Tianeptine: a new frontier in surveillance and understanding through social media

Tianeptine, an Antidepressant with Opioid Agonist Effects: Pharmacology and Abuse Potential, a Narrative Review

Tianeptine is an antidepressant drug approved for the treatment of major depressive disorder in countries other than the US. It is classified as an atypical tricyclic antidepressant and has shown potential benefits in addressing anxiety and irritable bowel disease. However, it is important to note that tianeptine is not approved for any use by the United States Federal Drug Administration (FDA). Despite its lack of approval by the FDA, tianeptine has been distributed online and at small retail locations. The term "gas station drugs" refers to a wide range of substances typically available for purchase from gas stations, corner stores, bodegas, mini marts, smoke shops, and the Internet. These substances may be produced commercially by drug manufacturers or in clandestine laboratories to mimic the effects of more well-known illicit/controlled substances such as marijuana, cocaine, opioids, etc. Tianeptine has made its way to convenience stores and gas station shelves, branded as "Zaza" and "Tianna Red." It can also be obtained online from independent vendors without a prescription. Misuse of tianeptine can lead to euphoric, opioid-like highs with the potential for chronic users to develop dependence and tolerance. Overdose and use in suicide attempts have also been documented. This manuscript is a narrative review, highlighting the dangers of tianeptine and other gas station drugs and underscoring the urgent need to regulate these substances.

Nursing Implications for Tianeptine Use and Misuse

ABSTRACT

Tianeptine is an atypical antidepressant that is not approved for use in the United States and has a significant potential for abuse. In recent years, illicit use and misuse of tianeptine have become increasingly common. Symptoms caused by illicit use and withdrawal from tianeptine have become an emerging public health concern. Nurses should be aware of serious or even fatal opiate-like intoxication or withdrawal symptoms, which may present in the absence of a positive urine drug screen or in cases where withdrawal does not follow expected patterns. The associated health effects of tianeptine exposure and misuse include neurologic, cardiovascular, and gastrointestinal symptoms, which manifest in a similar manner to opioid toxicity and opioid withdrawal syndrome. People who illicitly use or misuse tianeptine should be educated regarding the risks associated with this drug. In addition, nurses should promote screening, intervention, and referral to treatment for this and other substance use disorders. Nurses should also support efforts to control access to products containing tianeptine.

Microdose Induction of Buprenorphine in a Patient Using Tianeptine

BACKGROUND

Opioids and opioid alternatives are a serious threat to public health in the United States and other countries. Patients are looking to the internet increasingly as a source of opioid alternatives to self-treat addiction or other psychiatric conditions. It is imperative that patients receive proper treatment to prevent morbidity and mortality related to opioid use disorder.

CASE SUMMARY

We report a case of a middle-aged male with a 3-year history of tianeptine use who presented to an outpatient clinic looking for addiction treatment options after failed attempts at tapering his daily dosage of approximately 10 grams per day. The patient underwent a microdose induction of sublingual buprenorphine over a 7-day period (0.25-12 mg) while continuing tianeptine use, and self-monitored for withdrawal symptoms daily using the Clinical Opiate Withdrawal Scale. The patient was seen over the course of treatment by a board-certified toxicologist and addiction specialist on day 2, 5, 6, and 14 to ensure patient safety and treatment adherence. After 14 days of treatment, the patient was able to stop tianeptine use without any major symptoms of withdrawal, anxiety, or depression.

DISCUSSION

This case report highlights the effectiveness of buprenorphine in the treatment of opioid use disorder in a patient using tianeptine and further exemplifies the utility of buprenorphine in an outpatient setting.