Prior to 2008, the only drugs you could (usually) buy at the gas station were the legal and well controlled drugs like tobacco and alcohol. While these products certainly pose significant dangers and health risk, the risks associated with tobacco and alcohol are well known and well documented. Additionally, the products are consistent. Each time you buy a particular brand of beer or pack of cigarettes, you are getting exactly what you intend. While alcohol and tobacco aren’t health products by any stretch, they are predictable in their taste, ingredients, and amounts of alcohol and nicotine they contain. Those rotating hot dogs at the gas station are another story...
Around 2008 the market began to change. All of the sudden products ‘not meant for human consumption' began appearing at the gas station counter (and the internet, smoke shops, etc.) and we entered the era of the gas station drug store.
One of the biggest concerns with these drugs is they are not marketed for the effect they produce. They are marketed as ‘incense” or ‘dietary supplement’, so people are not approaching these substances with the same caution and knowledge that they might approach alcohol, cocaine, or marijuana.
2008 saw a rise in the US of synthetic marijuana which is produced by synthetic cannabinoid receptor agonists (SCRAs). The products were given names such as spice and K2 and sold in small plastic containers or foil packs at gas stations and smoke shops. They were often called ‘potpourri’ and labeled ‘not for human consumption’ which helped sidestep FDA scrutiny. SCRAs were not regulated well at the time and the primary SCRA being used was a compound known as JWH-018.
However, by the end of 2009 JWH-018 had been regulated, so producers created new analogs that were not explicitly controlled to quickly replace those that could lead to prosecution.
Each time a specific compound was banned, a new analog was released but over time this often resulted in more risks for the consumer. In August 2016, Austin, TX saw over 50 EMS calls in approximately 24 hours related to K2.
The potency of unregulated products can vary wildly, and some compounds are more damaging than others. Risks associated with the products included severe agitation and anxiety, nausea, vomiting, tachycardia, elevated blood pressure, tremors and seizures, hallucinations, dilated pupils, and behavioral changes.
The level of hysteria that surrounded the bath salt craze served to frighten rather than educate. Many reports were either greatly exacerbated or just patently false. However, bath salts do carry substantial risks.
Bath salts contain synthetic substituted cathinones related to amphetamines such as mephedrone, methylenedioxypyrovalerone (MDPV) and methylone – all highly addictive. Synthetic cathinones are a class of lab-made stimulants chemically related to substances found in the khat plant. Khat is a shrub grown in East Africa and southern Arabia that some people consume for its stimulant effects.
‘Bath salts’ were marketed as bath salts, but also plant food and jewelry cleaner. They could be taken orally, injected, or smoked, with the latter two producing the worst outcomes. Generally, people experience euphoria followed by paranoia, depression, agitation and intense craving for more. Bath salts produce an intense high, extreme energy, tachycardia, excessive sweating, and insomnia reported to last up to 8 hours. In more extreme cases people have become severely dehydrated, experienced renal failure and death.
Gas Station Heroin
The drug getting the focus now is tianeptine, known informally as gas station heroin. Frequently sold under the name “Neptune’s Fix” which is often promoted to boost the mood, help focus, relieve pain, or is simply called a ‘dietary supplement’.
Tianeptine is an antidepressant drug approved for the treatment of major depressive disorder in countries other than the US. Misuse and/or high doses of tianeptine can lead to euphoric, opioid-like highs with the potential for people to develop tolerance and withdrawal. Overdoses have also been documented.
Tianeptine has been linked to at least 20 cases of ingestion with severe, adverse effects which included seizure and cardiac arrest, in the New Jersey area alone.
Like earlier iterations of gas station drugs, “Neptune’s fix” is often sloppily made and mixed with other unlabeled, and unregulated ingredients. Since ingredients and potency can vary, so can the risks and the overdose symptoms.
Tianeptine: Harm Reduction
If you choose to use products containing tianeptine, you deserve to have information that may help keep you safe.
Rash, itching, swelling of face or tongue and/or difficulty breathing could mean you are allergic to tianeptine.
Tolerance increases VERY rapidly with continued use.
Tianeptine does not dissolve easily in water and therefore should NOT be injected (risk of vein collapse/hardening).
Snorting tianeptine should also be avoided (painful).
Mixing tianeptine with antidepressants/MAOIs can cause serious cardiovascular problems.
Take similar precautions that you might with other opioids (slow/low, do not mix with alcohol/benzos/other opioids, avoid using alone).
Naloxone/Narcan should be kept available. It helps sometimes, but not in all overdose cases.
To ban or not to ban
On the one hand, banning these substances takes them out of stores where they could be marketed to uninformed people who think the products are safe. It would also help prevent the sale of these products to minors. However, others, including some poison-center directors worry that this worsens and continues the cat and mouse—create a product, ban a product, create a new, more harmful analog…and so on, ad infinitum.
For now, the best we can do is stay informed.
Support if you need it.
I believe that a person has the right to decide for themselves when it comes to what they put in their body. However, people also have the right to be well informed and make knowledgeable, calculated risks and decisions. You deserve to be safe and your health matters, no matter what you choose to use.
If you have concerns about your substance use and need support, reach out. Whatever you are facing, you don’t have to face it alone.
About the Author:
Kimberly May, LPC-S, LMFT is the founder of Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples, and families whose lives have been impacted by substance use. By using a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30-minute consultation.