U.S. cases of severe side effects from exposure to tianeptine have increased from 11 in total between 2000 and 2013 to 151 in 2020 alone.

While tianeptine is not listed in the federal Controlled Substances Act, which bans drugs like heroin and cocaine that have no medical use or a high likelihood of abuse. But about a dozen states, including Alabama, Georgia, Michigan, Tennesee and Ohio, restrict or ban it.

Sometimes called “gas station heroin,” the products are usually marketed as energy shots or cognitive supplements but actually contain tianeptine, an unapproved drug that can be addictive and carries risks of serious side effects.