Tianeptine Products: Public Health Threat or Niche Substance use?

Among adults who have used tianeptine, we aimed to determine demographic and substance-use patterns and gain insights into tianeptine doses, effects, and consumer conceptualizations. We also evaluated problematic use, quit attempts, and tianeptine-specific substance-use disorder (SUD). Between December 2023 and July 2024, an online survey was conducted. Participants were ≥18 years old and endorsed lifetime use of kratom, kava, tianeptine, and/or akuamma seed. Of the 369 respondents, 6.0% (<i>n</i> = 22) reported lifetime tianeptine use; they were 35.6 years old on average, White, and male (81.8%) and evinced diverse substance use. Mean age of tianeptine-use initiation age was 31.0. More within the tianeptine-use group believed they currently had any SUD (40.9% versus 20.2%, <i>p</i> = .0002), had ever been prescribed methadone/buprenorphine (27.3% versus 8.1%, <i>p</i> = .009), and were interested in recovery (72.7% versus 28.8%, <i>p</i> < .0001). Use motivations included euphoria, self-management of psychiatric symptoms, and drug substitution. Tianeptine-tolerance onset was considered rapid (59.1%), with one-third experiencing adverse effects. For past-year tianeptine SUD (<i>n</i> = 15), 13.3% of participants were mild, 53.3% were severe. Many tianeptine conceptualizations were unfavorable: "habit-forming" (68.2%), "addictive" (68.2%), "problematic" (59.1%); 86.3% believed overdose was possible. Tianeptine was used at low rates in this sample of adults who consumed gray-market supplements and included unfavorable perceptions.