Opioid Addicts Turning to Unapproved Antidepressant to Get High
In a trend that suggests opioid addicts are turning to new fixes, a government report shows that use of an unapproved antidepressant is becoming more widespread in the United States.
Tianeptine is used in some European, Asian and Latin American countries for treatment of depression and anxiety. But the U.S. Food and Drug Administration has not approved use of the drug in the United States, according to the U.S. Centers for Disease Control and Prevention.
Despite this, U.S. poison control centers have been receiving a growing number of reports related to tianeptine, which is sold abroad under the names Coaxil or Stablon.
There have been 207 calls to poison control centers regarding tianeptine within the last four years, compared with just 11 calls in the 14 years prior, according to a report in the Aug. 3 issue of the CDC's Morbidity and Mortality Weekly Report.
"There's essentially been an exponential increase in cases being reported to poison control, which likely underestimates the prevalence of tianeptine use or exposure by many orders of magnitude," said Dr. Harshal Kirane, director of addiction services for Staten Island University Hospital in New York City.
Tianeptine produces effects similar to opioids, and officials suspect that people are taking the drug as an alternative to those narcotics, the new report noted.
There were 83 reports of tianeptine being used with other substances, most commonly benzodiazepines, opioids, ethanol and phenibut, an anti-anxiety medication also sold abroad, Dr. Tharwat El Zahran, of the CDC's National Center for Environmental Health, and colleagues reported.
Kirane said, "I don't think it's a coincidence that the uptick in these tianeptine reports coincides with some of the broader changes in [tightening] prescribing policies" for opioid painkillers.
Tianeptine acts upon opioid receptors in the brain, the authors of the report explained. People taking it can become addicted and suffer from withdrawal when they stop. Poison control received 29 calls associated with tianeptine withdrawal, the researchers found.
Dr. Robert Glatter, an emergency physician with Lenox Hill Hospital in New York City, said, "Tianeptine is a dual threat. It not only leads to euphoria and a high, but also leads to opiate withdrawal in casual users who abuse this antidepressant."
The opioid-overdose drug naloxone is effective in reversing a tianeptine overdose, the report stated.
Although tianeptine is not sold in the United States, it is readily available for purchase online as a dietary supplement or research chemical, according to the report.
Experts like Glatter and Kirane are particularly concerned that standard drug screens don't look for tianeptine.
"Tianeptine is not something that is generally screened for," Kirane said, "so detecting if someone is using this is from the outset quite challenging."
Reports like these reaffirm the need for better addiction treatment in the United States, said Linda Richter, director of policy research and analysis for the National Center on Addiction and Substance Abuse.
"Unless we fix our broken addiction treatment system and get people with opioid use disorder the treatment they need, they will continue to turn to dangerous, non-prescribed drugs to stave off withdrawal and cravings," Richter said.
"While awareness about tianeptine among the public and health professionals is critical, the growing misuse of this drug is just the latest sign that our efforts to end the opioid epidemic have mostly amounted to putting Band-Aids on a hemorrhage," Richter concluded.
The U.S. National Institutes of Health has more about tianeptine.
SOURCES: Harshal Kirane, M.D., director, addiction services, Staten Island University Hospital, New York City; Robert Glatter, M.D., emergency physician, Lenox Hill Hospital, New York City; Linda Richter, Ph.D., director, policy research and analysis, National Center on Addiction and Substance Abuse, New York City; Aug. 3, 2018, Morbidity and Mortality Weekly Report
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