Booneville, Miss., resident John Doe (not his real name), 25, vaguely remembers what happened in 2021 when a gas-station employee told him to “try this new thing.” Doe told the Mississippi Free Press on Dec. 16, 2022, that he later purchased Pegasus, the product’s name. It contains Tianeptine, a chemical substance that the French Society of Medical Research discovered and patented in the 1960s.
France and other European countries use Tianeptine to treat depression, but the U.S. Food and Drug Administration has not approved it for “any medical use” in the United States and, in fact, warns of “a potential for abuse.“ The Practical Pain Management Journal said that there is “evidence of increasing rates of tianeptine abuse over the past two decades.”
Doe, who is white, runs a business in Corinth, Miss., about 20 miles from Booneville in northeast Mississippi, and agreed to share his story on the condition of anonymity.
“I wouldn’t call it super strong, I guess maybe like a pain pill,” he said of his initial experience after taking the drug. “After a while, it was more of—if you didn’t take it, you knew it, and if you took it, it was like a normal feeling.”
“At the very beginning, there wasn’t like a severe withdrawal effect, but it didn’t take super long to become what I would call dependent, and going without it for some time, the withdrawal symptoms kicked in,” he said. “If it went far enough—like shaking or you may feel nauseous or tense, it would start like a minor headache, like an agitated-type feeling, anxious, I guess might be a word.”
The FDA warns that using Tianeptine can come with the risk of experiencing withdrawal symptoms. “The clinical effects of Tianeptine abuse and withdrawal can mimic opioid toxicity and withdrawal, according to the Centers for Disease Control and Prevention (CDC),” the agency reports.
“The FDA has identified cases in which people experienced other serious harmful effects from abusing or misusing Tianeptine by itself or with other drugs, including antidepressants and anti-anxiety medicines,” the agency added. “These effects included agitation, drowsiness, confusion, sweating, rapid heartbeat, high blood pressure, nausea, vomiting, slowed or stopped breathing, coma, and death.”
To feed the developing addiction, Doe started taking more and more doses of Tianeptine daily, with one bottle containing 15 capsules costing between $25 and $30 apiece. He would later share the information with Dickie Scruggs, a former attorney based in Oxford, Miss., (and a donor to the Mississippi Free Press). Scruggs gained fame in the mid-2000s for leading a team of lawyers in a class-action lawsuit against tobacco companies on behalf of the State of Mississippi. Scruggs later pleaded guilty in an unrelated bribery scandal involving judges and went to federal prison. He now lives back in Oxford.
Scruggs told the Mississippi Free Press by phone on Dec. 7, 2022, that his nephew, who was Doe’s friend, told him about Doe’s addiction. Scruggs then went to a convenience store in Oxford to find out if such drugs were for sale there. He found it by another name, Zaza, at the local, independently run Marathon Filling Station and paid $24 for it.
“I still have it unopened,” Scruggs said. “So it’s a real and present danger here in Mississippi as recently as last week when I bought this stuff.”
‘She Was Hooked’
A mother was going through depression, and her friend advised her to purchase a remedy at a convenience store, Flowood, Miss.-based family medicine doctor Jennifer Bryan told the Mississippi House of Representatives’ Drug Policy Committee members on Oct. 10, 2022.
Bryan described the woman as “a wonderful mother of a couple of kids” and said the friend told her to “try out the new gas station medication for depression,” which she did.
“After two or three doses of Tianeptine, she was hooked,” the medical doctor told the legislators during the hearing, which the House streamed on Youtube.
Bryan expressed alarm about the “backdoor” to getting “medications or toxic substances of abuse into the gas stations,” adding that “companies are definitely taking advantage of this backdoor opportunity and making a lot of money.”
Marathon Gas Stations Sell Tianeptine
This reporter traveled to another independently operated Marathon Gas Station in Jackson, Miss., where the cashier sold a bottle of Zaza for $28.
Under the “direction for use” label on the bottle was the phrase “research purposes only.”
The labeling also stated: “The Food and Drug Administration has neither reviewed these statements nor approved this product for consumption. It is not known to diagnose, treat, cure, or prevent disease; Manufacturers/resellers assume no responsibility for the use or misuse of this product; Not for sale to minors; 21+ only.”
The guidance for the intake merely describes the serving size as “1 capsule.”
The address for the distributor, M&J Distribution, only identified the city as Villa Rica, Ga., with ZIP code 30180. The bottle did not include any information about the manufacturer. On Dec. 23, a M&J Distribution salesperson returned this reporter’s call, while thinking this reporter wanted to order Zaza. She gave her name simply as Shama.
