Lawmakers are urging the Food and Drug Administration to review a supplement dubbed "gas station heroin" that has been linked to seizures, overdoses and death.

Five members of the U.S. House of Representatives from North Carolina, Tennessee and Colorado sent a letter to FDA Commissioner Dr. Robert Califf Thursday with an urgent request for the body to review tianeptine and its presence in the U.S. Rep. Jeff Jackson, D-North Carolina, wrote the letter.

Jackson noted that the FDA has issued several warnings about tianeptine, but said they aren't sufficient to stop its distribution. The FDA had previously said the supplement has been reported as addictive and that Neptune's Fix, a product containing the supplement, led to multiple hospitalizations.

"While we appreciate these warnings, we believe that more action on tianeptine use is needed to ensure the health and well-being of the American people," Jackson wrote. Reps. Rich McCormick, R-North Carolina; John Rose, R-Tennessee; Lauren Boebert, R-Colorado and Wiley Nickel, D-North Carolina, signed the letter.

The lawmakers asked the FDA to show its research on the supplement, and provide information on how it's working with health departments and law enforcement to halt tianeptine's distribution. They also asked whether the FDA has worked with the Drug Enforcement Administration to reclassify the supplement under the Controlled Substance Act.

What is tianeptine?

The National Institutes of Health says on its website that tianeptine is a supplement used in Europe to treat people who respond poorly to selective serotonin reuptake inhibitors or SSRIs, which are the most commonly prescribed medications for depression. SSRIs and include brands like Zoloft, Prozac, Celexa and Lexapro.

Tianeptine is marketed across the globe under Coaxil, Stablon and Tatinol, the NIH said. It's not available for medical use in the U.S., Australia, Canada, New Zealand or the UK, the agency said. But the substance is found in many gas stations, corner stores and other convenience stores under the brand names Zaza and Tianna Red.

"Recent reporting indicates that tianeptine is extremely addictive and that tianeptine withdrawal symptoms are strikingly similar to opioid withdrawal symptoms, including nausea, chills, and insomnia," Jackson wrote. "Recent medical research indicates that tianeptine can cause fatal overdoses."

A review published by the NIH in July said the supplement got the moniker "gas station heroin" after people reported its pain-relieving and addictive properties similar to heroin and other pain relievers.

"Similar to other 'gas station drugs,' the increasing incidence of individuals experiencing harmful effects brought attention to the use of tianeptine within the community," Dr. Amber Edinoff of Harvard Medical School wrote in the review. "WBRC, a media station in Birmingham, Ala., recently reported that tianeptine was cited in nearly 1000 poison control center calls and three deaths. Those involved in the recent outbreak included teenagers who could legally buy tianeptine-containing drugs."

She said that tianeptine lasts in the body for about 2.5 hours. It has been traced to overdoses and suicide attempts.

The Centers for Disease Control and Prevention says on its website that tianeptine abuse and withdrawal can mimic what happens with opioids.

What states banned tianeptine?

The dietary supplement is banned in Alabama, Florida, Georgia, Indiana, Kentucky, Michigan, Mississippi, Ohio and Tennessee.

The FDA issued an updated warning in November urging people not to purchase any product with tianeptine in it and called the supplement a "potentially dangerous substance." The agency said it's being sold illegally with the claim that it will improve brain function and is a treatment for mental illnesses and opioid use disorder.

Contact reporter Krystal Nurse at knurse@USATODAY.com. Follow her on X, the platform formerly known as Twitter, @KrystalRNurse.

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