Psychoactive products sold as supplements — kratom, 7-OH, tianeptine, delta-8 — are stocked at the register in convenience stores nationwide, in packaging designed to read as energy supplements. (Photo by Alejandra Villa Loarca/Newsday RM via Getty Images)
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Look behind the counter the next time you pay for gas. Somewhere between the phone chargers and the lighters there is usually a small acrylic case at eye level. Inside sit brightly colored tablets, single-serving shots, gummies, tins of powder. The packaging makes them look like energy supplements: lightning bolts, chrome lettering, words like focus and recovery and max strength.
Very little of it is what it appears to be. Some of these products are opioids. Some are inhalants that strip the myelin off your nerves. Some are prescription drugs hidden inside capsules labeled as herbal blends. Almost none have been tested for safety.
This is not a regulatory failure. It’s a system working as designed. Under the 1994 Dietary Supplement Health and Education Act, a supplement built from ingredients presumed safe requires no pre-market approval. A company can formulate a product, print a label and ship it. The FDA’s authority is retrospective: it acts after harm surfaces, through warning letters, import alerts and public notifications. Each step can take months or years.
The chemistry moves considerably faster than the regulation. If the FDA schedules one compound, a structural analog can appear on the market, often engineered specifically to sit outside the definition that was just written.
As an emergency physician, I see the downstream effects. Patients show up in the ER, sometimes obtunded from overdosing of one or more these gas station products. It happens across all demographics: young people in their 20s; older adults in their 70s; even in children. On a recent shift, I saw four patients over the course of two hours, all who arrived by EMS. One even had a cardiac arrest before he arrived. He thankfully survived.
Here is what’s in that gas station case, sorted by drug class: what each product does, what it does to you, and how fast it’s growing.
1. The opioid mimics
Kratom
Kratom is ground from the leaves of Mitragyna speciosa, a Southeast Asian coffee tree. It’s legal in most states. It is a partial agonist at the mu-opioid receptor. This is the same receptor that morphine binds. It also acts on other pathways including the adrenergic and serotonergic systems. The practical result is dose-dependent: users describe stimulation and sociability at low doses, sedation and analgesia at higher ones. Most people who use kratom are self-treating pain, anxiety or opioid withdrawal.
Regular use of kratom produces dependence and a withdrawal syndrome when it’s stopped — irritability, muscle aches, insomnia, runny nose and restless legs. The literature also documents rare liver toxicity, along with seizures, tremors, and respiratory depression. Deaths attributed to kratom overwhelmingly involve other drugs on board. The risk rises sharply when leaf products are adulterated or spiked with concentrated 7-OH (see below).
An estimated 1.7 million Americans aged 12 and older — roughly 0.6% of that population — report using kratom. Poison center reports have climbed far faster than use itself: 14,449 kratom exposure reports over eleven years, including a record 3,434 in 2025 alone, an increase of 1,200% over 2015. CDC investigators attribute the 2025 surge to the arrival of high-potency semisynthetic formulations. Of the 233 kratom-associated deaths in that data, 79% involved multiple substances, most often other opioids.
7-OH
Short for 7-hydroxymitragynine, 7-OH is a minor kratom metabolite present in trace amounts in the raw leaf. Manufacturers now concentrate or synthesize it to far higher potencies then sell it as tablets, gummies, drink mixes, shots and dissolvable strips. Unlike its parent alkaloid, 7-OH is a full mu-opioid agonist, estimated to be several times more potent than morphine.
The dangers of 7-OH are everything you’d expect from a potent opioid: respiratory depression, rapid tolerance, physical dependence within weeks, and withdrawal that patients describe as comparable to weaning off oxycodone. The FDA issued warning letters to seven companies in July 2025 for marketing it as a supplement, a food additive and an unapproved drug. A February 2026 query of the agency’s adverse event database returned 83 cases across 2025 and 2026, 79 of them classified as serious, including deaths.
Growth of 7-OH has been explosive because it economics are irresistible: it is cheap to produce and it sells at opioid prices. In July 2026 the DEA began temporary Schedule I placement of 7-OH above a specified threshold, along with three synthetic relatives: mitragynine pseudoindoxyl, MGM-15, and MGM-16. Regulators have been careful to note that the action targets concentrated and synthetic products, not natural leaf containing trace amounts.
Tianeptine
Tianeptine is the product commonly called “gas station heroin.” At therapeutic doses — 12.5 mg, three times daily — it modulates glutamatergic signaling and has only weak mu-opioid activity. Yet at the doses in the products sold are often hundreds of milligrams taken several times a day. That makes that weak opioid activity the dominant effect. Its half-life is short: roughly 2.5 hours, which explains the addiction pattern. Users redose every few hours, often through the night and often escalate fast. It has been sold as Zaza, Tianaa, Neptune’s Fix and Pegasus.
Adverse effects include respiratory depression, seizures, loss of consciousness, tachycardia and agitation. Withdrawal can be severe enough to require inpatient care. In an analysis of 892 single-substance exposures reported to U.S. poison centers between 2015 and 2023, 52% produced moderate effects and 12% major effects; 40% required medical admission and 23% an ICU. Adulteration compounds the problem. A case series in New Jersey documented tianeptine products spiked with synthetic cannabinoids.