A search of the Georgia Secretary of State’s website yielded an address that returned a hit for one M&J Distribution Inc., formed in 2014 and dissolved in 2016. The office dissolved the organization for “failure to deliver its annual registration, together with all required fees and penalties.”
“Shama” said she has “heard” about people becoming addicted to the product but insisted that “these products work really good for people who suffer from anxiety and depression; it helps them a lot.”
The sales representative said she “only takes orders,” from people with “a smoke shop or a gas station.”
“These are the customers that I deal with,” she said.
The website of Marathon Petroleum Corporation showed that the gas station that Scruggs went to in Oxford, Miss., and the one the reporter went to in Jackson, Miss., are part of a network of independently operated gas stations bearing its brand name. The Mississippi Secretary of State’s website search yielded the independent companies’ email addresses. Neither responded to emails from the Mississippi Free Press at press time, even after this reporter visited the Jackson location on Dec. 20, 2022, and left his business card. A clerk there said the reporter could not meet or interview the owner until 2023.
Dr. Bryan told legislators in October 2022 that Tianeptine products go by different names and has “strong opioid-like” properties.
“Tianeptine is also known as Zaza, gas-station heroine, Tiana Red; there are a lot of different names,” she said. She explained that some states had clamped down on the drug’s distribution.
Five States Ban Tianeptine
In 2018, Michigan became the first state to ban the sale of the drug, classifying it as a schedule II drug that may result in severe addiction with stringent punishment for the possession, distribution, or manufacture.
When the website woodtv.com reported the news that year, it said Tianeptine is “marketed as a supplement or research chemical through unregulated vendors but is often abused in high doses to simulate opioid-like highs.”
Alabama followed in Michigan’s footsteps in 2021. In 2022, Georgia, Tennessee and Ohio took a more severe stance by classifying it as schedule I. Ohio Gov. Mike Dewine wrote the Dec. 22, 2022, executive order banning the substance that “case reports have documented neonatal abstinence syndrome mimicking opioid neonatal abstinence syndrome occurring after tianeptine dependence during pregnancy.”
With the schedule I classification, Dewine explained that the State Board of Pharmacy said “the compound has no accepted medical use in treatment in this state and poses an imminent hazard to the public health, safety, or welfare.”
‘They Spend a lot of Money on Marketing’
In a subsequent phone interview on Dec. 26, 2022, the M&J Distribution salesperson said she had the manufacturer’s number but declined to provide it in order for this reporter to seek comment.
“He doesn’t give his number to anyone, only a few people that he trusts,” she said. “It took me like six months to earn his trust, and he gave me his number.”
While on the phone with the salesperson that Monday, she promised to link the reporter to someone she referred to as the “owner of M&J Distribution,” who arrived at her Atlanta, Ga., location, shortly afterward. After muting the call for two minutes to speak with him, she said he had declined to talk with this reporter.
“I spoke to him. He says no,” she said.
The salesperson said the manufacturer left Atlanta when the state banned Tianeptine. “M & J Distribution is based in Atlanta, Georgia, (but) they ship (Tianeptine) from the manufacturer,” she said.
The salesperson described how big Zaza’s business had been in the country.
“That’s an $80-million brand; it’s not a small brand; they sell in big numbers, but it’s really sad that they are banned from so many states,” she said. “They have been to very big trade shows, and they spend a lot of money on marketing, and customers try it, like it.”
“It helps a lot with depression,” she added. “A customer can buy 20 bottles; they can buy a half case—there are 50 bottles in a case—they buy 20, 10, they love it.”
Some Mississippi Doctors Want Tianeptine Banned
Dr. Jenniffer Byran served as the chairman of the Mississippi delegation to the American Medical Association at the June 2022 conference, where the Mississippi chapter proposed a resolution recommending that authorities schedule and ban the drug Tianeptine.The national delegate later approved the resolution.
While reporting on the approval, the American Medical Association noted that the resolution explained that the product is often legally sold over the counter in gas stations and convenience stores.
“While Tianeptine is not covered under the Controlled Substances Act, it may lead to severe psychological or physical dependence and joins other substances such as morphine, methamphetamine, cocaine, methadone, hydrocodone, fentanyl and phencyclidine,” the organization said in the report. “To address this, delegates directed the AMA to advocate ‘banning the sale of tianeptine directly to the public in the absence of research into the safety and efficacy of the substance.'”
State Health Officer Dr. Daniel P. Edney also spoke to the Mississippi House of Representatives drug policy committee members in October 2022 and condemned Tianeptine’s sale.
