The Alabama Department of Public Health is moving to ban a widely available antidepressant that can mimic the effects of opioids.
Tianeptine is approved in some other countries to treat depression but is not approved in the United States, State Pharmacy Director Nancy Bishop told Alabama Daily News.
“The dose for depression is very low but when taken in high doses, the drug produces a high and euphoric effect similar to opioids and can lead to dependence,” Bishop said. “It is taken as an opioid substitute or to eliminate opioid withdrawal symptoms and can be purchased at convenience stores and online as a dietary supplement.”
This week, the State Committee of Public Health, at the recommendation of Alabama Department of Public Health, moved to categorize tianeptine as a Schedule II drug. Other Schedule II drugs include morphine, cocaine, methamphetamine and hydrocodone. Some Schedule II drugs are available legally through prescriptions.
According to the Centers for Disease Control and Prevention, tianeptine exposure calls to U.S. poison control centers increased during from 2014 to 2017, suggesting a possible emerging public health risk. The associated health effects included neurologic, cardiovascular and gastrointestinal signs and symptoms, with some effects mimicking opioid toxicity and withdrawal.
While the drug has been on the state's radar for several years, it was about two years ago there was a noticeable increase in reports of people abusing it, including from emergency rooms treating people intoxicated from it or experiencing withdrawals, said State Health Officer Dr. Scott Harris.
The Alabama Syndromic Surveillance Program reports that 45 emergency department admissions between January 2019, and May 11, 2020 were potentially associated with tianeptine use.
“Some people have claimed they are trying to treat an opioid addiction by taking it,” Harris said.
Tianeptine is the active ingredient in Tianna, which is sold in convenience stores and online and sometimes marketed as a dietary supplement. It’s also called Tianna Red, Tianna Green and Tianna White.
“If you go in just about any convenience store in Alabama, it’s there,” Harris said.
A public comment period on the proposed change will be open until Sept. 4. Then, the state board will take a final vote to make the drug a Schedule II.
In 2018, Michigan became the first state to ban tianeptine through legislation.
Alabama Rep. Mike Holmes, R-Wetumpka, this year sponsored House Bill 6, which would have made tianeptine illegal. The bill passed the House but died in the Senate when the coronavirus outbreak derailed the legislative session.
Sen. Arthur Orr, R-Decatur, had planned to carry Holmes’ bill in the Senate. He told Alabama Daily News he’s heard for several years from multiple constituents concerned about tianeptine and its addictiveness.
“I’m pleased to see Dr. Harris and the state board move to add this substance to the list of Schedule II drugs in Alabama and have confidence that this is a good step for our state,” Orr said.