An outbreak of 34 severe poisonings in New Jersey was traced to tianeptine products sold at gas stations that were secretly laced with potent synthetic cannabinoids.
People who use unregulated supplements; harm-reduction advocates; emergency medicine professionals
43% of patients required intubation; 65% admitted to ICU
What the researchers found
Products marketed as containing tianeptine were found to contain the synthetic cannabinoids MDMB-4en-PINACA and ADB-4en-PINACA. Of 37 acute exposures, 43% required intubation and 65% were admitted to the ICU.
Why it matters
Unregulated products sold openly at gas stations and online can contain dangerous adulterants with no labeling to warn users.
The numbers in context
34 unique patients over about 8 months, compared to a background rate of 0.5 tianeptine cases per year. 43% (16 patients) required intubation. 65% (24 patients) admitted to ICU.
How the study worked
Retrospective and prospective surveillance through New Jersey Poison Control. Six product samples were analyzed by gas chromatography and mass spectrometry.
What this study cannot tell us
Case series without controls. Product composition varied across samples. Only two patient blood samples were tested.
How to read the evidence
Case series documenting an outbreak; provides clinical and toxicological evidence but no controlled comparison.
When this study was published
2025 publication covering June 2023 to February 2024 cases
The bigger picture
This outbreak illustrates a broader pattern in unregulated markets: products sold as one substance may contain entirely different and more dangerous compounds.
Questions still open
- How widespread is synthetic cannabinoid adulteration in unregulated consumer products? Would regulation of tianeptine reduce these incidents?
Common questions
What is tianeptine?
What made these cases so severe?
Read the original research
An Outbreak of Synthetic Cannabinoid-Adulterated Tianeptine Products in New Jersey - Case Series.
Journal of medical toxicology : official journal of the American College of Medical Toxicology, 21(2), 253-259
Citation
Counts, Christopher J; Spadaro, Anthony V; Cerbini, Trevor A; Krotulski, Alex J; Walton, Sara E; Greller, Howard A; Nelson, Lewis S; Ruck, Bruce E; Hung, Oliver; Logan, Barry; Calello, Diane P. (2025). An Outbreak of Synthetic Cannabinoid-Adulterated Tianeptine Products in New Jersey - Case Series.. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 21(2), 253-259. https://doi.org/10.1007/s13181-025-01068-7
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