Tianeptine, or ‘gas station heroin,’ causes intense withdrawals | Hacker News Reader

Tianeptine, or ‘gas station heroin,’ causes intense withdrawals

vice.com

63 pointspseudolus71 comments

> He said he plans to move back to Alabama, where tianeptine is banned. Despite the difficulty of his withdrawal, he said he celebrated his 10-day detox by taking 12 pills. But he doesn’t believe it will override the detox.

Man these addiction stories are hard to read.

I'm not going to get into specifics of this, mainly because they aren't my stories to tell, however I do allot of work with addicts to help them to recover.

You would be amazed the amount of people how do something similar to this. They get past the first week (typically the hardest part), and because they can see the light at the end of the tunnel they assume they are "cured". They then relapse to celebrate.

Usually it takes several attempts for someone to understand that the voice telling them that they are cured is still just the addiction. It takes even more attempts for someone to understand that you are never really "cured", because the fact is drugs are awesome, more awesome than life itself. That's why they're so dangerous because logically why would you'd choose life in that scenario (esp if your life is already pretty crap)

Quitting an addition is difficult - but staying clean in the long term makes the quitting part look easy

.. state certified harm reduction counselor here .. yet another inflamed fear-inducing shite article not rooted in science or reality. Stablon [tianeptine] is a valid tri-cyclic, in use since the mid-80's and quite effective under proper guidance. And while it indeed nudges all three opiate receptors - it by no means is anywhere near as addictive [physiologically] as heroin. VICE, one step above The National Enquirer. Why this garbage makes it way to HN is beyond me.

I think you are using the most uncharitable reading here. I had never heard of tianeptine before this article and yes if my doctor was to prescribe it I'd have concern now, but the article is not about it being worst than heroin. It's about the fact that a substance which can cause significant physical and psychological addiction is being sold in gas stations without any indication that it might be addictive.

If you look at the label in the picture, this is terrifying stuff that is marketed as a dietary supplement while causing enough symptoms that people are going to detox over it. Even if it's half or a tenth as bad as heroin, that's way too much considering how it's marketed.

the mandatory warning label on alcoholic beverages doesn't say anything about addiction either...

> GOVERNMENT WARNING: (1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects.

> (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.

you can buy malt liquor at gas stations in several US states. at least they warn you not to drink it on your way home!

in all seriousness, I really doubt the type of person who buys random "supplements" from a gas station to get high is going to be deterred by a scary warning label.

That argument is intellectually dishonest at best. Alcohol causes physical and psychological addiction as well, but its effects are well known and it isn't marketed as a dietary supplement.

You also need serious abuse with alcohol to get to a point where you are spending every paychecks on booze and become non-functioning like the people that are described in the article. Alcohol addiction does not happen over a week.

Finally it all comes down to the ratio of casual users vs addicted users. Millions (perhaps billions) of people drink alcohol and a fraction have serious addiction issues with it. Same goes for caffeine. They are not comparable.

fwiw, I do think the labeling issue is a fair point. I just doubt it would have much impact.

as for the rest, it reads much like the rest of the sensationalism typically heard when the general public funds out about a new drug of abuse for the first time. if you wanted to write a piece like this, I doubt it would be hard to find a handful of people who became severely addicted to alcohol from the first sip.

and I suspect you will want to split hairs with me on what exactly "casual vs addicted" means, but the figures I can easily find suggest that opioids have a similar addiction risk versus alcohol. it's hard to find a good denominator for casual opioid users, but this [0] study puts the rate of addiction among PM patients around 10%. meanwhile, about 10% of Americans over 12 years old develop alcoholism [1]. not quite an apples to apples comparison, but the raw "addictiveness" is likely within the same ballpark.

[0] https://journals.lww.com/pain/Abstract/2015/04000/Rates_of_o...

[1] https://drugabusestatistics.org/alcohol-abuse-statistics/

Here's an entire subreddit that would disagree with you [1] as well as some pretty harrowing withdrawal accounts [2] [3].

[1] https://www.reddit.com/r/QuittingTianeptine/ [2] https://www.reddit.com/r/QuittingTianeptine/comments/z7gopv/... [3] https://www.reddit.com/r/QuittingTianeptine/comments/yp7y6n/...

Yeah, every reputable nootropics community recommends avoiding tianeptine for a reason. It's right up there with phenazepam in the "this should probably be illegal" category.

