John with some of his supplements, and at the hospital. Supplied.
A little over a week after John took his last dose of tianeptine, an unregulated supplement known as “gas station heroin,” his girlfriend heard a loud “thud” coming from the guest room of their upstate New York home. When she found him on the hardwood floor, the bridge of his nose was bleeding—he’d hit it on a bedside table on his way down—and he couldn’t stand or speak coherently. She called an ambulance. It was early morning on Labor Day and John didn’t wake up for 10 hours. He remained in hospital for four days, barely sleeping and riddled with shame.
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“(I was) trying to convince everybody that I wasn't trying to kill myself,” said John, 55, who asked VICE News not to use his last name for privacy reasons. “Having my family see me there and know what was going on. Super, super embarrassing.” John wasn’t trying to kill himself. On the contrary, he was trying to regain control of his life after falling into a severe tianeptine addiction, a drug that mimics opioids but has a short-lived high. He’d been using it hourly for the last four months, taking 30 grams of a powdered version of it a week.
Although John had a bed at a local rehab on standby, he said none of the doctors or health practitioners he’d spoken to had any familiarity with tianeptine, which is federally legal but banned in some states. He said the rehab he was considering attending discussed putting him on buprenorphine, an opioid medication that is effective at treating opioid addiction. But he wanted to avoid that route if possible because he was concerned about becoming reliant on it. “As nice as the detox folks were on the phone, they admittedly weren't sure how they were going to help me… Not their fault. It's just our reality as tianeptine addicts.” When John decided to quit, he opted for an at-home detox involving potent vitamin C capsules and an arsenal of other drugs and supplements. It was based almost exclusively on information he’d learned from a subreddit called r/QuittingTianeptine. Because tianeptine isn’t an approved drug, there’s a dearth of research on it and many doctors have never heard of it, leaving people who are addicted to fend for themselves a lot of the time. So they turn to Reddit.
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“We don't feel safe turning to doctors. They often put us in a worse spot. So we lean on each other,” John said.
If you or someone you know has been impacted by tianeptine or other grey market drugs, we’d like to hear from you. Please email manisha.krishnan@vice.com.
But taking advice that isn’t vetted by medical professionals comes with its own risks, as highlighted by John’s hospitalization. VICE News reached out to four medical experts with experience in treating addiction about the idea of detoxing off tianeptine at home and all said it’s safest to taper off drugs under medical supervision. “Obviously there are a lot of barriers to accessing good treatment, and people who use drugs have been incredibly resourceful… But it’s still dangerous to withdraw without at least the ability to get help should complications arise,” said Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland. Tianeptine is used as an antidepressant in over 60 countries, but in the U.S. it isn’t approved by the Food and Drug Administration. Unregulated versions of it, which act on a person’s opioid receptors, are sold as capsules in gas stations and convenience stores around the country, under brand names like Zaza and Pegasus; powdered versions, like what John used, are easily available online. At least 10 tianeptine users have told VICE News that after initially experiencing opioid-like euphoria, they quickly became addicted to the drug, needing more and more of it to stave off withdrawal symptoms including nausea, chills, restless legs, and a sense of doom.
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But for those who want to stop using the drug, or are forced to by state bans, the detox route isn’t clear cut. While medications like methadone and buprenorphine are the gold standard for treating opioid addiction, tianeptine doesn’t function exactly like an opioid so it’s not clear that these drugs would have the same impact.
So John and others like him are crowdsourcing information, primarily on r/QuittingTianeptine, which has amassed nearly 5,000 members since it formed in 2017. Posts range from people journaling their detox journeys to advice on what medications can ease withdrawal to seeking moral support before “jumping off”—a term used for quitting. “We're helping each other through. I have people that are a day ahead of me, a day behind me. That’s 90 percent of it, that’s what’s keeping me going,” John said. This is John’s second attempt at quitting tianeptine, a drug he came across in 2016, reading that it was helpful for anxiety and depression. The first time he quit wasn’t as difficult, physically, because he wasn’t using as much of it, he said. This time around, he told his girlfriend and his “Reddit family,” which he said boosted his emotional support and accountability—and fueled him with ideas of what to take to ease the withdrawal. Those products included: gabapentin (an anti-seizure medication), vitamin C, kratom (a herbal substance known to produce opioid effects), several supplements he hoped would boost his serotonin levels, and a supplement meant to control his restless legs. He also occasionally took Xanax, a benzodiazepine, throughout the detox and he believes he took at least three of them prior to falling and needing to be hospitalized. He thinks they’re the reason he was so out of it.
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John recently detoxed off tianeptine at home using a protocol he found on Reddit.
In 2019, after he stopped using tianeptine the first time around, John began moderating r/QuittingTianeptine, where he said he and others were constantly encouraging people who also wanted to stop. He said two of them died—one by an alleged suicide and another whose mother said he had a heart attack right after he quit. “It hits home personally,” said John, whose father died by suicide when he was 13. “When I went through the withdrawal before, I could see how people would feel that way, because you do feel helpless.” Another former tianeptine user, Sam, told VICE News the r/QuittingTianeptine subreddit also helped him get through his withdrawal at a time when he was intensely depressed. “It took over my life and almost drove me to suicide,” he said. In April 2017, after spending $12,000 on tianeptine in a nine-month period, Sam sought the help of several doctors and clinics in Jacksonville, Florida and said he “broke down on the phone crying” and begging a doctor for a buprenorphine prescription to no avail.
He finally got one from a wellness center and holed up in a hotel room for nearly a week for “an incredibly insane detox” involving vivid hallucinations. Afterwards, Sam said he was left with a benzo dependence (he also found people on Reddit recommending them for sleep). Eventually he stopped using them. Marino said John and Sam’s experiences highlight the limitations of crowdsourcing advice from sites like Reddit.
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“Benzos themselves have a very high risk of dependence and a very life-threatening withdrawal themselves.” Still, he said he understands why people crowdsource for support in dealing with addiction, particularly because the medical establishment has a history of stigmatizing people who use drugs. “I can’t fault people for looking elsewhere, especially when it comes to tianeptine, which most healthcare professionals would be at a loss to help with even if they wanted to.” Marino said.Prior to his hospitalization, John told VICE News he’d been steadily improving day-by-day, posting his progress on r/QuittingTianeptine, where he became a moderator again. Sharing tips on his recovery was giving him a newfound purpose, he said. But now his confidence is shaken. While he thinks the benzos are to blame for his fall, he can’t be 100 percent sure.
“My failure in what I did, it made me really question, should I be giving other people any advice?,” he said. “My biggest fear is, ‘Oh my god, could something that one of us says on there inadvertently or just trying to be helpful, could it hurt somebody? Could it potentially end up harming someone or killing somebody?’”He said he’s filled in the other moderators on his situation and hopes to discuss with them how to proceed in the group responsibly. Despite its shortcomings, both he and Sam said it’s unlikely they would have gotten off tianeptine without Reddit. “Honestly it was the information I learned and the people I talked to on Reddit that kicked off my entire recovery,” Sam said. Without the group, “I’d probably not be married, probably in financial ruin. Possibly dead.”
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