Narcotics Awareness...Nitrous Oxide Explained

DESCRIPTION/OVERVIEW Inhalants are a diverse group of substances that include volatile solvents, gases, and nitrites that are sniffed, snorted, huffed, or bagged to produce intoxicating effects similar to alcohol. These substances are found in common household products like glues, lighter fluid, cleaning fluids, and paint products. Inhalant abuse is the deliberate inhaling or sniffing of these substances to get high, and it is estimated that about 1,000 substances are misused in this manner. The easy accessibility, low cost, legal status, and ease of transport and concealment make inhalants one of the first substances abused by children.(1) There are four general categories of inhalants: Volatile solvents are liquids that vaporize at room temperatures. They are found in a multitude of inexpensive, easily available products used for common household and industrial purposes. These include paint thinners and removers, dry-cleaning fluids, degreasers, gasoline, glues, correction fluids, and felt-tip marker fluids.(2) Aerosols are sprays that contain propellants and solvents. They include spray paints, deodorant and hair sprays, vegetable oil sprays for cooking, and fabric protector sprays.(3) Gases include medical anesthetics as well as gases used in household or commercial products. Medical anesthetic gases include ether, chloroform, halothane, and nitrous oxide, commonly called “laughing gas.” Nitrous oxide is the most abused of these gases and can be found in whipped cream dispensers and products that boost octane levels in racing cars. Household or commercial products containing gases include butane lighters, propane tanks, whipped cream dispensers, and refrigerants.(4) Nitrites often are considered a special class of inhalants. Unlike most other inhalants, which act directly on the central nervous system (CNS), nitrites act primarily to dilate blood vessels and relax the muscles. While other inhalants are used to alter mood, nitrites are used primarily as sexual enhancers. Nitrites include cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl (butyl) nitrite, and are commonly known as “ poppers” or “snappers.” Amyl nitrite is used in certain diagnostic procedures and was prescribed in the past to treat some patients for heart pain. Nitrites are now prohibited by the Consumer Product Safety Commission, but can still be found, sold in small bottles, often labeled as “video head cleaner,” “room odorizer,” “ leather cleaner,” or “liquid aroma.”(5) CONTROL STATUS Inhalants are not regulated under the Controlled Substances Act (CSA). STREET NAMES(6) Air blast Moon gas Ames Oz Amys Pearls Poor man's pot Aroma of men Bolt Shoot the breeze Buzz bomb Bullet bolt Satan's secret Bullet Rush Snappers Boppers Quicksilver Poppers Discorama Snappers Hardware Snotballs Heart-on Spray Texas shoe shine Hiagra in a bottle Highball Thrust Hippie crack Toliet water Huff Toncho Laughing gas Whippets Locker room Whiteout SHORT-TERM EFFECTS Most inhalants act directly on the central nervous system (CNS) to produce psychoactive, or mind-altering, effects. They have short-term effects similar to anesthetics, which slow the body's functions.(7) Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream and quickly distributed to the brain and other organs. Within seconds of inhalation, the user experiences intoxication along with other effects similar to those produced by alcohol. Alcohol-like effects may include slurred speech, an inability to coordinate movements, euphoria, and dizziness. In addition, users may experience lightheadedness, hallucinations, and delusions.(8) Prolonged sniffing of the highly concentrated chemicals in solvents or aerosol sprays can induce irregular and rapid heart rhythms and lead to heart failure and death within minutes of a session of prolonged sniffing. This syndrome, known as "sudden sniffing death," can result from a single session of inhalant use. Chronic exposure to inhalants can produce significant, sometimes irreversible, damage to the heart, lungs, liver, and kidneys.(9) LONG-TERM EFFECTS The chronic use of inhalants has been associated with a number of serious health problems. Sniffing glue and paint thinner causes kidney abnormalities, while sniffing the solvents toluene and trichloroethylene cause liver damage. Memory impairment, attention deficits, and diminished non-verbal intelligence have been related to the abuse of inhalants. Deaths resulting from heart failure, asphyxiation, or aspiration have occurred.