That second post is absolutely brutal. Holy hell. I’m someone with a very addictive personality and I can easily see myself in this situation if I don’t avoid these substances. So seeing someone struggling in this way, just how I would be if I took a wrong turn in life, is heartbreaking.

The more comments I read about this stuff, the worse it looks...

"I'm a father of 3 who is currently going through a divorce because of tia. I lost everything and currently staying at a friend's house and not with my family and wife of almost 18 years. I blew through all of our money and it took this to happen for me to get off. I've been on suboxone for 8 days now and tia free for 8 days. If he truly wants to get off tia, he will have to get off of everything and take his subutex for the reason it is prescribed. Tia is the devil. I started taking it when I quit drinking and fell in live with the way it made me feel. I've spent thousands of dollars on it the last couple years." [1]

[1] https://www.reddit.com/r/QuittingTianeptine/comments/xunr2i/...

As someone that has used and been extremely hooked on it, it is as bad psychologically as heroin. I drained my bank to use it, came up with extremely clever ways to get more. I was on a 10g+ per day habit. I had to get on methadone to stop.

Thanks for sharing your comments.

I have a flurry of thoughts on all of this:

- Vice is often very hyperbolic

- but these sure sound like real stories

- the medical community is kind of famous for telling people their symptoms aren’t real, so I’m cautious of any claim

- but maybe you’re not saying it’s not addictive, and while it might be able to destroy lives, it’s just not “heroin” magnitude.

- maybe the “heroin” label is a term developed by the community and not Vice itself

- how this isn’t controlled in the US and Canada is beyond me. Ignorantly this makes me wonder if it truly is that dangerous. Then again there sure are a lot of chemicals out there…

“state certified harm reduction counselor here”

Which means almost nothing. Unless you’re a pharmacologist, or a neuroscientist (as I am), please refrain from giving scientific opinions in this field.

This seems pretty gatekeeper-y. Who gets to decide which credentials are valid in this discussion and which aren't?

Whichever self-proclaimed "expert" spends more money lobbying the government and has more friends in legacy and social media corporations wins I think.

I do. I rule in favor of the person who claims to be claiming to be trained officially.

Anyone is allowed to look at numbers and do simple math. You have exclusive license for that.

It's one thing to say "here's how my opinion is educated" and quite another to say "only my opinion matters and those others don't".

Holy cow do you hear yourself? Didn't we just have someone run for US president recently who was famously stupid and ignorant despite being a neurosurgeon? So you're a neuroscientist? Big fucking whoop. I'm sure your mom is proud.

Yes, we had a neurosurgeon run for the Presidency who, according to experts, had some foolish tax policies he wanted to implement. You don’t hear me making pronouncements on tax policy, because I don’t know enough about it. Nor should a “harm reduction counselor” try to make authoritative statements about neurological pharmacokinetics and the like.

Seems like you didn’t quite think that analogy through.

But a real life neurosurgeon did do that stupid thing.

Being educated enough to be accredited in some field does not automatically prove either intelligence or wisdom, let alone character or integrity, even IN that field, and so is merely a data point to consider and not the end of all conversation when they voice an opinion, even in their claimed wheelhouse.

One can be very smart and very informed on a topic, and also be an asshole whose opinions on that topic and most others should be disregarded because their motivations are shit.

But one way you can judge some of those things is by the difference between the two types of statements in my first comment.

field experience with psychoactives can easily trump desk-jockeying work.

9/10 doctors think boobs feel like sand.

Physician here... it is being sold unregulated at gas stations. I echo the comments of many others that "supplements" should have to undergo safety vetting similar to any other pharmaceutical. Bogus supplement companies put people in harm at the worst and make people waste their money at the best. Snake oil salesmen.

Online nootropics communities have been warning about tianeptine for over a decade. Yes, it's quite effective under proper guidance. So are benzos, but we don't let people buy Xanax at the gas station, or let people buy 300 Xanax pills online without a prescription.

tianeptine isn't FDA-approved. and though tianeptine is structurally a TCA, and is prescribed abroad as an antidepressant, it doesn't hit serotonin receptors. it's like calling tramadol an antidepressant - actually, tramadol is more antidepressant-like than tianeptine.

as a harm reduction counselor, wouldn't you agree that kratom is a better choice than Stablon? kratom at least has a dose ceiling, much reduced risk of respiratory depression, and a millenia-old history of use.

