Join our Chief Product Officer, Eric Malis, as he delves into the world of Kratom in this live recorded educational webinar. Gain key insights into its usage trends, potential effects, legal challenges, and advancements in drug testing. This is a must watch for anyone seeking clarity on this controversial substance.
In recent years, a new substance has quietly infiltrated gas stations, smoke shops, and convenience stores across the United States, contributing to the growing problem of “gas station dope.” Known by names like Zaza (Zaza Red, Zaza White) and Tianaa (Tianaa White, Green, Red), this substance, Tianeptine, has evolved from a little-known antidepressant into a drug of concern, responsible for an increasing number of poisonings, addiction cases, and even deaths. Originally developed in the 1960s by the French Society for Medical Research, Tianeptine has slipped through the cracks of federal regulation in the U.S. Its opioid-like effects, especially at high doses, have made it a popular but dangerous drug for recreational use, leading to a troubling spike in poisonings and other serious health consequences. We touched briefly on Tianeptine in our Gas Station Dope webinar, but as we are hearing more and more about its misuse from our clients, we felt it needed its own spotlight. This blog will dive into the history, pharmacology, dangers, and public health concerns of Tianeptine misuse, as well as the ongoing legislative responses to control its spread.
Tianeptine is classified as an atypical tricyclic antidepressant. While it shares some molecular similarities with traditional tricyclic antidepressants (its three-ring structure gives it the name “tricyclic”), it has an atypical mechanism of action. One of the most significant factors that makes Tianeptine stand out is its mild μ-opioid agonist properties, meaning it binds to opioid receptors in the brain, leading to mood-elevating and pain-relieving effects, not unlike opioids.
In therapeutic doses, Tianeptine’s antidepressant properties have been used in various countries to treat depression and anxiety disorders. However, at high doses, it acts more like an opioid, which significantly increases the risk of addiction, overdose, and death. Because of this, recreational use of Tianeptine has become a growing public health threat, particularly in regions where it is easily accessible and largely unregulated.
The earliest recorded instances of Tianeptine misuse date back to 1989 in Europe, particularly in France. Since then, its misuse has slowly increased, with its effects becoming more widely recognized and documented. Despite early warnings, the drug’s reputation as a relatively safe antidepressant in other parts of the world shielded it from regulatory scrutiny in the U.S. until more recently.
The opioid crisis has made Americans more aware of the dangers of opioid addiction. Yet, many are unaware that substances like Tianeptine, legally sold under names like Zaza and Tianaa, are part of the problem. The CDC reported an alarming increase in Tianeptine-related poisonings, from 11 cases between 2000 and 2013 to 151 cases in 2020 alone *figure 1. The fact that it can be purchased in gas stations, often without any age restrictions or warnings, makes it a hidden danger.
While Tianeptine is marketed as a dietary supplement in the U.S., consumers are often unaware of the potential dangers of misuse. At higher-than-recommended doses, it exhibits opioid-like effects—leading to euphoria, sedation, and a reduction in pain. This has made it attractive to those seeking an opioid-like experience without the perceived stigma or legality issues associated with traditional opioids.
Some of the most serious consequences of Tianeptine misuse include:
Due to its opioid properties, Tianeptine overdose can look similar to opioid overdose, with the risk of respiratory failure being especially high. Unfortunately, public awareness about these risks is low, partly because the drug is often marketed as a “supplement” or “natural remedy.”
*figure 1
Despite the dangers, Tianeptine is not classified as a controlled substance at the federal level in the U.S. This means that in most states, it can still be legally sold in gas stations and other retail outlets. However, the FDA has ruled that it is unlawful for use in dietary supplements or food products, though enforcement of this ruling remains inconsistent.
Several states have taken their own steps to ban or restrict the sale of Tianeptine. These include:
Some states, such as Indiana, are considering similar legislation, though no official law has been passed as of this writing. In states where Tianeptine has been banned, the black market has stepped in to fill the demand, with the drug now being trafficked illicitly. This mirrors patterns seen in the opioid crisis, where restrictions on legal access have led to a surge in illicit drug markets.
The rise of Tianeptine misuse is a clear example of the dangers posed by unregulated substances sold in seemingly harmless locations like gas stations. To address this issue, education and awareness are crucial. Both the general public and healthcare professionals need to be better informed about the risks associated with Tianeptine and other so-called “gas station drugs.” Additionally, policy measures at both the state and federal levels are needed to regulate the sale and distribution of Tianeptine. This could involve tighter controls on the sale of products containing the substance, as well as increased enforcement of existing FDA rules prohibiting its use in dietary supplements. Finally, international cooperation may be necessary to combat the global nature of Tianeptine misuse. As the drug continues to be prescribed in some countries, efforts to prevent its diversion into the U.S. market will require collaboration across borders.
