Notes from the Field: Cluster of Severe Illness from Neptune’s Fix Tianeptine Linked to Synthetic Cannabinoids — New Jersey, June–November 2023

Tianeptine is an atypical tricyclic antidepressant with pharmacologic effects that include enhancement of serotonin reuptake and mu-opioid receptor agonism.The Food and Drug Administration has not approved tianeptine for use in the United States; however, it is readily purchased in elixir formulations online or at gas stations informally referred to as "gas station heroin" (1-3).This report describes an uncharacteristic spike in tianeptine ingestions in New Jersey during June-November 2023, with severe associated clinical effects with synthetic cannabinoid receptor agonists (SCRAs) identified in samples of the ingested products.