Forrest Health residency research helps classify ‘gas station heroin’ as Schedule III drug

HATTIESBURG, Miss. (WDAM) - Research by a team of Hattiesburg doctors and residents helped pass a Mississippi House bill that classified tianeptine, a.k.a. “gas station heroin,” as a Schedule III drug.

Forrest Health’s Family Medicine Residency Clinic (FRMC) residency director Dr. Rambod Rouhbakhsh said these products had been marketed for various applications like the self-treatment of anxiety, depression, asthma and irritable bowel syndrome.

After FRMC physicians observed multiple patients exhibiting opioid withdrawal symptoms while consuming high daily doses of tianeptine-based products, Rouhbakhsh decided to oversee a research team to learn more about the effects of the drug.

The team included Dr. Joseph Nosser, Dr. Robert “Bob” Brahan, Dr. John Lloyd Martin and Dr. Adam Purvis. (Martin and Purvis were residents when the research was conducted.) Their research was pivotal in the passage of House Bill 4 - an act to amend Section 41-29-117, Mississippi Code of 1972, to include tianeptine as a Schedule III drug.

Mississippi Governor Tate Reeves signed the bill into law on March 23.

“It makes us feel useful to our community that we were able to identify a public health threat, educate our colleagues about it and then help eliminate it through legislation,” said Rouhbakhsh. “And all relatively quickly, as well.”

Nosser agreed.

“We knew working with Forrest General and Hattiesburg Clinic they had the influence to get this information in front of the right people to advocate for what we had seen out on the front lines – local residents seeing the effects of tianeptine,” he said. “It’s been very interesting to see this grassroots effort come into play over a period of time.

“We had two resident physicians seeing patients who presented with these same symptoms, so we worked together with the team to develop a study and report to the state what we found. From there, it started building momentum and getting in front of the right people. Our goal was to get this dangerous substance off the street.”

The following is a timeline of the FMRC team’s research:

• January 2022: FMRC physicians observe multiple cases of tianeptine withdrawal.
• March-May 2022: Rouhbakhsh oversees a case series study outlining finding from tianeptine-withdrawal cases.
• June-September 2022: Data is compiled into a manuscript titled “Tianeptine Withdrawal: A Cause for Public Health Concern in Mississippi” that undergoes a peer review process by the Mississippi State Medical Association.
• September 2022: The team’s findings are published in the Journal of the Mississippi State Medical Association.

The team also presented their research to the Food and Drug Administration.

Nosser said it is starting to come to light that tianeptine is a problem, and people are discussing it.

Some convenience stores selling tianeptine are now pulling the product from their shelves. However, others are waiting until the day before the bill goes into effect - June 30, 2023.

“We may see more patients between now and then until the product is no longer available,” Nosser said.

The principal authors and co-authors of House Bill 4 were Rep. Lee Yancey of District 74 and Rep. Dana McLean of District 39.

Mississippi becomes the seventh state to ban the tianeptine formulation, behind Alabama, Michigan, Tennessee, Georgia, Indiana and Ohio.

For more information, visit www.forresthealth.org or www.fda.gov.

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