One of the challenges in combatting Tianeptine misuse has been the difficulty in detecting the drug in standard drug tests. Until recently, most drug testing panels did not include Tianeptine. However, recent advances have led to the development of instant urine drug tests specifically designed to detect Tianeptine.
These tests are currently available as single-panel strip tests, but they have not yet been incorporated into more comprehensive multi-panel tests. This means that individuals who misuse Tianeptine can still pass many standard drug tests, complicating efforts to monitor its use in populations at risk.
We always get a lot of interesting questions from our clients. Sometimes these questions lead to meaningful and educational conversations or will even spark the next topic for one of our webinars. Sometimes, we get questions about something as simple as an excuse from one of your donors explaining as to why they might have had positive results on their drug test. Regardless, there is no such thing as a bad question and as a part of our core values here at National Test Systems, we encourage always asking why or how. Drug testing often encounters a myriad of excuses from individuals attempting to explain or justify why their results came back positive. These excuses can range from somewhat plausible to downright amusing. Still, I believe these are worth addressing, not only to be safe but, to know whether or not someone’s explanation is warranted and based on fact, or if they are just trying to pull one over on you. If nothing else, I hope that this can shed a little light on certain myths, true or not, but most importantly the facts about excuses a donor may come up with.
The following entries all have come from actual questions I have received from clients over the years.
Myths VS Facts
CLAIM: “I went to a concert where people were smoking weed; that must be why my test was positive for THC.”
FALSE: To test positive for THC, a significant amount of the substance must be consumed in a direct manner, meaning to be inhaled or digested directly. Even in an environment, such as small room, with heavy second-hand smoke, the exposure most likely would not be sufficient to produce a detectable amount of THC metabolites in the body. Generally, the rule of thumb is that the individual would have had felt the effects of THC in order to have the amount needed in their system to test positive, but merely being present in a smoke filled environment would not cause a positive test result.
CLAIM: “I am staying at someone else’s house, and they smoke a lot of meth; that must be why my test was positive for methamphetamine.”
FALSE: Similar to the THC myth, passive exposure to methamphetamine smoke is not enough to produce detectable levels of the drug in the body. It requires direct and substantial intake of the substance.
CLAIM: “My significant other uses meth, and we had intercourse; that must be why my test was positive for methamphetamine.”
FALSE: While substances due flow through bodily fluids, there just would not be a significant enough amount in a person’s system, or bloodstream, to be transferred in such a scenario that would cause positive drug test result. Mucous membranes can absorb substances, but the concentration required to test positive far exceeds what would be transferred through intercourse.
CLAIM: “I am a bartender, and I get alcohol on my skin and inhale the fumes all night; that must be why my test was positive for EtG (a marker for alcohol consumption).”
FALSE: Handling alcohol or inhaling its fumes is insufficient to elevate someone’s blood-alcohol levels to a detectable amount. To test positive, one would need to elevate their blood-alcohol level to excrete a detectable amount of the alcohol metabolite, EtG.
CLAIM: “I gargle mouthwash/use hand sanitizer obsessively; that must be why my test is positive for EtG.”
FALSE: Although mouthwash and hand sanitizers do contain alcohol, the levels absorbed through gargling or skin contact are too low to result in a positive test for alcohol metabolites.
CLAIM: “I drank Nyquil because I have a cold; that must be why my test is positive for EtG.”
FALSE: Although Nyquil does in fact contain alcohol and could very well cause intoxication, the amount in which some one would need to consume in order to cause a positive result for EtG would have to be much more than the recommended amount and would not be normal for a person with a cold.
CLAIM: “I drank Nyquil because I have a cold; that must be why my test is positive for methadone.”
TRUE: Nyquil contains doxylamine, which is known to cause false positive test results in all commercially available drug tests that screen for methadone. Doxylamine is also found in most sleep aids as well, such as Unisom, ZzQuil, and other over-the-counter medications.
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CLAIM: “I took Zantac for my acid reflux; that must be why my test is positive for methamphetamine.”
TRUE: Zantac (ranitidine), an over-the-counter medication used to treat acid reflux, heartburn, and other GI ailments, is known to have caused false positive results on all commercially available drug tests that screen for methamphetamine.
CLAIM: “I ate a poppy seed bagel; that must be why my test is positive for opiates.”
