US health officials are raising serious concerns about 'Gas Station Heroin', a substance called tianeptine. This has opioid-like-effects and the availability and accessibility is only increasing.

It is also sold as over-the-counter supplements at gas stations, smoke shops, and convenience store. The drug is also marketed as Zaza, Tianaa, Pegasus, and TD Red.

Though used as an antidepressant in some other countries, tianeptine is not approved for medical use in the United States. Experts warn that its effects can mimic those of opioids, including addiction and withdrawal symptoms, even though it is not officially classified as one.

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What Is Tianeptine?

A 2023 study published in journal Pain and Therapy, notes: "Tianeptine is an antidepressant drug approved for the treatment of major depressive disorder in countries other than the US. It is classified as an atypical tricyclic antidepressant and has shown potential benefits in addressing anxiety and irritable bowel disease. However, it is important to note that tianeptine is not approved for any use by the United States Federal Drug Administration (FDA). Despite its lack of approval by the FDA, tianeptine has been distributed online and at small retail locations."

The term “gas station drugs” refers to a wide range of substances typically available for purchase from gas stations, corner stores, bodegas, mini marts, smoke shops, and the Internet. These substances may be produced commercially by drug manufacturers or in clandestine laboratories to mimic the effects of more well-known illicit/controlled substances such as marijuana, cocaine, opioids, etc.

The study also notes that misuse of tianeptine can lead to euphoric, opioid-like highs with the potential for chronic users to develop dependence and tolerance. Overdose and use in suicide attempts have also been documented.

Its popularity stems from its ability to bind to the same brain receptors as opioids, which can create feelings of euphoria, calmness, and even pain relief. “It’s kind of this grey area of consumer products, or supplements, where the contents are not regulated or tested the way they would be with a medication,” explained Dr. Diane Calello of the New Jersey Poison Information and Education System. “You never quite know what’s in that bottle.”

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FDA Warns Against Its Easy Accessibility

In response to rising reports of adverse effects, the FDA issued a formal warning last month, calling tianeptine "a dangerous and growing health trend." The agency urged retailers to stop selling these products and asked consumers to avoid purchasing or using them altogether.

Poison control centers have seen a sharp rise in tianeptine-related incidents. The FDA noted that many of these cases involve young people, and the symptoms often require emergency medical attention. Reported side effects include seizures, low blood pressure, rapid heartbeat, and mental distress. In a review of 20 recent cases, more than half of the patients had to be admitted to intensive care units.

The Alabama Case Study

The state of Alabama serves as a stark example of the risks associated with tianeptine. Between 2018 and 2021, poison control calls related to the drug spiked by over 1,400%. However, after the state imposed strict regulations and bans, the number of such incidents saw a notable decline. This indicates that legal restrictions can play a significant role in curbing misuse.

Health professionals are urging federal and state authorities to take faster and stronger action before tianeptine use becomes a full-blown public health crisis. Some compare the current trajectory of the drug to the early days of the opioid epidemic, which caught the country off guard and led to long-term consequences.

In a disturbing case from the US state of Florida, a pregnant woman in active labor was forced to attend a virtual court hearing via Zoom from her hospital bed for refusing a Cesarean delivery, also known as C-section — a common method of childbirth.

ProPublica reported that Cherise Doyley was in her 12th hour of contractions at the University of Florida Health facility, when she was, without her consent, made to sit in front of a host of people — a judge in a black robe and several lawyers, doctors, and hospital staff — for the Zoom proceeding.

While in active labor, a nurse came in with a bedsheet and told her to cover up, and a supervisor followed with a tablet.

“It’s a real judge in there?” Doyley asked the nurse at the beginning of what would be a three-hour hearing.

What Was The Case?

The mother of three, and a professional birthing doula, Doyley had arrived at the facility after her water broke.

While her doctors expressed concerns about the risk of uterine rupture —a potentially deadly complication for her and her baby — Doyley wanted to try for a vaginal delivery, as the risk was less than 2 percent, unless there was an emergency.

She told doctors she wouldn’t consent to a cesarean without trying to have a vaginal delivery first.

While the doctors initially relented, after several hours, she had to face a virtual court hearing, where the hospital and state attorney’s office forced Doyley to undergo a cesarean section.

