The drug, called an atypical tricyclic antidepressant, is not approved by the FDA, though some countries have authorized it for treatment of anxiety and depression. Since November, the agency has issued at least three warnings against one such product sold as Neptune’s Fix, citing reports of seizures, unconsciousness, and death. One distributor of the product agreed to recall it in January, and a second one did so on Feb. 15. Several states, including Florida, have banned or restricted its use.

Some distributors have marketed the supplement as an aid for depression, anxiety, and pain. Others claim it boosts energy and focus.

The New Jersey study described 20 adverse episodes in 17 people who used tianeptine between June 17 and Nov. 6, including eight seizures and one cardiac arrest. All were described as having “altered mental status.”

Six of the patients reported using various supplements or prescription drugs, as well, so those substances may have played a role in the toxic effect, said lead study author Christopher J. Counts, a toxicology fellow at the New Jersey Poison Control Center at Rutgers New Jersey Medical School.

In addition to analyzing the patient outcomes, Counts and his coauthors tested six samples of Neptune’s Fix, finding that in addition to tianeptine, they contained synthetic cannabinoids or other unreported ingredients. The samples were tested by the Center for Forensic Science Research and Education, a nonprofit lab in Horsham.

Since the study period concluded on Nov. 6, the New Jersey poison center has gotten an additional 18 reports of adverse events after use of tianeptine, for a total of 38 episodes involving 35 patients, Counts said. In many cases, the calls come from emergency-room doctors or nurses who seek guidance on how to treat such patients.

Among other recommendations: Patients should get an electrocardiogram, as the drug can cause an abnormal heart rhythm, he said.

Public health officials have been raising the alarm about tianeptine since at least 2018. That’s when a CDC analysis found that between 2013 to 2017, U.S. poison centers received more than 200 calls about adverse effects after use of the drug.