Abuse and Addiction Potential
Abuse of tianeptine is rare and thus far has only been seen in patients with pre-existing multi-substance abuse disorders. 141 cases of abuse were identified between 1989 and 2004, correlating to an incidence of 1 to 3 cases per 1000 patients treated with tianeptine. The main reason for abuse is to achieve an anxiolytic effect. According to Servier, cessation of treatment with tianeptine is difficult, due to the possibility of withdrawal symptoms in a patient.
One patient reportedly consumed a total of 240 12.5 mg tablets (3000 mg) per day for several months and was later successfully detoxified in an inpatient setting. The report indicated that a tolerance was developed and there were physical withdrawal symptoms.
In 2007, according to French Health Products Safety Agency, tianeptine's manufacturer Servier agreed to modify the drug's label, following problems with dependency.
Singapore's Ministry of Health has restricted the use of tianeptine to psychiatrists due to its abuse potential, while Bahrain has classified it a controlled substance due to increasing reports of misuse and abuse by patients. In September 2012, France began treating Stablon as a controlled substance. Its use now requires a "secure prescription" form in France, just as is required for narcotics.
Tianeptine (under "Coaxil" brand name) has been intravenously injected by drug users in Armenia and Russia. This method of administration reportedly causes an opioid-like effect and is sometimes used in an attempt to lessen opioid withdrawal symptoms. As tianeptine tablets do not fully dissolve and often the solution is not filtered well, particles in the injected fluid can block small blood vessels, leading to thrombosis and then severe necrosis.
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