Doyley has her own reasons to avoid a C-sec. She already had three prior C-sections, and one that resulted in a hemorrhage. She feared that a C-sec would lead to another serious complication and a lengthy recovery, and her kids would suffer.

However, the hospital was worried that her medical decisions may cause harm to the fetus, and that the courts may help decide which one mattered more, the report said.

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After three hours of testimony — all while Doyley lay in her hospital bed — the judge ruled that she could keep laboring unless there was an emergency. If that happened, the hospital could operate, whether she wanted it or not.

Overnight, doctors said the baby’s heart rate dropped for seven minutes. Doyley woke to her hospital bed being wheeled into surgery. The baby girl was delivered by C-section, the report said.

What Happens In A C-section?

It is a surgical procedure that is used to deliver a baby through an incision made in the abdomen and uterus.

The method is preferred, especially in cases with complications during labor or breech presentation, or multiple births.

Unlike the popular conception, it hurts. In a vaginal delivery, the pain is experienced during labor and pushing, especially if done without an epidural.

Whereas, in a C-section, a surgery is performed that numbs the body from the chest down. However, the recovery could be painful and prolonged. It is also because in a C-section, it involves healing from a major abdominal surgery, while vaginal birth recovery may be quicker, more complicated, or traumatic.

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Does A C-sec Affect The Baby?

Usually, it does not harm the baby, but there could be potential risks to the baby, including:

• Surgical injury, which is very rare; however, the baby may be accidentally nicked during the incision.

• Respiratory issues: Babies born via C-section may have a higher risk of breathing, since they miss the natural compression during the vaginal birth that helps expel the amniotic fluid from their lungs

• Delayed bonding: Immediate skin-to-skin contact may take longer due to the surgical process.
• Feeding challenges: Some newborns may initially struggle with breastfeeding.

Risks Of A C-section Birth?

• Excessive blood loss
• Infection
• Blood clots in the legs, lungs, or pelvis
• Damage to nearby organs
• Adverse reactions to anesthesia

The American College of Obstetricians and Gynecologists (ACOG) advises against elective C-sections due to these potential complications.

American drugmaker Eli Lilly’s first oral pill for weight loss, Orforglipron, marketed as Foundayo, has been given the green signal by the US Food and Drug Administration (FDA).

Lilly is also known for injectable drugs like Zepbound for obesity and Mounjaro and Trulicity for diabetes.

Foundayo’s approval comes after the US FDA in December last year approved Novo Nordisk’s Wegovy pill — the first-ever GLP-1 pill for weight loss. The Danish drugmaker rolled out the pill in January this year.

Novo Nordisk was also the first to launch oral GLP 1 Rybelsus to treat type 2 diabetes. It was approved by the US FDA in September 2019.

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In a statement, the US FDA said that "Foundayo has been approved for use in combination with a reduced-calorie diet and increased physical activity. The pill is targeted to reduce excess body weight and maintain weight reduction for the long term in adults with obesity or overweight".

Lilly said that the drug will be available from April 6 through its its direct-to-consumer platform LillyDirect at a cost of $149 per month for the lowest dose for self-pay customers — on par with Novo's pill. "Shortly after” it will be available through retail pharmacies and telehealth providers in the US.

"Today, fewer than 1 in 10 people who could benefit from a GLP-1 are taking one, held back by access, stigma, perceived complexity, or the belief that their condition isn't serious enough for treatment. We believe Foundayo can help level the playing field for those living with obesity or who are overweight and living with weight-related complications," said David A. Ricks, chair and CEO of Eli Lilly and Company.

"As a convenient, once-daily oral pill that delivers meaningful weight loss, this is obesity care designed for the real world," he added.

Foundayo: A Meaningful Reduction In Body Weight

Also Read: Foundayo: US FDA Approves Eli Lilly’s GLP-1 Weight Loss Pill

In these trials, 72 weeks of treatment with Foundayo, in combination with a reduced-calorie diet and increased physical activity, resulted in a statistically significant and clinically meaningful reduction in body weight.

Deborah Horn, Director of the Center for Obesity Medicine at McGovern Medical School at UTHealth Houston, stated that Foundayo “delivered an average of 12.4 percent weight loss at the highest dose in clinical trials – addressing both the clinical realities of obesity and the practical challenges patients face every day."

In addition, Foundayo also led to reductions in many markers of cardiovascular risk, including waist circumference, non-HDL cholesterol, triglycerides, and systolic blood pressure across all doses, Eli Lilly said.

