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nails and hair, promote joint health, lessen joint pain, and even cannabidiol (or CBD) in a laboratory. It is commercially
improve strength and body composition. 40–46,48–50 Researchers available in vape cartridges, tinctures (liquid form), and edi-
have proposed that collagen supplementation may promote bles and is readily accessible online. Importantly, some delta-
connective tissue repair and synthesis and protect joints from 8-THC products may be labeled simply as “hemp products,”
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damage. We expect more recommendations on the use of col- which may mislead consumers who associate “hemp” with
lagen peptides to emerge in the future. “non-psychoactive.” Delta-8-THC is also typically less ex-
pensive than delta-9-THC, which is the primary psychoactive
In short, many performance-enhancing peptides, peptide hor- component in the plant.
mones, and hormone-releasing agents—sometimes sold as DSs
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or in other forms without a prescription—are on the DoD Interest in delta-8 THC increased in mid-June 2020. In 2021,
Prohibited Dietary Supplement Ingredients List as well as on the Center for Disease Control and Prevention issued a health
the WADA Prohibited List. Each substance in this group poses advisory concerning the widespread availability of delta-8
specific and serious health risks and should only be used under THC-containing products and reported cases of adverse
the supervision of a qualified healthcare provider. Conversely, events. Between 1 January 2021 and 28 February 2022, 2,362
collagen peptides are legal dietary ingredients that may pre- calls were made to U.S. Poison Control Centers due to acci-
vent muscle injuries and expedite return to duty, among other dental delta-8 THC exposure. 65,67 In 2022, the FDA released
uses. Regardless, the use of such products should be discussed a document entitled “5 Things to Know About Delta-8 Tetra-
with a provider or performance dietitian. hydrocannabinol: Delta-8 THC” and warned the public of
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the potential dangers. One 2023 study of online storefronts
Tianeptine concluded that cannabinoid derivatives were illegally sold and
Tianeptine is a µ-opioid receptor agonist with anxiety- reducing shipped to U.S. consumers. 68
effects. It is addictive and often abused for the euphoric effects,
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and overdoses have been reported. Withdrawal from tianep- Of particular concern is the quality of available products. Del-
tine is similar to opioid withdrawal and may result in severe ta-8-THC rapidly entered the marketplace with “no required
symptoms that require hospitalization. 52,53 It is prescribed in warning labels or packaging protections in place and no man-
approximately 24 countries to treat depression but has not dated laboratory analysis to assure label accuracy or product
been approved in the U.S. for any medical use. 52,54–57 Tianep- purity.” As such, the final products are often contaminated
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tine is, therefore, an unapproved drug. or yield inconsistent amounts of delta-8 THC. 65,69 Testing of
products suggests the presence of “several impurities in con-
Tianeptine has, however, become a part of the nootropic/ centrations far beyond what is declared on certificates of anal-
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cognitive enhancing world—a billion-dollar industry. More ysis.” Meehan-Atrash et al. reported inaccurate labeling in
concerning is its presence as an ingredient in some DS prod- 27 products from 10 brands: “None had accurate Δ8-THC
ucts. According to the FDA, companies are making danger- labeling, 11 had unlabeled cutting agents, and all contained
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ous claims that tianeptine can improve brain function and reaction side-products,” heavy metals, and an undescribed
treat depression, anxiety, pain, opioid use disorder, and other cannabinoid. In essence, with no consumer protections in
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conditions. Some have nicknamed tianeptine a “gas station place, the accuracy of product labels and the purity of avail-
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heroin” because it can be found in gas stations, truck stops, able products are largely unknown.
corner stores, bodegas, mini marts, smoke shops, and the in-
ternet. 52,55 It is important to note that this substance is banned The use of a delta-8-THC product could result in a positive
in several states (Michigan, Alabama, Ohio, Georgia, and Mis- drug test. Any products containing hemp, CBD, THC, and
sissippi). However, these bans do not limit anyone from pur- delta-8 THC are prohibited for use by Servicemembers.
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chasing tianeptine online or crossing state lines to buy it. In
the illicit drug market, it has been found in counterfeit pills Solutions
mimicking hydrocodone and oxycodone and in small packets
commonly used to distribute heroin. 61 Mitigating the likely risk of compromised performance or
harm to Servicemembers requires careful DS selection and in-
Abuse of tianeptine has been increasing over the past two de- tentional education. We will discuss the concept of third-party
cades. The FDA first issued a warning about the potentially certification/verification, how to select supplements, then edu-
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dangerous adverse effects of this substance in 2018 and then cation and DS resources. 72
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again in 2022. In 2023, the Department of Justice released a
report on the emergence of tianeptine on the illicit drug market Third-Party Testing
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in the U.S. and the adverse effects of tianeptine withdrawal. Careful product selection can involve several steps or a single
The adverse effects included agitation, confusion, drowsiness, step: verifying that the product has a well-vetted third-party
sweating, rapid heart rate, hypertension, nausea, vomiting, certification seal (See Figure 2). These seals confirm indepen-
respiratory depression, seizures, coma, and even death. 60,63 dent testing, evaluation of DS ingredients, and compliance
Tianeptine is on the DoD Prohibited Dietary Supplement In- with Good Manufacturing Practice (GMP) or similar require-
gredients List and should be avoided by all Servicemembers ments. Some certifications also have requirements for post-
and the public. certification and testing.
Delta-8-THC In Figure 2, the three seals shown with green checks below
Delta-8-THC, a nootropic/cognitive altering agent, is the last the seal (Informed Sport, BSCG Drug Free, and NSF Certified
substance to discuss. This psychoactive substance is naturally Sport) confirm that the product has tested negative for many
found in the plant Cannabis sativa, but in small quantities. ingredients banned by WADA. Testing for substances banned
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Most delta-8-THC on the market is made from hemp-derived in sports presents the most stringent criterion of third-party
116 | JSOM Volume 24, Edition 4 / Winter 2024