"Gas Station Heroin" in Plain Sight: Tianeptine Misuse, Detection Gaps, and the Role of Substance-Use Screening.

Most often sold in the United States as a dietary supplement, nootropic, or research chemical, tianeptine has become better known by the troubling nickname "gas station heroin." At high doses, it can produce opioid-like effects and lead to dependence, severe withdrawal, poisoning, and even death. This article traces how tianeptine entered the U.S. market and how it is promoted, resulting in the alarming present-day use trends. Attention is given to a large problem: tianeptine is typically excluded from conventional, immunoassay-based routine drug panels, necessitating targeted chromatographic-mass spectrometric toxicology panels for definitive identification. As a result, its use may go unnoticed in treatment programs, workplaces, and criminal justice settings. Although specialized toxicology tests can identify the drug, they are not widely used and are often costly. General substance-use screening instruments cannot establish tianeptine exposure alone; however, when used along with structured interviews, they can help identify broader substance-use risk by uncovering patterns of misuse, including the use of multiple substances and over-the-counter products. Asking direct questions and combining screening methods may help professionals recognize tianeptine use earlier so intervention can begin.