The war goes on, yet somehow victory always seems elusive.
On Monday, tianeptine became a Schedule II drug in Alabama, meaning it can no longer be sold over the counter. The action by the Alabama State Board of Health was applauded by Morgan County Circuit Judge Charles Elliott, who oversees the county’s drug court and refers to tianeptine, which is sold under a variety of brand names, as “gas station dope.”
“This is fantastic,” Elliott said Monday. “The quicker it’s off the streets, the better.”
Elliott maintains tianeptine is “highly addictive, highly dangerous” and “deadly.” He also referred to it as “basically over-the-counter heroin.”
The evidence of tianeptine’s dangers, however, is unclear. In a 2018 report, the Centers for Disease Control and Prevention found no deaths reported among “the 114 tianeptine-only exposures, excluding withdrawal-related calls.”
Tianeptine has also been approved for clinical use in roughly 60 countries, although not the United States.
None of this is to say that tianeptine is safe, especially when taken without a doctor’s prescription, or that people should use it. But it may be that banning it turns out to be worse than not, because now that it is banned from convenience store shelves in Alabama, rest assured something will come along to replace it. We know this from experience, because tianeptine is itself a replacement for a now-banned supplement that once lined store shelves.
State Sen. Arthur Orr, R-Decatur, helped persuade the Board of Health to classify tianeptine as a Schedule II drug.
“I’ve been working with (State Health Officer) Dr. (Scott) Harris on this for several years,” Orr told The Daily.
Orr was also instrumental in banning from store shelves in 2016 tianeptine’s predecessor, kratom. Like tianeptine, kratom is legal in many other countries but not approved for clinical use here, and it was sold under a variety of brand names.
It was also, according to those seeking to ban it, almost as dangerous then as tianeptine is now.
It was easy to predict in 2016 that someone would come up with and market a kratom replacement that got around the ban. Tianeptine was it. And it is easy to predict now that the same people will come up with a tianeptine replacement, and we’ll be right back in this situation again.
No doubt, the state will ban that drug, too, and the cycle will continue, all of which is a long way of saying there is no substitute for improved mental health care.
Tianeptine is an antidepressant, and in the countries where it is approved for clinical use, it’s used to treat depression. The way to stop people going to the convenience stores to buy unapproved supplements to self-medicate, possibly with negative side effects, is to make sure they have access to the appropriate clinical care.
Alabama has failed in this regard, and the result has too often been people turning to drugs from shady sources and area law enforcement being called upon to deal with people experiencing mental health crises.
Removing kratom and tianeptine from the shelves may seem like doing something, but it is window dressing. The real problems continue to go on behind the curtain, and removing some pill bottles with colorful labels from the shelves is no substitute to investing in mental health — but that takes money.