Mar. 16—Tianeptine, referred to by the Morgan County judge who oversees the drug court as "gas station dope," was banned statewide Monday from over-the-counter sales.
"Effective Monday, tianeptine became a Schedule II substance in Alabama," said Nancy Bishop, the state pharmacy director with the Alabama Department of Public Health. "Therefore, it cannot be sold over-the-counter in Alabama."
Morgan County Circuit Judge Charles Elliott, who oversees drug court, last week pushed the Decatur City Council to ban the substance if the state failed to do so.
"This is fantastic," Elliott said Monday. "The quicker it's off the streets, the better."
Elliott said he's seen the effect of tianeptine addiction in defendants in his courtroom.
"It is highly addictive, highly dangerous, it is deadly and it is currently available to anyone in our community," Elliott said at the March 8 council meeting. He said tianeptine is the substance that delivers the "high" in products with names like Tianaa and ZaZa sold at gas stations and convenience stores.
The State Committee of Public Health voted at its November meeting to make tianeptine a Schedule II substance in Alabama and, after a comment period that ran from Dec. 1 to Jan. 4, the committee took a final vote on the rule at its January meeting. The committee is authorized to act on behalf of the State Board of Health.
"The data and clinical nature of tianeptine show that it can be a harmful substance," Bishop said. "By making it a Schedule II substance, it will be available with appropriate dosing by prescription if/when it is approved by the Food and Drug Administration."
The drug is available by prescription as an antidepressant in some European and Latin American countries.
Under state law, the State Board of Health may add or delete substances from the Alabama Controlled Substance List. The law requires the board to consider factors including the actual or relative potential for abuse, the history and current pattern of abuse, risk to the public health and scope, duration and significance of abuse and, after considering the factors, to issue a rule controlling the substance if it finds the substance has the potential for abuse.
Comments on the proposed action could be submitted in writing or made by calling Bishop, who said 60 comments were received — all favoring the proposal to make it a Schedule II drug — from people who have used tianeptine, family members and representatives of treatment centers.
Sen. Arthur Orr, R-Decatur, also pushed to ban the substance.
"I've been working with (State Health Officer) Dr. (Scott) Harris on this for several years," said Orr.
In 2016, state lawmakers passed legislation introduced by Orr to classify kratom — also sold then at many gas stations and convenience stores — as a Schedule I drug.
In arguing for a citywide ban, Elliott had said the drug had no benefit but caused much harm.
"There is no justification for the sale of tianeptine in Decatur except to improve the bottom line of those businesses profiting from this drug," Elliott said, arguing the costs of those profits are "enormous" to the city with citizens ultimately bearing the cost of increased crime, incarceration rates and emergency room visits.
Elliott said that within an hour before speaking to the council, he found brands like ZaZa Red and Tianna Red in five different stores in four districts across the city.
"Each store I went into had (the products)," he said. "That's what floored me."
A legislative effort to ban over-the-counter sales of tianeptine will continue despite the action by the Board of Health, Orr said.
The Alabama House on Thursday passed a bill, introduced by Rep. Mike Holmes, R-Wetumpka, which would classify it as a Schedule II controlled substance.
"I'm handling (the bill) in the Senate and seeing if there are other convenience store-type drugs that need to be looked at," Orr said. He said the bill should be referred today to a Senate committee, possibly the Judiciary Committee of which he's a member, and "I will ask the chair to bring it up as soon as possible."
Orr said that if tianeptine's classification as a Schedule II substance is "in the state code, it gives you a sense of permanence that it's going to stay on the schedule of controlled substances and not be subject to an undoing by a future Board of Health."
At least two Alabama cities had already moved to rid tianeptine from retailers' shelves.
The Pell City Council late last month approved an ordinance banning the sale and delivery of tianeptine within the city limits, and last week the Oxford City Council also voted to ban its sale.
Elliott said that after drug court officials learned about tianeptine in 2017, drug court participants were banned from using, purchasing or possessing it, yet it still presented a challenge "because it is so hard to detect on drug screens and it's readily available at gas stations, convenience stores and vape shops in our community."
The product is so dangerous, because "it replicates the effects of opioids and in high doses, it replicates (the effects of) heroin," according to Elliott. With tianeptine, Elliott said, withdrawal can be fatal.
'I didn't want him to die'
Elliott gave an example of one drug court participant: A delivery driver for a local business who was taking one to two bottles a day and, though he was screened two times a week, it took about a year before it was detected on a drug screen.
"The problem was I could not put him in jail until I could find him a medical detox bed because I didn't want him to die," he said.
Elliott's father, Dr. Charles Elliott, who practiced medicine in the state for 38 years and has been the medical adviser for drug court for 10 months, told council members that tianeptine isn't approved or regulated by the Food and Drug Administration.
It can have the same dangerous problems in higher doses as heroin, like respiratory depression, unconsciousness and cardiac arrest, he said. "People can die from this stuff."
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