How Foundayo Works

Lilly licensed Orforglipron, the main ingredient in Foundayo, from a Japanese pharmaceutical company in 2018.

As with the injectable forms of GLP-1s, Foundayo is available in six doses, ranging from 0.8mg to 17.2mg.

In consultation with their doctors, patients start with the lowest dose and gradually work up to higher doses; not everyone may need to reach the highest dose.

Also read: Eli Lilly's Experimental GLP-1 Pill Shows Promising Weight Loss

Unlike the Wegovy pill, people taking orforglipron do not need to restrict food or drink after taking the pill. Orforglipron is a small molecule that the body can absorb quickly and get into the blood, where it reaches the necessary tissues.

Foundayo: Side Effects

Foundayo is not safe for use in children and has an increased list of side effects, such as tumors in the thyroid, including thyroid cancer.

The drugmaker urged watching for possible symptoms, such as

• a lump or swelling in the neck,
• hoarseness,
• trouble swallowing
• shortness of breath.

• nausea,
• constipation,
• diarrhea,
• vomiting,
• indigestion,
• stomach (abdominal) pain,
• headache,
• swollen belly,
• feeling tired,
• belching,
• heartburn,
• gas,
• hair loss.

New Zealand has stepped up surveillance after the first detection of a dengue and Zika-carrying mosquito larvae in the country.

The larval species was confirmed as 'Aedes aegypti' — known to carry diseases including dengue fever, yellow fever, Zika, and chikungunya, across the globe.

As New Zealand does not normally have the mosquito species, the larvae detected were counted as "exotic".

The mosquito species did not cause any outbreak, but were spotted during a routine surveillance program in Auckland.

"The National Public Health Service has commenced a heightened surveillance and interception programme following mosquito larvae being collected from a routine surveillance trap at Queens Wharf, Auckland, on Monday 30 March," Health New Zealand said in a statement.

Health New Zealand reported that exotic species were occasionally found at ports and airports.

Not A Public Threat Yet

The health body noted that the larvae were not considered a public health or biosecurity threat yet because there was no indication they had become established.

But the agency aimed to continue "intensive monitoring for at least three weeks".

"The monitoring would take place within a 400m radius of the site where the larvae were identified. Health Protection Officers would place mosquito traps in the survey area," the statement said.

"These have been hidden away from plain sight so they are not disturbed, for example, in old tyres, bushes, or pools of water. We ask members of the public to avoid touching or disturbing these traps if they find them, as it may disrupt our monitoring and trapping efforts," medical officer of health Dr David Sinclair said.

Sinclair said New Zealanders were most at risk from diseases transmitted by mosquitoes when travelling overseas, including to Pacific Island countries and territories where dengue fever was known to be present.

Dengue Surging In 17 Countries

The US Centers for Disease Control and Prevention recently issued a travel alert of dengue outbreaks across 17 countries.

The CDC alert issued on March 23 identified 17 countries reporting an increased number of cases of dengue. These include: Afghanistan, Bangladesh, Bolivia, Colombia, Cook Islands, Cuba, Guyana, Maldives, Mali, Mauritania, New Caledonia, Pakistan, Samoa, Sudan, Timor-Leste, Vietnam, and the United States territories of American Samoa, Puerto Rico, and the US Virgin Islands, where local transmission is already common.

Also read: Long-term Exposure To Air Pollution Increases Fatality Rates In Dengue: Study

What Is Dengue?

Dengue is a disease caused by a virus spread through mosquito bites. It is transmitted through infected mosquitoes, primarily the species Aedes aegypti.

The breakbone fever is caused by an infection with any of four different dengue viruses. These include:

• Dengue virus type 1 (DENV-1 or DEN-1)

• Dengue virus type 2 (DENV-2 or DEN-2)

• Dengue virus type 3 (DENV-3 or DEN-3)

• Dengue virus type 4 (DENV-4 or DEN-4)

Also read: New dengue vaccine over 80% effective, prevents severe disease for up to 5 years

Common Symptoms of dengue include:

• Sudden onset of high-grade fever.

• Intense headache

• Severe muscle, joint, or bone pain.

• Skin Rash that often appears 2–5 days after the fever starts

• Nausea and Vomiting

• Minor bleeding

• Fatigue.