Trends in tianeptine use are concerning. Exposures rose roughly 1,400% between 2015 and 2023, including a 525% jump from 2018 to 2023 alone. At least fifteen states banned or scheduled tianeptine on their own while federal action has lagged. That lag is now closing: the DEA published a proposed rule in July 2026 to place tianeptine in Schedule I.
2. The inhalants
Nitrous oxide
Nitrous oxide is sold as culinary whipped-cream chargers in dessert flavors under brands including Galaxy Gas, Baking Bad, Cosmic Gas, HOTWHIP, InfusionMax, MassGass, Whip-it! and Miami Magic. In March 2025 the FDA advised consumers not to inhale any flavor of nitrous oxide from canisters, tanks or chargers. Pharmacologically it is an NMDA receptor antagonist. In users it produces two to five minutes of euphoria, dissociation and analgesia. Because the effect is so short, a user chasing it can go through dozens of canisters in a sitting.
That volume is what separates nitrous from the other inhalants. Nitrous oxide irreversibly disables methionine synthase, the enzyme your body needs to build and maintain the myelin sheath insulating the nerves. Sustained use produces subacute combined degeneration in the spinal cord: numbness starting in the feet and hands, weakness, loss of coordination and in serious cases paralysis. The FDA also cites asphyxiation, blood clots, frostbite injuries from the gas, psychiatric disturbances and death.
Mortality from nitrous oxide is escalating. Nitrous-related deaths rose from 23 in 2010 to 156 in 2023, a 578% relative increase, with 1,240 deaths across that period. Nitrous remains federally unscheduled. However, a bill introduced in the House in March 2026 would classify consumer nitrous products as banned hazardous products.
Alkyl nitrites (“poppers”)
Alkyl nitrites are labeled as leather cleaner, room deodorizer or video head cleaner. They are sold under names like Rush and Jungle Juice. Inhaled, they release nitric oxide, producing near-immediate smooth muscle relaxation and vasodilation. This produces a brief head rush and a drop in blood pressure.
Sharp decreases in blood pressure are one risk. The other is methemoglobinemia, a condition where hemoglobin is oxidized into a form that can’t release oxygen to tissue. Here’s a presentation that I have seen several times in my career: a patient who is visibly cyanotic while the pulse oximeter reads a reassuring 95%+. It is treatable with methylene blue if recognized, yet can be easy to miss. Ingestion rather than inhalation is far more dangerous. It is becoming more common because popper bottles now closely resemble the energy shots sitting on the same shelf.
A 2025 study in JAMA Network Open reported that inhalation exposures rose from 52 in 2013 to 228 in 2023, while ingestions rose from 78 to 277, with disproportionately severe outcomes among the ingestions. New York City’s health department began distributing consumer warnings and issued a clinician advisory on methemoglobinemia in 2024.
3. The hemp-loophole cannabinoids
Delta-8 THC, delta-10, THC-O, and HHC exist because the 2018 Farm Bill legalized hemp by defining it around delta-9 THC content. Manufacturers now convert cheap CBD into intoxicating cannabinoids and sell the product nationwide. Delta-8 is a genuine cannabinoid receptor agonist, roughly half to two-thirds as potent as delta-9. Yet it is still meaningfully psychoactive.
Because no agency oversees production, the conversion process leaves residual solvents, unreacted reagents, and byproducts nobody has characterized. Researchers at the University of Rochester tested 27 delta-8 vaporizer products from 10 brands. None were accurately labeled, 11 contained unlabeled cutting agents and all 27 contained reaction byproducts and heavy metals, including nickel, chromium, and mercury.
Acute presentations of these hemp cannabinoids look like severe cannabis intoxication: tachycardia, vomiting, anxiety and in children lethargy and respiratory depression. Cases in children are increasingly common because the products are packaged to mimic familiar candy and snack brands. Poison center calls involving delta-8, delta-10, and THC-O rose 88% between 2021 and 2022, from 1,746 to 3,276. Children under six accounted for roughly 30% of exposures, with a peak at age two.
What to do before buying any of these products at the gas station
Read the label first. “Not for human consumption,” “research chemical,” and “for novelty use only” are printed on these bottles for legal cover. They are the clearest signal you are holding an unapproved drug. Also be wary of a proprietary blend that lists no per-ingredient amounts. And any product promising to treat pain, anxiety, depression, or withdrawal should stop you outright. This is a drug claim, and a legitimate supplement can’t make it.
Second, check the FDA’s health fraud notification database before buying any supplement promising sexual, weight-loss, or energy effects. It is searchable and free.
Third, if you have been using tianeptine or high-potency 7-OH regularly, don’t stop abruptly on your own. Withdrawal can be severe. This is a conversation to have with a physician who can supervise a taper, just as you would coming off a prescription opioid.
Fourth, call poison control with any concern: 1-800-222-1222, staffed around the clock. Slowed breathing, seizures, chest pain, or unresponsiveness after any of these products is an emergency. Call 911.
The display case being the checkout at the gas station looks harmless: bright, cheap, positioned as an impulse buy alongside the gum and the beef jerky. What it actually holds is a rotating inventory of unapproved drugs, chosen not for safety or efficacy but for the single quality of not yet being illegal.