The Dangers of “Gas Station Heroin”

Tianeptine, Kratom, and 7-OH (7-Hydroxymitragynine)

Mood booster! Energy shot! Natural calm! These are some of the buzz words you might see in the marketing for tianeptine, kratom, and 7-OH, also known as “gas station heroin” or “gas station opioids”. These three drugs come up again and again in poison-center calls, emergency rooms, and coroners’ reports. These substances can act like opioids, can cause dependence, and have been linked to severe illness and deaths.

Tianeptine

What it is: Tianeptine is a man-made synthetic prescription medication (sold under the names Coaxil, Stablon, and Tatinol) available in some countries for depression and anxiety, but it is not FDA-approved in the U.S. In the United States, tianeptine products are often sold illegally online and at gas stations (under several brand names, including Pegasus, TD Red, Neptune’s Fix and Zaza, to name a few) as dietary supplements purported to improve brain function and treat conditions including anxiety, depression, pain and opioid use disorder.¹

Tianeptine has mu-opioid receptor activity. Mu-opioid receptor (MOR) activity drives addiction by producing euphoria and reward when activated by opioids, leading to compulsive use, while changes in MOR signaling during chronic use cause tolerance, dependence, and intense withdrawal cravings that reinforce the cycle. Tianeptine isn’t an opioid, but it has the same effects.

Why people get hooked: Many users don’t start out seeking an “opioid.” They start with a bottle labeled like a supplement. But repeated use can lead to tolerance (needing more to feel the same effect) and dependence (feeling sick without it). CDC reporting on poison-center data has described effects and withdrawal that can mimic opioid toxicity and opioid withdrawal.²

Real-world warning sign: In the United States, the National Poison Data System (NPDS) reported 11 tianeptine exposure calls in the years between 2000 and 2017 and 207 calls between 2014 and 2017, and the FDA reported 151 cases in 2020. Due to this increase, some states have banned products containing tianeptine and have designated it a Schedule I or II controlled substance.

In early 2024, a CDC report described a cluster of severe illnesses tied to a tianeptine product (“Neptune’s Fix”) in New Jersey. Neptune’s Fix, which contains tianeptine and kavain, a chemical compound in the kava plant used to promote relaxation, was the most commonly used product among tianeptine exposures reported to the New Jersey Poison Control Center during the second half of 2023. Between June and November, the center received 20 exposure calls from health care facilities regarding tianeptine use in 17 people, an “uncharacteristic spike” from the center’s average of two or fewer cases per year. Of the 17 cases, 13 were admitted to intensive care units, and seven required intubation, the report says. At least one person went into cardiac arrest.³

Neptune Resources issued a nationwide recall and said in a statement, “The products are being recalled because they contain tianeptine, an ingredient that is not FDA-approved for any medical use. The presence of tianeptine renders the products unapproved drugs for which safety and efficacy have not been established and, therefore, are subject to recall.”

Additionally, researchers say that an analysis of at least two of the bottles of Neptune’s Fix found that they contained synthetic cannabinoid receptor agonists (synthetic weed) which wasn’t listed on the labels. Synthetic cannabinoids are human-made mind-altering chemicals that are similar to the chemicals found in marijuana, but they can cause serious side effects that are different from those of marijuana.⁴

Bottom line: Tianeptine isn’t just “sketchy supplements.” It’s an opioid-acting drug being sold in ways that can disguise the risk. The FDA has warned about a growing “gas station heroin” trend. When you get drugs from unregulated sources, you have no way of knowing what the ingredients actually are and in what amounts, or what effect it will have on you.

Kratom

What it is: Kratom (Mitragyna speciosa) is a Southeast Asian plant whose alkaloids, especially mitragynine and 7-hydroxymitragynine, can affect opioid receptors and other brain systems. People use it for energy, mood, pain, or to self-manage opioid withdrawal, but “natural” doesn’t equal safe.

Studies have found that some kratom sellers add more of the active ingredient than kratom naturally has. And because kratom products lack clear labels, it’s not possible to know how much kratom people who use it take.

Kratom starts to work in minutes. The effects last a few hours. The more kratom you take, the stronger the effects are. Depending on the amount of active ingredient in the product and the health of the user, taking kratom can be harmful. There are too few studies to be able to rate the claims about the benefits of kratom.⁵

Addiction risk: Regular kratom use can lead to dependence and a withdrawal syndrome (often described as anxiety, irritability, insomnia, GI upset, and cravings). The risk tends to rise with higher-dose products (shots/extracts) and frequent daily use, and it gets more complicated when kratom is mixed with other substances.