I don't understand how these pills end up in gas stations. they're not legal! legal to buy, sure, because they don't contain scheduled drugs (and tianeptine isn't an analog of a scheduled opioid), but you can't sell synthetic chemicals as dietary supplements without FDA approval!

like, kratom is fair game because it's a plant, and natural products aren't regulated. but tianeptine doesn't grow on trees.

it just seems so brazen that the company is up front about it being tianeptine and selling it commercially on a gigantic scale. how are they not shut down?

A jocular saying is that, in England, "everything which is not forbidden is allowed", while in Germany, the opposite applies, so "everything which is not allowed is forbidden". This may be extended to France—"everything is allowed even if it is forbidden".

But that's not true for Germany.

Tianeptine isn't a recognized drug in the US (though it is in Europe, iirc), but it's been available from online RC/nootropic vendors for years. It's not the first time something like this has happened, either - a while back it was found that several brands of "herbal viagra" sold in gas stations actually contained pharmaceutical PDE5 inhibitors.

Make a quick buck and run, I guess.

Edit: apparently tianeptine is a full mu-receptor agonist

I posted this link elsewhere in the thread, but basically "herbal viagra" products are consistently found to include actual drugs (usually the active ingredient of the real thing): https://www.fda.gov/drugs/medication-health-fraud/tainted-se...

“VICE News reached out to several manufacturers and retailers that sell tianeptine to ask for comment on the health concerns surrounding the drug but did not receive a response.”

Name them. Why not?

The total lack of regulation for "supplements" is kind of bizarre. Seems to me people shouldn't be able to sell any compound they like as a pseudo-medicine.

It shouldn’t be surprising. It’s the typical self-interested “freedom” debate.

Senator Orrin Hatch of Utah essentially neutered the ability of the federal government to take most any useful action against supplements unless they are proven to cause harm. The rationale is pretty simple. Utah is the center of the MLM universe, and they are big supporters of the Senator.

Supplements attract scammers like the flies to light. Herbalife is the best known of these products, but there are dozens of these schemes selling everything from powered bone material to herbal viagra.

It’s a common pattern that effective in selling bad ideas.

>Senator Orrin Hatch of Utah essentially neutered the ability of the federal government to take most any useful action against supplements unless they are proven to cause harm.

Would you rather that the federal government can shut down any company they want without having to prove harm?

Yes. They should be able to take action against false claims of efficacy or purity.

In theory, they can. Supplements are required to have labeling that "This product is not intended to diagnose, treat, cure, or prevent any disease." And they can't have advertising that says otherwise.

In practice, the FDA doesn't even begin to enforce this rule. Even if the company is careful in its language, they're not going to monitor stores to ensure that the staff isn't pushing the product, or contradict social media posts.

Smaller companies will just plain defy the rules. If it comes to the FDA's attention, they'll send a letter -- at which point the company will go bankrupt, and a new company will appear selling exactly the same product.

The FDA does take a fair bit of action, especially after somebody has gotten hurt, but they don't have anywhere near the budget required to monitor the $40 billion supplement market.

Supplements are not really all that different from drugs. And for those you have to prove they're safe before you can sell them. For supplements you have to prove nothing.

> Would you rather that the federal government can shut down any company they want without having to prove harm?

No, not "any". Is that really what you meant to ask?

Supplements, though? Whether extracts or synthetic chemicals that don't have evidence of being safe in that form? Yeah probably.

There is plenty of middle ground. Create a safe harbor for small producers and anyone who voluntarily gets certain certifications, with increased liability and maybe disclosure requirements for those who don’t. Or maybe require a safety study without needing to prove efficacy, et cetera.

I think I’d you’re selling me a cure, you should prove that it cures something and is safe.

Safe needs to be defined as well. As we learned during the pandemic, there’s a spectrum of risk tolerance that individuals have.

> I think I’d you’re selling me a cure, you should prove that it cures something and is safe.

Are these marketed as a cure? The pictures in the article doesn't seem to indicate that they're claiming to cure something, just a vague label of "dietary supplement".

Yes. They’ve lawyered up after “Airborne” was marketed as developed by a teacher to prevent the cold, and subsequently sued.

Now, they say “developed by a teacher” and use social media influencers to make or imply health claims.

