(67) Self-reported Tianeptine Experiences: A Mixed-Methods Study of Reddit Users

Background & Introduction: Tianeptine is an atypical tricyclic antidepressant approved for anxiety and depression in some European, Latin American, and Asian countries. Although not approved for use in the US, it is widely available for purchase from unregulated markets such as gas stations, smoke shops, and the internet. At high doses tianeptine is a mu opioid receptor agonist, and is thus informally called ‘gas station heroin’ (1,2). Anonymous online forums such as Reddit provide a space for open discussion of substance use, and may offer insight into the use patterns and experiences of this emerging drug of misuse (3).

Methods: We collected all Reddit data from 2005 to December 2023 using the pushshift.io application programming interface (API). We searched for the keyword tianeptine in the collected data to identify relevant posts. Since non-standard or street names are commonly used on Reddit, we used three strategies to identify relevant ones: (i) we manually searched the Internet; (ii) we reviewed posts that mentioned tianeptine to discover additional references to the substance; and (iii) we used a word2vec model (4) to identify expressions, including multi-word expressions, that are semantically similar to tianeptine, and manually selected relevant ones. Our final list consisted of the following terms/expressions: tianeptine, neptune's fix, neptune's elixir, zaza red, pegasus red, tianaa, pegasus, zaza, td red, gas station heroin, gas station dope. We re-ran our search using these identified keywords and selected a random sample for manual review. We qualitatively evaluated the sample of posts to identify common themes surrounding tianeptine use.

Results: 18,941 Reddit posts were identified between 2005-2023. Tianeptine and relevant keyword mentions increased sharply over the last two years (2021: 527 posts; 2022: 1,555 posts; 2023: 2,358 posts). 50 posts were selected for manual thematic analysis. Common themes identified were discussions of tianeptine dependence (n=12, 24%); withdrawal symptoms and their management (n=11, 22%); tianeptine use in the setting of opioid use disorder (n=10, 20%); substances coingested with tianeptine (n=7, 14%), and the use of tianeptine for pain and depression (n=6, 12%). 28% of posts (n=14) commented on kratom in addition to tianeptine. Three posts discussed access to tianeptine in the setting of state-level bans, and one post discussed suspected adulteration of a tianeptine product.

Conclusion & Discussion: Reddit posts regarding tianeptine and related keywords increased sharply over the past two years. Thematic analysis highlighted the risk of dependence on tianeptine and its use as a management strategy for OUD, depression, and pain. Mentions of Kratom alongside tianeptine suggest overlap in the populations using both of these unregulated substances. Overall, this study highlights tianeptine as a drug of public health concern.

References: 1. Lauhan R, Hsu A, Alam A, Beizai K. Tianeptine abuse and dependence: case report and literature review. Psychosomatics 2018;59:547–53.
2. Clark, Day. ‘Gas station heroin’ is addictive and, in some cases, deadly [Internet]. News Nation Now; 2023 [cited 2023 Aug 15]. Available from: https://www.newsnationnow.com/health/gas-station-heroin-tianeptine-addictive-withdrawl/
3. Spadaro, Anthony MD, MPH; O'Connor, Karen MS; Lakamana, Sahithi MS; Sarker, Abeed PhD; Wightman, Rachel MD; Love, Jennifer S. MD; Perrone, Jeanmarie MD. Self-reported Xylazine Experiences: A Mixed-methods Study of Reddit Subscribers. Journal of Addiction Medicine 17(6):p 691-694, 11/12 2023. | DOI: 10.1097/ADM.0000000000001216
4. Mikolov T, Sutskever I, Chen K, Corrado GS, Dean J. Distributed Representations of Words and Phrases and their Compositionality. In Proc: Advances in Neural Information Processing Systems 26 (NIPS 2013). Lake Tahoe, Nevada, USA. 2023.