TRUE: Poppy seeds can contain trace amounts of codeine and morphine, enough to trigger a positive result for opiates. This is a well-documented phenomenon and a valid concern for those undergoing drug testing.
I have done some semi-scientific research on this, and my results can be found on this blog post. The short version is that poppy seeds do contain enough Codeine and/or Morphine to trigger a positive result, just from ingesting these foods. This is an exception to the rule mentioned above, in that one does not necessarily feel the effects of the Opiates in poppy seeds, even if there is a detectable amount in their urine.
Also important to note, is that ingestion of larger quantities of poppy seeds can and will cause Opiate intoxication.
CLAIM: “I added bleach/Visine/oxidizing agents to my urine sample; that must be why my test was negative for THC.”
TRUE: Bleach and other oxidizing agents can destroy THC molecules in urine, leading to a false negative result. This is a known and fairly common method of adulteration.
CLAIM: “I drank Sure-Gel; that must be why my test was negative for THC.”
FALSE: This is unfounded with no reliable evidence to support the claim that consuming gelatin products like Sure-Gel can affect THC test results. The body processes toxins through the kidneys and liver, carrying those toxins to the bladder, and consuming gelatin products to coat the bladder in an attempt to minimize levels of THC would have minimal impact on detection of these substances in urine.
Drug testing is a complex field with many myths circulating about what can and cannot cause a positive or negative result. Understanding the science behind these tests helps debunk these myths and ensures accurate interpretations of test results. While this showcased just a few “myths” or “excuses” surrounding this topic, it is important to note that there are many more examples of this and probably more yet to be seen or heard of. Donors will sometimes go to great lengths in order to adulterate or “justify” a drug test result and it is crucial for us to recognize these situations so that the best and most appropriate course of action can be taken.
Share your experiences with us! Let us know if you have encountered any other interesting excuses or myths about drug testing.
Join our Chief Product Officer, Eric Malis for another in-depth webinar on Nitazines, a potent and emerging class of synthetic opioids. We’ll explore current trends in Nitazine usage, the challenges in detecting and testing for these substances, and the latest screening methods, as well as, the significant threat they pose to public health. This session is crucial for healthcare professionals and policymakers to understand the growing impact of Nitazines and develop effective strategies to address the rise in use.
In recent months, the emergence of Medetomidine as a drug of concern has alarmed health professionals and law enforcement agencies across North America. Initially detected in Toronto in 2023, Medetomidine cases have now surged in the United States, particularly in Pennsylvania’s Philadelphia and Pittsburgh areas. The Center for Forensic Science Research & Education (CFSRE) has issued a public Alert due to the increasing instances of hospitalizations and overdose events linked to this potent veterinary tranquilizer.
Understanding Medetomidine
Medetomidine, sold under the brand name Domitor, is primarily approved for veterinary use on canines in the U.S. It belongs to a class of drugs known as alpha-2 adrenergic agonists, which also includes Romifidine and Detomidine. These substances share similar chemical structures and effects, including sedation, analgesia (pain relief), muscle relaxation, and anxiolysis (anxiety reduction). While these effects are beneficial in controlled veterinary settings, their misuse in humans poses significant health risks.
Medetomidine functions by stimulating alpha-2 adrenergic receptors in the central nervous system, leading to a decrease in the release of norepinephrine. This action results in sedation and analgesia. The drug’s potency and efficacy in animals have made it a valuable tool in veterinary medicine. However, these same properties make it particularly dangerous when used improperly in humans.
The rise of Medetomidine misuse began with the first signs observed in Toronto. Since then, the drug has spread to various parts of the U.S., with Pennsylvania being a primary hotspot. In April 2024, Philadelphia witnessed approximately 160 hospitalizations over just a few days, highlighting the drug’s rapid and dangerous impact. Additionally, Chicago has reported mass overdose events, indicating that the issue is not isolated and may soon affect broader regions.
Medetomidine is primarily being used as an additive to street opioids, including Fentanyl, and is also found in counterfeit pills. This trend is particularly concerning because the sedative properties of Medetomidine amplify the effects of opioids, increasing the risk of overdose. Similar to Xylazine, another veterinary tranquilizer misused in the illicit drug market, Medetomidine’s increased potency poses a severe threat to public health.
Reports from hospitals and emergency responders indicate a disturbing pattern of Medetomidine-related incidents. For instance, the surge in Philadelphia hospitalizations is attributed to the drug being mixed with other substances, leading to severe respiratory depression and unconsciousness. Emergency medical services in Chicago have also noted a rise in cases where individuals exhibit extreme sedation and unresponsiveness consistent with Medetomidine exposure.
Challenges in Detection and Treatment
One of the critical challenges in addressing Medetomidine abuse is the lack of effective detection and treatment options. Although it shares similarities with Xylazine, there is currently no instant drug test specifically for Medetomidine. This limitation hampers timely identification and intervention in overdose cases. Furthermore, because Medetomidine is not an opioid, the commonly used overdose reversal drug Narcan (Naloxone) is ineffective against it, complicating emergency response efforts.
Currently, Medetomidine can be detected using advanced laboratory techniques, but these are not readily available in emergency settings. The reliance on comprehensive toxicology screenings means that many cases may go undiagnosed in the initial stages, leading to delayed treatment and increased risk of severe outcomes. Developing rapid testing methods is crucial for improving response times and patient outcomes.
The treatment of Medetomidine overdose focuses primarily on supportive care. This includes maintaining airway patency, providing respiratory support, and monitoring vital signs. In severe cases, mechanical ventilation may be required. The absence of a specific antidote further complicates treatment, emphasizing the need for medical personnel to be well-versed in managing the symptoms associated with alpha-2 adrenergic agonist toxicity.
Public Health Implications, Policy, and Regulatory Considerations
The rise of Medetomidine as a drug of abuse underscores the need for increased vigilance and proactive measures within the public health and law enforcement sectors. Hospitals and emergency responders must be aware of the signs and symptoms of Medetomidine overdose to provide appropriate care. Moreover, the development and deployment of specific drug tests for Medetomidine and similar substances are crucial for early detection and intervention.
Raising public awareness about the dangers of Medetomidine is essential in curbing its spread. Educational campaigns targeting both the general public and healthcare professionals can help disseminate vital information about the risks and signs of Medetomidine misuse. Community outreach programs, informative workshops, and the distribution of educational materials can play significant roles in these efforts.
Addressing the issue of Medetomidine abuse also requires robust policy and regulatory measures. This includes tighter control over the distribution and sale of veterinary tranquilizers and increased surveillance of the illicit drug market. Law enforcement agencies must collaborate with public health officials to monitor and respond to trends in Medetomidine usage and distribution effectively.
Conclusion
Medetomidine represents a growing threat within the landscape of illicit drug use. Its potent effects, combined with its presence as an additive in street opioids and counterfeit pills, make it a significant public health concern. The current lack of effective detection methods and antidotes exacerbates the risk it poses to communities. Addressing this issue requires a coordinated effort between public health officials, law enforcement, and healthcare providers to mitigate the impact of Medetomidine and prevent further harm.
As this situation evolves, staying informed and vigilant is essential. Public awareness and education about the dangers of Medetomidine can play a pivotal role in curbing its spread and ensuring that appropriate measures are taken to protect public health. The development of rapid testing methods and effective treatment protocols is also critical in enhancing the response to Medetomidine-related incidents. By addressing these challenges head-on, we can work towards reducing the incidence of Medetomidine abuse and its associated harms.
Additional Considerations:
Research and Development
Investing in research to better understand Medetomidine’s effects on humans and to develop targeted interventions is crucial. This includes studying its pharmacokinetics and pharmacodynamics in human subjects, as well as exploring potential reversal agents that could mitigate its toxic effects. Collaborative efforts between academic institutions, government agencies, and the pharmaceutical industry can drive advancements in this area.
International Perspectives
While Medetomidine misuse is currently a pressing issue in North America, it is essential to consider its potential impact on a global scale. International cooperation and information sharing can help prevent the spread of Medetomidine abuse to other regions. Learning from the experiences of countries that have successfully managed similar drug crises can provide valuable insights and strategies.
Long-term Public Health Strategies
To combat the rising threat of Medetomidine, long-term public health strategies must be implemented. This includes enhancing substance abuse prevention programs, improving access to addiction treatment services, and addressing the underlying social determinants of drug abuse. A comprehensive approach that combines immediate response efforts with long-term preventive measures can create a more resilient public health system.
Final Thoughts
The emergence of Medetomidine as a drug of abuse highlights the ever-evolving nature of the illicit drug landscape. As new substances enter the market, staying ahead of these trends is essential for protecting public health and safety. By fostering collaboration, investing in research, and prioritizing education and awareness, we can better equip ourselves to handle current and future challenges posed by drugs like Medetomidine. In summary, Medetomidine is a powerful veterinary tranquilizer whose misuse in humans has led to significant public health concerns. Its detection and treatment present unique challenges, necessitating a multi-faceted approach to mitigate its impact. Through concerted efforts across various sectors, we can work towards reducing the harm caused by Medetomidine and safeguarding the health of our communities.