Gas Station Highs

Sunday, April 26, 2026

10:15 AM - 11:30 AM PT

Location: Harbor D-F, Level 2

Presenter(s)

Alaina R. Steck, MD, FACMT, FASAM

Associate Professor of Emergency Medicine
Emory University
Atlanta, Georgia

Slides
Steven Quam, MD

Addiction Medicine Fellow
University of Minnesota
Saint Paul, Minnesota
JoAn Laes, MD

Addiction Physician
Allina
Minneapolis, Minnesota
Jeremiah D. Fairbanks, DO

Physician
Allina
Inver Grove Heights, Minnesota

Non-presenting author(s)

Robert Cole Pueringer, MD

Addiction Medicine, Medical Toxicology; Medical Director of Substance Use and Addiction Care Program
Essentia Health
Duluth, Minnesota
Evan S. Schwarz, MD, FASAM

Clinical Professor of Emergency Medicine, Medical Toxicology Fellowship Director
UCLA
Los Angeles, California
Lewis S. Nelson, MD, MBA

Professor of Emergency Medicine and Medical Toxicology
Florida Atlantic University College Of Medicine
Delray Beach, Florida

"Gas station" and internet drugs such as tianeptine, phenibut, kratom, and alkyl nitrites exist in a lax regulatory environment that permits easy access, leading to increased emergency presentations for intoxication, withdrawal, and unique harms. In this session, toxicology, emergency medicine, and addiction experts use case vignettes to teach rapid toxidrome recognition, practical management, and effective discharge counseling grounded in current FDA and CDC alerts and recalls. Attendees will gain practical tools, algorithms, and up-to-date references for bedside management.

Learning Objectives:

Learners will be able to:

Identify common “gas station” or internet-accessible agents (e.g., tianeptine, alkyl nitrites/“poppers,” phenibut, kratom) and describe core pharmacology and toxidromes.
Recognize intoxication, withdrawal, and unique complications including poppers maculopathy, severe tianeptine toxicity, phenibut withdrawal, and kratom-associated adverse events.
Apply evidence-informed outpatient and acute care strategies, including supportive care, targeted antidotes and adjuncts, and discharge harm-reduction counseling specific to unregulated products.

Disclosure(s):

Alaina R. Steck, MD, FACMT, FASAM: No financial relationships to disclose

Steven Quam, MD: No financial relationships to disclose

JoAn Laes, MD: No financial relationships to disclose

Jeremiah D. Fairbanks, DO: No financial relationships to disclose

Robert Cole Pueringer, MD: No financial relationships to disclose

Evan S. Schwarz, MD, FASAM: No financial relationships to disclose

Lewis S. Nelson, MD, MBA: No financial relationships to disclose