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Comment by DueDilligence | Hacker News Reader

.. 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.

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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/...

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/...

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.

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.

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?

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

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

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

9/10 doctors think boobs feel like sand.

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.

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.

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