(10) A strong need to continue using inhalants has been reported among many individuals, particularly those who abuse inhalants for prolonged periods over many days. Compulsive use and a mild withdrawal syndrome can occur with long-term inhalant abuse. Additional symptoms exhibited by long-term inhalant abusers include weight loss, muscle weakness, disorientation, inattentiveness, lack of coordination, irritability, and depression.(11) Inhalants are breathable chemical vapors that produce psychoactive (mind-altering) effects. A variety of products commonplace in the home and in the workplace contain substances that can be inhaled. Many people do not think of these products, such as spray paint, glues, and cleaning fluids, as drugs because they were never meant to be used to achieve an intoxicating effect. Yet, young children and adolescents can easily obtain them and are among those most likely to abuse these extremely toxic substances. Parents should monitor household products closely to prevent accidental inhalation by very young children. Inhalants fall into the following categories: Solvents Industrial or household solvents or solvent-containing products, including paint thinners or solvents, degreasers (dry-cleaning fluids), gasoline, and glue Art or office supply solvents, including correction fluids, felt-tip-marker fluid, and electronic contact cleaners Gases Gases used in household or commercial products, products, including butane lighters and propane tanks, whipping cream aerosols or dispensers (whippets), and refrigerant gases. Household aerosol propellants and associated solvents in items such as spray paints, hair or deodorant sprays, and fabric protector sprays Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous oxide ("laughing gas") Nitrites Aliphatic nitrites, including cyclohexyl nitrite, which is available to the general public; amyl nitrite, which is available only by prescription; and butyl nitrite which is now an illegal substance. Health Hazards Although they differ in makeup, nearly all abused inhalants produce short-term effects similar to anesthetics, which act to slow down the body's functions. When inhaled via the nose or mouth into the lungs in sufficient concentrations, inhalants can cause intoxicating effects. Intoxication usually lasts only a few minutes. However, sometimes users extend this effect for several hours by breathing in inhalants repeatedly. Initially, users may feel slightly stimulated. Successive inhalations make them feel less inhibited and less in control. If use continues, users can lose consciousness. Sniffing highly concentrated amounts of the chemicals in solvents or aerosol sprays can directly induce heart failure and death within minutes of a session of prolonged use. This syndrome, known as "sudden sniffing death," can result from a single session of inhalant use by an otherwise healthy young person. Sudden sniffing death is particularly associated with the abuse of butane, propane, and chemicals in aerosols. High concentrations of inhalants also can cause death from suffocation by displacing oxygen in the lungs and then in the central nervous system so that breathing ceases. Deliberately inhaling from an attached paper or plastic bag or in a closed area greatly increases the chances of suffocation. Even when using aerosols or volatile products for their legitimate purposes (i.e., painting, cleaning), it is wise to do so in a well-ventilated room or outdoors. Chronic abuse of solvents can cause severe, long-term damage to the brain, the liver and the kidneys. Harmful irreversible effects that may be caused by abuse of specific solvents include: Hearing loss - toluene (paint sprays, glues, dewaxers) and trichloroethylene (cleaning fluids, correction fluids) Peripheral neuropathies or limb spasms - hexane (glues, gasoline) and nitrous oxide (whipping cream, gas cylinders) Central nervous system or brain damage - toluene (paint sprays, glues, dewaxers) Bone marrow damage - benzene (gasoline). Serious but potentially reversible effects include: Liver and kidney damage - toluene-containing substances and chlorinated hydrocarbons (correction fluids, dry-cleaning fluids) Blood oxygen depletion - organic nitrites (poppers, bold, and rush) and methylene chloride (varnish removers, paint thinners). Abuse of amyl and butyl nitrites has been associated with Kaposi's sarcoma (KS), the most common cancer