The Concerning Emergence of “Gas Station Heroin”

The dangers of tianeptine, synthetic kratom, and other “gas station” drugs.

KEY POINTS

• “Gas station heroin” (tianeptine) exploits a loophole that allows sales of dangerous psychoactive substances.
• Tianeptine was initially developed for depression, but its opioid-like effects led to misuse and dependence.
• 7-OH products, often falsely marketed as kratom leaf extracts, are synthetics that pose heroin-like dangers.

The term “gas station heroin” encompasses the drug tianeptine and other 7-OH drugs with dangerous opioid-like effects, but which may be purchased (for now) at smoke shops, gas stations, and other outlets. Typically synthesized in overseas labs (often in China or India), tianeptine has had an alarming rise in misuse. Stablon (tianeptine) is not approved for medical use in the United States but is an approved antidepressant in some countries. At higher doses, tianeptine acts similarly to heroin and other opioids in its addictive potential. It is not FDA-approved as a medication, but is often marketed as “Zaza,” “Tianna Red,” or “Neptune’s Fix.” Other dangerous drugs, such as synthetic kratom, are available in many of the same outlets. Together, these drugs are a public health threat.

More About Tianeptine

Tianeptine has also been referred to as “gas station heroin” as users have described opioid-like drug effects, intense cravings, severe withdrawal, and tolerance, leading to increased dosages and escalating use. Drowsiness, confusion, nausea, respiratory depression, and in severe cases, coma and overdose (fatal and nonfatal) have been reported to poison control centers. U.S. consumers are ingesting high doses—up to 250 times the daily foreign drug product dose—of tianeptine recommended for depression. Tianeptine is not approved by the U.S. Food and Drug Administration (FDA). The FDA has issued warnings to consumers about opioid effects, sent warning letters to companies that distribute and sell unlawful tianeptine products, and placed tianeptine shipments on an import alert to try to stop them at our borders. The DEA considered banning the substance, as gas station heroin remains dangerously accessible in many areas.

With effects comparable to heroin or prescription opioids, tianeptine causes severe withdrawal symptoms: anxiety, tremors, depression, vomiting, and insomnia. Tolerance develops rapidly. It can also cause respiratory depression, seizures, and death (especially when mixed with other CNS depressants).

Urine drug screens do not detect tianeptine. If a person experiences withdrawal symptoms from this drug, naloxone (Narcan) should be used.

7-OH Products

Another problematic “gas station” drug is composed of 7-hydroxymitragynine (7-OH) semi-synthetic products often falsely marketed as “natural kratom extracts.” This drug is 30 times more potent than morphine. Usually, native kratom leaf does not contain any detectable amounts of 7-OH, or the amount is minuscule. But synthetic 7-OH is highly concentrated and leads to opioid-like withdrawal symptoms, kratom use disorder (KUD), and overdoses.

Important and timely web monitoring surveillance from the NDEWS Early Warning Network recently highlighted kratom-related concerns about mislabeled products, novel formulations, and emergency medical encounters. For example, out of 4,233 EMS encounters for kratom/7-OH-related fatal or nonfatal overdoses from January 2023 to April 2025, 1,071 (25.3 percent) occurred in western states, 1,191 (28.1 percent) in central states, and 1,971 (46.6 percent) in eastern states. The data shows significant increases in kratom/7-OH-related EMS encounters across all three regions and nationally.

7-OH produces very strong opioid-like effects even at low doses, and there is a high potential for tolerance, dependence, and opioid-like withdrawal. 7-OH products are much more likely than kratom leaves to cause respiratory depression, especially combined with other CNS depressants. Disturbingly, both natural and synthesized 7-OH products may be sold at the same gas station or smoke shops, even right next to each other, both marketed as “kratom.”

According to University of Florida professor Oliver Grundmann, PhD, “It is important to note reporting of kratom toxicity sadly lumps kratom leaf together with semi-synthetic and synthetic derivatives, which may lead to kratom leaf being a victim of a confounder effect when 7-OH and other potent substances account for a majority of cases.”

The Scientific Association for Botanical Education and Research (SABER) is also sounding the alarm over health risks associated with 7-OH products. According to SABER, while kratom tea is relatively mild, synthetic kratom derivatives are far more potent, on par with opioids. The proliferation of synthetic products lies in the drug’s potency, lack of regulation, and packaging appealing to younger consumers. It’s also important to note that these products are marketed as dietary supplements or wellness aids, despite substantial health risks.

