Kristi Terry keeps replaying the last time she saw her son Johnathon Morrison alive.
The 19-year-old scholarship student came into her bedroom on the night of Feb. 20, 2019 and asked if it was OK if he cooked some pizza rolls; he didn't want to hog them from his younger sister, who was a fussy eater.
Terry, 41, and her husband found it odd that he was asking permission.
“We were like ‘you don’t have to ask to cook something," she said. In hindsight, she wishes she’d gotten up to see if he was feeling alright. She wonders if he was feeling sick at that point and was trying to settle his stomach with food.
The next morning Terry and her 15-year-old daughter found Morrison unresponsive in his bedroom in Trafford, Alabama. Paramedics spent an hour trying to revive him, but they couldn't. Next to his body was a half-eaten plate of pizza rolls and a nearly empty bottle of tianeptine pills, an unapproved drug known as “gas station heroin” because of its addictive effects on some users.
Morrison’s cause of death is asphyxia due to aspiration of gastric contents—meaning he choked on his vomit—and is considered accidental, according to his autopsy report, which VICE News has obtained. But the high level of tianeptine he had in his system was similar to the level found in another reported tianeptine fatality in which no other drugs were detected, the medical examiner wrote.
His death is one of the few rare fatal overdoses that’s been linked to tianeptine, a drug that is sold at gas stations and convenience stores around the U.S. as well as online, often illegally marketed as a dietary supplement or cognitive booster. Tianeptine is a tricyclic antidepressant that is used as medication in over 60 countries around the world, but it is not approved by the Food and Drug Administration for medical use in the U.S., so the versions sold here are unregulated. While at least a dozen states have banned tianeptine, it remains federally unscheduled.
Because it also hits opioid receptors in the brain, it can produce euphoria and pain relief. Many users have told VICE News tianeptine’s effects were similar to prescription opioids at first, but were quickly replaced with brutal withdrawal symptoms including insomnia, shakes, nausea, and anxiety. It’s also been linked to seizures and hospitalizations.
But Morrison, a theater and business student at the University of Alabama at Birmingham, didn’t know any of that.
He stumbled upon tianeptine by chance when he popped into a gas station in search of medication to relieve his migraine, according to his mom. The gas station didn’t have Excedrin, but an employee there offered Morrison a bottle of pills called Tianaa, a popular brand of tianeptine.
“He had no clue what he was taking,” said Terry. “They told him that it was all natural, herbal, and that it was like a powerful Tylenol.”
So Morrison took it like Tylenol, popping a couple at a time over the next few hours. In the morning, Terry and her teenage daughter went to check on Morrison after his boss sent a concerned text saying he hadn’t turned in a report. They found him lying flat on his bed. While it seemed like he was making a snoring noise, he wasn’t breathing.
Just three of the 15 tianeptine pills in the bottle remained, Terry said.
VICE News has left messages with MT Brands, a Florida-based company that makes Tianaa, but has not yet received a response.
The degree to which tianeptine toxicity may have contributed to Morrison’s death, “either directly due to the toxic effects of the drug or indirectly by potentially reducing his seizure threshold, remains uncertain,” the autopsy said. His system had therapeutic amounts of a couple of prescription drugs he was taking for his migraines as well as an anti-seizure medication, though Terry said he’d only had two seizures in his life.
Dr. Ryan Marino, medical director of toxicology and addiction medicine at University Hospitals in Cleveland, said it’s common for people to vomit and aspirate during drug overdoses because they “lose higher functioning.”
“A helpful comparison is alcohol,” he said. “It’s pretty hard to die from drinking alcohol in one night or one sitting. But obviously people can throw up and have bad things happen.”
He said it’s not clear that tianeptine causes overdoses by causing people to stop breathing, which is the case for opioids like fentanyl. But he cautioned there’s not enough data yet on high levels of tianeptine in humans to draw strong conclusions about its toxicity.
The FDA, which has issued several consumer alerts about tianeptine in the last few months, said it has received two tianeptine-related death reports since 2015. The agency also said poison control center cases about tianeptine exposure increased from 11 total cases between 2000 and 2013 to 151 cases in 2020 alone. A 2018 paper analyzing tianeptine deaths worldwide showed that the ones that didn’t involve other drugs were tied to respiratory depression or cardiac arrhythmias.
Despite the fact that deaths are rare, tianeptine users have still reported adverse health reactions to the drug.
Chris Ricks, who lives in Mobile, Alabama, was hospitalized for a week in 2021 after taking four bottles of Zazas, another popular tianeptine brand. He was found “urinating and defecating everywhere in the house,” according to a hospital report seen by VICE News, before being admitted into an intensive care unit.
“I just remember being out of it, I don't know what was going on,” he said, noting that in hospital he required benzodiazepines to stop him from ripping out his IV.
Ricks has been sober from tianeptine since he was discharged in March 2021. At the height of his addiction, he was taking eight bottles a day, spending $80,000 on them in one year.
“Within a month of taking those I looked in the mirror and said ‘You’re either headed back to rehab or death,’” he told VICE News.
After Morrison died, Terry was determined to get tianeptine banned in Alabama.
She testified at a state senate healthcare committee in February 2020.
“He was just the light of my life and he was my best friend,” Terry said, showing a photo of her son to the committee, according to an audio recording of the hearing obtained by VICE News.
Her friend explained that Terry had been bedridden with post-traumatic stress disorder since finding Morrison.
Also at the hearing was James Morrissette, CEO and founder of MT Brands. He said his tianeptine products were promoted as being for stress and anxiety relief, but “it has taken a direction where people are beginning to abuse the product” or use it as a “cessation product for opiates.”
Morrissette said while Terry’s story was heartbreaking, he supported stronger regulation over banning tianeptine, including increased age limits for customers. He has also accused other tianeptine manufacturers of making subpar products.
“There are other people that are benefiting from this product. And to just turn around and start banning products without having solid meaning behind it, where does it stop?” he said at the hearing.
A year later, Alabama became the second state to ban tianeptine. Florida, Arkansas, Kentucky, Michigan, Minnesota, Tennessee, Georgia, Ohio, Oklahoma, Mississippi, and Indiana, have also banned it.
In January, citing VICE News’ previous reporting, a group of five members of Congress wrote a letter to the FDA asking the agency to “to take immediate action to research and provide guidance on tianeptine use,” including working with the Drug Enforcement Administration to determine if it should be federally scheduled.
But bans can have unintended causes, including leading people back to using illicit drugs, especially because there’s no clear-cut detox protocol for coming off of tianeptine. Three former users previously told VICE News their tianeptine use led them back to using street drugs including fentanyl and crack cocaine.
In an email, an FDA spokesperson told VICE News it urges consumers not to use any tianeptine product and reiterated that it is not approved for any medical use.
“The FDA will continue to take regulatory actions and alert consumers of safety issues related to tianeptine products,” the statement said.
Terry said it makes her “sick” that there are many Americans who can still easily purchase the drug.
She said her son, who had the “biggest smile and dimples” had been saving up for a vintage Mercedes or BMW when he died. Instead, that money paid for his headstone.
“I do feel like Johnathon’s story is what got it banned in Alabama. I really do,” she said. “The senators and everybody had to look at my son’s picture.”