reported among AIDS patients. Early studies of KS showed that many people with KS had used volatile nitrites. Researchers are continuing to explore the hypothesis of nitrites as a factor contributing to the development of KS in HIV-infected people. Extent of Use Initial use of inhalants often starts early. Some young people may use inhalants as a cheap, accessible substitute for alcohol. Research suggests that chronic or long-term inhalant abusers are among the most difficult drug abuse patients to treat. Many suffer from cognitive impairment and other neurological dysfunction and may experience multiple psychological and social problems. Monitoring the Future Study (MTF)* NIDA's nationwide annual survey of drug use among the Nation's 8th-, 10th-, and 12th-graders indicates that inhalant use for 8th- and 10th-graders appears to have peaked in 1995, and in 1990 for 12th-graders, and has declined since then. In 2002, lifetime, past year, and past month inhalant use among 8th and 10th-graders was the lowest seen in the history of the survey and the lowest in about 20 years for high school seniors. In 2002, a persistent pattern of higher rates of use by younger children continued as more 8th-graders than 10th- or 12th- graders said they used inhalants. However, the percentage of 8th-graders who said they had ever used inhalants decreased from 17.1 percent in 2001 to 15.2 percent in 2002. This represents a substantial decline from the peak year of 1995 when 21.6 percent of 8th graders said they had used inhalants during their lifetimes. National Household Survey on Drug Abuse (NHSDA)** NHSDA data show that, between 2000 and 2001, the number of people age 12 and older having used inhalants at least once in their lifetime rose by roughly 1.5 million, to over 18 million users. As in 2000, highest past year use was among 14- and 15-year-olds, with 4.2 percent of this population reporting having used inhalants in the year preceding the survey. Inhalant use in the month before the survey was also highest among this age group, at 1.3 percent. Past-month use did not statistically significant increases among 12- and 13-year-olds and 18- and 20-year-olds (both at 0.9 percent in 2001), although it dipped for 16- and 17-year-olds (from 1.0 percent to 0.7 percent).   USE/USER POPULATION Among students surveyed as part of the 2005 Monitoring the Future study, 17.1% of eighth graders, 13.1% of tenth graders, and 11.4% of twelfth graders reported lifetime use of inhalants. Approximately 37.5% of eighth graders and 45.7% of tenth graders surveyed in 2005 reported that trying inhalants once or twice was a “great risk.”(12) The Centers for Disease Control and Prevention (CDC) also conducts a survey of high school students throughout the United States called the Youth Risk Behavior Surveillance System (YRBSS). Among students surveyed for the 2005 YRBSS, 12.4% reported using inhalants at least one time during their lifetime.(13) LEGISLATION Although not regulated under the Controlled Substances Act (CSA), many state legislatures have attempted to deter youth who buy legal products to get high by placing restrictions on the sale of these products to minors. As reported by the National Conference of State Legislatures, by 2000, 38 States had adopted laws preventing the sale, use, and/or distribution to minors of various products commonly abused as inhalants. Some States have introduced fines, incarceration, or mandatory treatment for the sale, distribution, use, and/or possession of inhalable chemicals.(14) TREATMENT RESOURCES Treatment Publications and Research | Treatment and Patient Education | Treatment Facility Locator SOURCES 1. Drug Enforcement Administration, Drugs of Abuse, 2005 2-5. National Institute on Drug Abuse, Inhalant Abuse Research Report, 2005 6. Office of National Drug Control Policy (ONDCP), Inhalants Street Terms 7. National Institute on Drug Abuse, Community Drug Alert Bulletin: Inhalants, January 2005 8-9. National Institute on Drug Abuse, Inhalant Abuse Research Report, 2005 10. Drug Enforcement Administration, Drugs of Abuse, 2005 11. National Institute on Drug Abuse, Inhalant Abuse Research Report, 2005 12. National Institute on Drug Abuse and University of Michigan, Monitoring the Future 2005 Data From In-School Surveys of 8th-, 10th, and 12th-Grade Students, December 2005 13. Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance—United States, 2005, June 2006 14. ONDCP, Drug Facts: Inhalants, August 2006