An Outbreak of Synthetic Cannabinoid-Adulterated Tianeptine Products in New Jersey – Case Series

• DOI: 10.1007/s13181-025-01068-7
• Publication Date: 2025-03-18T16:53:38Z
• Authors: Christopher J. Co...; Anthony V. Spadaro; Trevor A. Cerbini; Alex J. Krotulski; Sara E. Walton; Howard A. Greller; Lewis S. Nelson; Bruce E. Ruck; Oliver Hung; Barry Logan; Diane P. Calello
• Keywords: Tianeptine; Synthetic cannabinoids

Abstract Background Tianeptine, an atypical antidepressant not approved in the United States, is readily purchased from unregulated markets such as internet and gas stations. We became aware of a cluster 34 patients New Jersey who ill following ingestion tianeptine containing-product Neptune’s Fix, rate which (4.6 cases per month) far exceeded background for this substance 0.5 year. Methods retrospectively identified exposures reported to Poison Information Education System (NJPIES) prior June 2023 determine exposure. From 2023– February 2024 we prospectively surveilled NJPIES, recorded demographic clinical information, recruited samples testing. Six ingested products were obtained analyzed using chromatography mass spectrometry (GC-MS) liquid quadrupole time-of-flight (LC-QTOF-MS). Whole blood two tested synthetic cannabinoids. Results During period interest, NJPIES received 41 exposure calls, with 37 reporting acute toxicity unique patients, chronic use, withdrawal. Among resulting toxicity, commonly effects included altered mental status, tachycardia, hypotension, seizures. 43% ( n = 16) intubated, 65% 24) admitted ICU. Analytical testing six variable product composition, containing various xenobiotics including tianeptine, kava alkaloids, natural cannabinoids, cannabinoids MDMB-4en-PINACA ADB-4en-PINACA. was detected one patient specimens. Conclusions These represent marked increase compared poison center’s historical average. revealed presence Clinicians should be that are widely available, unregulated, can adulterated.