Poison control centers in the United States received more than 3,400 reports about use of kratom from 2014 through 2019. These included reports of death. Side effects reported included high blood pressure, confusion and seizures.

Case study: a kratom-only fatality report

A published forensic case report describes a single-drug fatality where mitragynine (kratom’s main alkaloid) was the key toxicology finding, discussing postmortem distribution and the circumstances around the death.⁶

Kratom has been reported to react with other medicines. This may lead to severe effects, such as liver damage and death. In a study testing kratom as a treatment for symptoms of quitting opioids, called withdrawal, people who took kratom for more than six months reported withdrawal symptoms like those from opioid use. They may need treatments given for opioid addiction.

Kratom products have been found to have heavy metals, such as lead, and harmful germs, such as salmonella, in them. Salmonella poisoning can be fatal. The FDA has linked more than 35 deaths to salmonella-tainted kratom.

Kratom also affects babies during pregnancy. When a pregnant person uses kratom, the baby may be born with symptoms of withdrawal and need treatment.

Important context: Many kratom-associated deaths reported publicly involve multiple substances (alcohol, sedatives, opioids, stimulants). That doesn’t make kratom “safe.” It just highlights how easily risk spikes when products are strong, inconsistent, or combined with other depressants.⁷

7-OH (7-Hydroxymitragynine)

Here’s where the landscape has shifted fast: 7-OH is a kratom alkaloid, but many newer products are concentrated, semi-synthetic, or synthetic 7-OH and they can be dramatically stronger than typical kratom leaf preparations. Public health agencies have warned about products claiming high 7-OH percentages being sold as gummies, tablets, and shots. Many of the products available today, which are often associated with or advertised as kratom, no longer resemble botanical kratom. Instead, they contain “enhanced” or concentrated amounts of 7-OH and are formulated as powders, capsules, and liquid extracts designed to generate a stronger effect on users.⁸

The availability of 7-OH products is a major concern to the FDA, as consumers can easily purchase products with concentrated levels of 7-OH online and in gas stations, corner stores and vape shops. The FDA is particularly concerned with the growing market of 7-OH products that may be especially appealing to children and teenagers, such as fruit-flavored gummies and ice cream cones. These products may not be clearly or accurately labeled as to their 7-OH content and are sometimes disguised or marketed as kratom.⁹

Regulatory actions (recent):

In 2025, FDA issued warning letters over illegal marketing of products containing 7-OH.¹⁰
FDA also released an assessment/risk report describing 7-OH as an emerging opioid threat and pushing for tighter control.¹¹
In December 2025, FDA announced seizure of tens of thousands of 7-OH product units in coordination with DOJ/U.S. Marshals.¹²

Addiction risk: When a product is built around a potent opioid-like ingredient, dependence can happen quickly, especially when dosing is unclear and the product is marketed like a “supplement.” 7-OH produces respiratory depression, physical dependence, and withdrawal symptoms characteristic of classical opioids, such as morphine, fentanyl, oxycodone, and hydrocodone.

Based on its opioid pharmacology, there is significant potential for abuse of 7-OH. In fact, in various preclinical studies it has demonstrated greater potency than classical opioids. For example, 7-OH produces respiratory depression with more than 3-fold greater potency than morphine.¹³

Since Los Angeles County started tracking the substance in April 2024, their public health department reported six fatal overdoses among people aged 18 to 40 linked to “synthetic kratom” / 7-OH products, noting that alcohol and other substances were often present but emphasizing the serious overdose risk associated with these products.¹⁴

What to watch for: red flags that risk is escalating

If someone is using tianeptine/kratom/7-OH products, these are signs it may be moving from “experiment” to dependence¹⁵:

Needing more to feel normal (tolerance)
Withdrawal symptoms when stopping (sweats, anxiety, insomnia, nausea/diarrhea, shaking, agitation)
Using to avoid feeling sick rather than to feel good
Hiding use, financial strain, or taking risks to get more
Mixing with alcohol, benzodiazepines, sleep meds, or other opioids (higher overdose risk)

Including these medical emergencies¹⁶:

Slow or stopped breathing
Blue lips
Unable to stay awake
Seizure
Severe confusion
Chest pain
Collapse

If overdose is suspected, call emergency services. If opioids may be involved, naloxone can save a life¹⁶.

In the U.S.: 988 (Suicide & Crisis Lifeline) for urgent mental health support.¹⁷
SAMHSA National Helpline: 1-800-662-HELP for treatment referral.¹⁸
Poison Control: 1-800-222-1222 for exposure guidance.¹⁹

References: