US health authorities are issuing a warning to consumers regarding a lethal and illegal drug known as gas station heroin, after a sudden upsurge in its consumption has resulted in serious health effects, hospitalization, and deaths.

The substance in question here is tianeptine, which is not licensed by the United States Food and Drug Administration (FDA) but is typically sold under many different names including Zaza, Tianaa, Pegasus, and TD Red. Such substances are sold at gas stations, smoke shops, and convenience stores and typically marketed as dietary supplements or mood enhancers with little or no mention of the danger involved.

What is Gas Station Heroin?

Although it carries a street name that suggests otherwise, gas station heroin is not actually an opioid. It does, however, interact with the same brain receptors as opioids, producing a similar high and addiction. It is used legally as an antidepressant in some countries, but in the United States, it is sold with absolutely no regulation—and is unsafe to use.

As New Jersey Poison Information and Education System's Dr. Diane Calello has described it, "It's kind of this grey area of consumer products or supplements, where the contents are not regulated or tested the way they would be with a medication. You never quite know what's in that bottle."

FDA Issues Stark Warning

The FDA recently released an official announcement labeling gas station heroin as an emerging health threat, after an increase in adverse events, and urging stricter regulation of the drug. The agency said tianeptine has the potential to lead to serious health effects, such as addiction, overdose, and death—particularly among young purchasers who may believe such products are safe simply because they can legally be purchased over-the-counter.

"This is a health-threatening and emerging trend," the FDA stated. "Consumers should be aware that these products are a new and serious health threat and should avoid them."

Alarming Health Consequences

Symptoms of heroin use at a gas station include seizures, near-fatal low blood pressure, fast heart rate, and severe psychological distress. Patients in the majority of cases need to be hospitalized in intensive care. In a single Associated Press report, more than half of 20 recent hospitalizations for tianeptine use needed ICU-level care.

Even more alarming is the reality that withdrawal symptoms are also similar to those of opioids, and thus, the drug cessation becomes both physically and emotionally painful.

State Responses and Poison Control Alerts

Poison control centers across the country have been flooded with a growing number of tianeptine calls. Alabama saw an astounding 1,400% boost in gas station heroin cases between the years 2018-2021. It wasn't until the state imposed some limitations on the drug that cases started to decline.

Other nations are also planning to get on the bandwagon as public awareness grows and health hazards mount.

 Lack of Regulation Spreads Crisis

One of the largest problems with heroin on the market at gas stations is that it is not regulated. The drugs can get around traditional drug regulation by being sold as "dietary supplements." This loophole allows them to be sold as dangerous substances without ever receiving FDA approval or safety testing.

Experts are urging lawmakers to fill these gaps in regulation. "The laws in place just haven't kept up with the quick rate at which these hazardous supplements are being marketed and sold," said a toxicology specialist close to the crisis.

Emergency Call to Action

The rise of gas station heroin is a new frontier in America's lengthy war on drug addiction. Though not an opioid, the impact of tianeptine—and the public health hazard it poses—are similar to the earlier epidemics.

Physicians, poison centers, and advocacy groups increasingly call for stronger labeling bills, public education efforts, and national bans to stem the tide of gas station heroin before it reaches epidemic proportions.

The public is also requested not to take any supplement with tianeptine and to report any response to the local poison control center or to the FDA's MedWatch program.