These companies make millions ripping you off. People don’t take blood pressure meds they need, but drop $75 on CoQ10 and cod liver oil.

I'm confused about what is actually going on here. The FDA claims [1] that Tianeptine can't be used as a supplement ingredient so selling it should be illegal. That was from 2018 so there is no reason it should still be able to be sold.

Notwithstanding, The FDA could simply put Tianeptine on the controlled substances list.

1: https://www.fda.gov/food/dietary-supplement-products-ingredi...

Drug regulation is typically done from the benefit side: prove that your drug has the benefits you say it does or you’re not going to market. I’d be okay with supplements taking the opposite stance: prove that your supplement doesn’t inflict serious harm on your test group and we’ll let you go to market.

We could look at it as a problem, but if we keep idiots safe from this bullshit, they'll just go do something equally as stupid. If we get rid of this it'll be one less thing we have to thin out the herd.

I look at it as a solution.

.../s

Thought this was going to be about Kratom.

All of the "supplements" should be banned by default and have to pass some sort of regulatory check to be sold. Just insane that after the opioid epidemic that we are still allowing this.

The war on drugs (and prohibition at large) has caused externalities in the form of weird, experimental drug cocktails being marketed in this legal grey area since they aren't on the naughty list yet. Instead of treating the root cause (that prohibition has largely failed everyone except pharmaceutical drug companies and the companies that sell military gear to the police and DEA), we're going to expand the naughty list to include everything that hasn't been whitelisted by regulators and the pharma companies?

I am really not sure how you look at this story about drugs which are just subject to no prohibition at all (those you can literally buy at a gas station) and the trouble they're causing for people, but your take-away is "the war on drugs is bad".

How much have you followed along with the progression of grey area drugs over the last 30 years? Who was it that started the opioid epidemic again?

Yeah, I'm thinking the solution is ban more stuff and then hand the reigns back to the regulators who have definitely not been subject to regulatory capture by the companies that started the opioid epidemic.

Why should the companies that pushed opioids be allowed to push anything else? All those doctors who knew they were overperscribing opioids to addicts knew what they were doing, and they would do it with any other drug too.

I love how nuanced the thinkers of HN are. Given the responses here, evidently the options are to either (a) let Purdue market heroin to kids or (b) ban all non-pharmaceutical drugs and give no-knock warrants to FULLY TACTICAL® DEA AGENTS so that they can smash in the doors of non compliers.

EDIT: this was in response to the pre-edit version of the comment. I think the current version of your comment is much more reasonable. I broadly agree with your point: when people have bad incentives they will do bad things. So my response to that is to try to give doctors better incentives, and limit the extent to which pharmaceutical companies like Purdue can inject perverse incentives back into the system.

I totally thought it was sarcasm

I really am confused here - are you say there should be regulation, but it should be done better, or that there should not?

"Yeah, I'm thinking the solution is ban more stuff and then hand the reigns back to the regulators who have definitely not been subject to regulatory capture by the companies that started the opioid epidemic."

That is sarcasm. Prohibition has failed and the growth of grey area drugs ("designer" drugs) is one of the direct consequences. I am not arguing against regulation, I am arguing against prohibition. As JumpCrisscross brought up, they are very different things.

None of e.g. fentanyl, methamphetamine or cocaine are "prohibited" since they're Schedule II drugs.

> no prohibition at all

Prohibition is black and white. You can’t have a little prohibition, that’s on par with ending a ten-day detox with a mouthful of pills.

The war on drugs enforced a prohibition. Most of this thread advocates for regulation. I suspect you and the comment you’re responding to do as well.

Sure you can have a little prohibition. Many prohibitions have exceptions. Between drug scheduling and various scopes of jurisdiction and enforcement, prohibition can be shades of gray.

> Between drug scheduling and various scopes of jurisdiction and enforcement, prohibition can be shades of gray

You’re describing enforcement. Prohibition is the legal action that precedes its enforcement. That semantic nuance is derailing this discussion.

Prohibition can exist for the most dangerous drugs while sensible regulation can steer people toward the safest possible use of safer alternative substances.

As in, opium can be legal while carfentanyl is not, or marijuana instead of the synthetic compounds that mimic it but are more dangerous, etc.

Ok, pretend I didn’t mention enforcement. The written law for almost every prohibition the US has ever had, has explicit exceptions. Even the Volstead Act itself.

