First there was poppers, next came K2 and spice, then bath salts, then kratom, and now Zaza red. All of these drugs, at one point or another, could be bought at gas stations and smoke shops across the country and promise to deliver a high without the consequences and hassle associated with illegal narcotics. Except like all of its predecessors, “gas station heroin,” as some are calling it, is turning out to be anything but harmless.
What Is Zaza Red?
Zaza Red is a product containing tianeptine that is sold as a powder or tablet at convenience stores, gas stations, and online throughout much of the U.S. Zaza Red is also sold under various brand names such as Tianaa, Tianaa Red, Neptune’s Fix, Pegasus and Stablon, and is known sometimes by its street names, “gas station heroin” and “gas station dope.”
Tianeptine is used as an antidepressant in some countries in Europe and Asia, where its prescription and use is subject to strict regulations [1]. Here in the US, companies have marketed tianeptine as dietary supplements, and this loosely used definition has created a significant gap in regulation, allowing them to openly sell tianeptine with no regulatory oversight.
The U.S. Food and Drug Administration (FDA) has issued a clear warning that tianeptine is not approved for any medical use, and companies marketing and selling it are doing so illegally.[2] Many states, including Alabama, Michigan, Tennessee, Georgia, and Indiana, have moved to classify tianeptine as a controlled substance due to increasing reports of overdoses, hospitalizations, and addiction rates [3]. The legality of tianeptine is still in question; in many states, it continues to be sold over the counter.
How Does Tianeptine Work?
Tianeptine structurally resembles tricyclic antidepressants such as amitriptyline. But what makes it potentially more dangerous is that it binds to and activates the same mu-opioid receptors as opioids like heroin, fentanyl, oxycodone, and other prescription drugs. [4] When tianeptine binds to those receptors, it raises dopamine levels in the brain, reduces stress hormones, and affects serotonin uptake in ways that produce mood improvement.
When taken at prescribed therapeutic dosages, the opioid-like effects produce euphoria, sedation, and anxiety relief. However, people abusing Zaza or equivalent products are not taking therapeutic doses. An analysis of online communities of tianeptine users found that many were taking it at excessive dosages to “chase the OK-ness,” referring to the drug’s ability to provide relief from anxiety, dysphoria, and discomfort that becomes difficult to achieve without continued use.
Many users also combine tianeptine with other over-the-counter substances that act on mu-opioid or GABA (gamma-aminobutyric acid) receptors, a neurotransmitter responsible for calming nervous system activity, such as kratom and phenibut, which significantly raises the risk of dependence, adverse effects, and overdose.
Signs of Zaza Addiction
Because tianeptine is a legal substance that can be purchased at many locations, some who develop a physical dependence on it may not realize what is happening until they experience signs of addiction.
Symptoms of Zaza Red or tianeptine addiction can include:
- Having to take increasingly larger doses to achieve the desired effect
- Using the drug several times a day to avoid feeling sick or anxious
- Experiencing withdrawal symptoms within hours of your last dose
- Continuing to use the drug despite harm to your health, relationships, or finances
- Wanting to stop or cut back but being unable to
- Spending significant time and money acquiring tianeptine products
- Hiding use from family and friends or downplaying how much you have taken
- Combining tianeptine with other substances to elevate or prolong its effects
The easy accessibility of tianeptine products has led many users to deny how severe the addiction has become. The fact that these products are sold in convenience stores does not make them safe, and the withdrawal syndrome associated with Zaza Red makes that clear.
Zaza Red Withdrawal Symptoms
Zaza Red withdrawal is one of the major factors that makes tianeptine so dangerous. Tianeptine withdrawal can occur as little as one to two hours after your last dose [5]. This rapid onset makes it highly likely that individuals will need to dose multiple times a day to maintain their habit.
Zaza Red withdrawal symptoms are similar to opioid withdrawal symptoms and include:
- Intense opioid-like withdrawal, including anxiety, agitation, nausea, vomiting, and diarrhea
- Muscle aches, cramps, and uncontrollable twitching
- Excessive sweating, chills, and a significantly elevated heart rate
- Intense cravings
- Insomnia and restlessness
- Depression and dysphoria
- In extreme cases, delirium requiring intensive medical care
During the 2019 tianeptine outbreak, the Alabama Poison Information Center reported a surge of patients seen for tianeptine-related cases, including complications that required ICU-level care [6].
The administration of naloxone (Narcan), which reverses opioid overdose, has resulted in the sudden onset of withdrawal symptoms, confirming that tianeptine acts on mu-opioid receptors and produces a genuine opioid use disorder risk.
How to Safely Detox From Tianeptine and Zaza Red
The severity and rapid onset of tianeptine withdrawal makes it extremely dangerous to attempt to quit Zaza pills without medical support. Medical detox is necessary to provide clinical supervision, medication management, and psychiatric support as part of comprehensive addiction treatment for substance abuse.Because tianeptine has an opioid-like mechanism of action, clinicians have used opioid-use disorder treatments like buprenorphine to manage withdrawal and dependence. [7] The medical staff will evaluate each client individually to determine which option will work best based on their history of use and clinical needs.
The acute withdrawal phase of tianeptine typically lasts between one and two weeks with medical support; however, persistent cravings, anxiety, and dysphoria associated with tianeptine can linger and may require continued support through outpatient treatment, inpatient care, and group therapy or other ongoing programming. [8]