A recently published article in Drug and Alcohol Dependence examined 304 online products marketed as kratom but which actually contained semi-synthetic 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl (MP). These products are highly selective mu opioid receptor agonists, unlike fresh kratom leaves, and pose potential public health risks.

The researchers found that nearly all (93 percent) of the products were mislabeled as kratom despite containing potent opioid agonists absent from the natural plant. Almost 73 percent of sellers made claims about its effects, such as increased focus and relaxation.

Kratom Use Disorder

A recent update from Johns Hopkins University School of Medicine highlighted an algorithm for a new disorder—kratom use disorder (KUD). The algorithm emphasizes product type, disorder severity, and co-existing diagnoses. The update warned that synthetic 7-hydroxymitragynine (7-OH) products complicate KUD assessment and may resemble opioid use disorder (OUD), requiring appropriate intervention. KUD includes opioid-like tolerance, withdrawal, and craving. Helping patients taper from kratom with appropriate support may be the best start for many with KUD.

Hopkins expert Dr. Kirsten Smith suggests clinicians assess SUD patients for kratom use and also KUD, considering not only kratom use, but also the type of kratom product used. She suggests products sold as “kratom” but which are primarily composed of 7-OH should not be equated with traditional kratom leaf. The pharmacologic and toxicologic profiles are markedly different, and 7-OH products carry a substantially higher risk, similar to that of traditional opioids.

A good analogy is that different cannabinoids may vary greatly in potency and effects. For example, Delta-8, delta-9, cannabis, high-THC cannabis, and synthetic cannabinoids all fall under a cannabis/cannabinoid umbrella, but they could hardly be considered the same drug unless THC, the active intoxicant, is present.

Kratom Leaf/Tea Differs From Synthetic Drugs

Natural kratom leaf produces mild stimulant effects at low doses and sedative or analgesic effects at higher doses, with a relatively low risk for respiratory depression or overdose. In general, kratom derived from the plant should not be considered problematic. In contrast, 7-OH-enriched products deliver potent opioid-like effects even at low doses and are associated with a much higher risk of tolerance, dependence, and opioid-like withdrawal. These products also carry a danger of respiratory depression, particularly when combined with other central nervous system depressants.

From a regulatory and safety perspective, kratom leaf is generally well-tolerated and legally ambiguous, while 7-OH-enriched products draw increasing scrutiny and are more likely to be restricted or banned. This distinction is critical: Although both drugs may be sold as “kratom,” their pharmacological profiles—and associated clinical risks—are fundamentally different.

Grundmann et al. have reported that many people use kratom leaves or tea without psychosocial impairments or addiction, even if they have mild physical symptoms related to dependence. Ultimately, it is important for investigators to study the classification of KUD in relation to the type and amount of the substance used.

While traditional kratom tea contains very low levels of 7-OH and has mild opioid-like effects, synthetic products—especially extracts, capsules, and shots—often contain concentrated 7-OH or synthetic derivatives many times stronger. Many users think they are taking a “natural” product when, instead, they are consuming a substance pharmacologically resembling short-acting opioids, with risks for dependence, withdrawal, and overdose. Some online user reports compare 7-OH effects to oxycodone and hydrocodone, with many expressing surprise that such highly potent drugs are legally available at smoke shops and other outlets. Poison control centers and clinicians should consider reporting kratom separately from 7-OH and other semi-synthetic and synthetic products, given the substantial difference in effects and toxicity.

Summary

There is an urgent need for comprehensive regulation, public education, and enforcement to mitigate risks associated with widely available synthetic and semi-synthetic drugs. NDEWS suggests greater public health prevention and outreach campaigns to address misconceptions about these newly popular drugs—tianeptine, kratom, and 7-OH. Tianeptine and the super-potent kratom 7-OH derivatives may lead unsuspecting users to experience opioid craving, addiction, withdrawal, and overdose-like symptoms, including respiratory depression. 

Clinicians seldom screen for nootropic use. With widespread and online availability of these substances, patients may not view them as medications or drugs at all and so may not report use. Very few people are familiar with the term “nootropics,” so clinicians should always ask patients if they are taking OTCs to enhance memory or boost energy levels.

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