“With everything we do in medicine and in pharmaceuticals, there is an obligation to demonstrate safety and efficacy, and somehow, our gas station products bypass that,” he said. “There should not be any products, in my opinion, in the gas stations that we have not proven to be safe and effective, at least, not be causing harm.”
“I can tell you the Tianeptine issue that Dr. Bryan testified on is escalating,” he said. “We have doctors calling around the state into the Poison Control Center to report Tianeptine overdoses, and those numbers are going up.”
Tianeptine overdose-related calls to the Mississippi Poison Control Center have increased from none in 2018, one each in 2019 and 2020, to seven in 2021 and 17 so far in 2022. The center provided the information to the Mississippi Free Press on Dec. 14, 2022, and noted that calls are primarily from hospitals.
Between 2019 and 2022, the center received six calls from Lee County, three each from Harrison and Desoto counties, and two from Jackson County. The center received one call each from Forrest, Hancock, Tippah, Lowndes, Jones, DeSoto, Simpson, Lafayette, Marshall, Rankin, Pearl River, Oktibbeha, Hinds and Madison counties over the last four years.
‘Toxicities Associated with Taking Such Large Amounts’
Dr. Bryan said the woman who came into her practice in September was not readily forthcoming about her addiction and tried to hide it.
“She came in, and it took a while to even get it out of her, but it was clear something was wrong,” the family medicine doctor said in October. “I sat with her, and I talked, and I talked, and it finally came out.”
“She was taking eight of these a day, which was just a massive amount,” she said. “It does take a good bit to induce the euphoric effect that people are after, (and) there are toxicities associated with taking such large amounts.”
As Doe's addiction progressed, he purchased Tianeptine in gas stations throughout Mississippi, including Corinth, Tupelo and Booneville. He developed health challenges that he attributed to the addiction, including feeling weak and having a low appetite.
"I didn't have any color, whiteish, gray looking, dry skin, that kind of thing," he said.
Doe concluded that Tianeptine made him "anemic," and he went to see the doctor with those complaints.
"I had been feeling bad, so I was getting blood work done, and then they did it again, and then one more time to track what numbers were moving," he said. "I never threw any up or anything, but it (Tianeptine) made me anemic, and it dropped my iron levels really, really, really, really low, like they were dropping so fast that my doctor at home thought that I had some internal bleeding."
"That went on for a few months, but then, in the end, the numbers started getting really alarming."
Around late September, 2022, the doctor performed a colonoscopy to check for rectal bleeding. "I had to have an emergency colonoscopy," Doe said. "Because I wasn't bleeding, I wasn't throwing up any blood or anything, but my blood (level) was dropping … that's why they did the colonoscopy."
"They thought maybe I had a tear somewhere or something, but I knew what it was, but they didn't know what it was."
State Health Officer Dr. Edney told the Mississippi Legislature that the addiction to the substance is difficult to uncover. "Two years ago, I saw zero in my practice; we're up to seeing three to four (now)—if you can find them—(because) they're hard to diagnose,” he said.
Dr. Bryan said her female client took eight doses of Tianeptine daily. But for Doe, the substance dependence progressed from less than a bottle at the beginning to two to four bottles a day and then eight to ten bottles, totaling $250 a day.
She said that the less profound impact of the drug includes nausea, constipation and dry mouth, while also mimicking "opioid toxicity and withdrawal."
"We don't have to fill the gas station up with more stuff that's going to cause (an) opioid crisis (among) our young folks and our young adults; we don't have to have it there," she said.
About one week after the colonoscopy, with the doctor finding no internal bleeding, Doe's mother and aunt took him on the hours-long drive to Pine Grove Behavioral Health and Addiction Service. He described the Oct 7, 2022, visit as an intervention. "My mom set it all up," he said. "it had gotten bad enough that I was ready to go."
The 30-day stay there, he said, cost his family close to $30,000, and he described the detoxification process as unpleasant.
"It was awful. It was terrible. Yeah, it was miserable," he said. "I lost probably 25 pounds over three or four days; I didn't have any vomiting or anything like that, just no appetite, didn't feel like drinking any water; (I had) the shakes, headpins, that kind of thing."
Doe came back home on Nov. 8, 2022, and said he knows some who are still addicted to Tianeptine. "I know people who do, (but) I don't know anybody that would openly talk about it," he said.
Editor’s Note: As described above, reporter Kayode Crown tried multiple ways to get response from the manufacturer and distributor of the drug described in the story above. If they respond after publication, he will add their comments to this story. He is available at firstname.lastname@example.org to set up interviews.