> pretend I didn’t mention enforcement. The written law for almost every prohibition the US has ever had, has explicit exceptions

Fair enough. Within a drug policy discussion, I think a lot of toes get snubbed by people disagreeing on the definition of prohibition. Exemptions to a blanket ban is quite different from e.g. requiring safety studies.

People addicted to substance do suffer and can produce negative externalities but spending money on militarised police which puts in jail anyone who possess a banned substance IMHO is not the best way to allocate (always) limited funds. What would actually help is not clear but I hate when politicians follow the algorithm: we need to do something about the problem, here is something so let’s do it (even if it doesn’t work or cost is too high for provided benefit).

The Drug War operates on a list of banned drugs.

There is more evidence against banning drugs than there is against when the goal is stopping drug abuse.

Adding this drug or a class of drugs to the ban list is not going to stop drug abuse.

The only way to stop the war on drugs is to stop fighting drug abuse and accept it as an inevitability of the human condition.

Totally different issue.

To sell a drug, you need to demonstrate therapeutic effectiveness. Someone demonstrated that beta blockers lower blood pressure, for example.

But I can sell a jar of bone meal mixed some ramen chicken flavor, and say that cavemen ate soup made with bone broth, and some people have reported developing caveman strength by consuming bone broth.

The loophole is that products have dual use or traditional use. For example, isopropyl alcohol isn’t a regulated “pesticide” for disinfecting surfaces because it predates the regulatory process. Or honey can help with a cough, but you can’t label honey as a cough suppressant. Scammers abuse that loophole.

Or you import "herbal supplements" from China; when the FDA figures out that your particular supplement also has amphetamines and/or viagra in it, you start importing one with a different name. Here's a bunch of notifications from the FDA about various gas station sexual enhancement pills which have "hidden drug ingredients": https://www.fda.gov/drugs/medication-health-fraud/tainted-se...

That’s kind of what happened in Australia after the explosion of research chemicals and “technically not xxx” alternatives were being imported legally.

They banned drugs based on ‘having an effect’ as opposed to the chemicals they contained.

https://www.justice.vic.gov.au/psychoactive-substances-laws

I knew a lot of people importing research chemicals from Chinese websites prior, and a lot of that stopped after these laws came into play. I’m not sure how wide spread the related issues were, but it was definitely a thing.

But Australia never had the synthetics being sold in service stations like the article stated. That was a big thing in New Zealand tho, until it got clamped down on.

Why should the government have such great control of what I put in my body? While the marketing should probably be limited and the risks made known, I don't think anything should be entirely banned.

Are you seriously saying this after reading the article?

You just read that it’s perfectly legal for some predatory “pharma” scum to flog heavily addictive opioids as “food supplements” on gas stations, and your instinctive reaction is to start spewing some “dont step on snek” drivel?

While banning stuff entirely should be reserved for most harmful substances, heavily addictive pharmaceuticals should be heavily regulated, because the consequences both for masses of individuals and the society as a whole would be dire otherwise.

No matter how you “limit the marketing” of the stuff that will make you wanna pop a whole bottle in one go and then go buy some more, there’s always going to be a tragic number of poor fucks who will eventually ruin their health and their lives with that shit, and probably end up living in one of those tent sprawls that you can find in the very center of practically every major US city today.

So, I’m sorry to pop your libertarian bubble, but this is not really about your liberty to put shit (legally) in your body, it’s about protecting the weak from predatory scum, and protecting the society from the externalities of addiction epidemics.

Selling as 'food supplement' is just due to the lack of regulation in the US. It is a drug, and should be labeled as such, but that is not legally possible because it is not approved as a drug in the US. Tianeptine is an antidepressant and anxiolytic drugs used in some countries. Honestly, I would not object too much if they go after those sellers, but this kind of logic leads to the war on drugs and legislations lime the Psychoactive Substances Act in the UK, which is essentially a blanket ban on all psychoactive substances. It restricts everyone's freedom to experiment and improve their lives with different substances.

Because some drugs are so addictive that they'd make you be willing to kill random passersby just to take their money and valuables to buy your next hit with. Such drugs should be banned for the same reason that DUI is.

This sounds more like FDA failing to properly regulate well-known psychotropic medications used around the world. There's a reason people can't sell Zoloft as a "dietary supplement".

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