No Laughing Matter: a Comprehensive Overview of Nitrous Oxide Abuse

No Laughing Matter A Comprehensive Overview of nitrous Oxide misapply Ryan Ardelle Anatomy & Physiology, Period 3 Mr. Syvret Due March 14, 2013 SUBSTANCE OVERVIEW The issue of inhalant ab lend oneself is a multifaceted problem, stretching across m whatsoever communities and locales in the entirety of the coupled States. inspirations as a class of drug vary widely, ranging from volatile solvents and aerosol propellants, to more broadly, any drug delivered by inhalation. Nitrous oxide straddles these categories, as it finds use not only a common dental consonant analgesic, but also as a propellant, in such uses as whipping unction, automotive racing, and rocketry.As a result, azotic oxide is found in many forms medical-grade, food-grade, and industrial-grade, with various purities (Erowid). Commonly known as laughing liquid, nitric oxide wears many hats and goes by many names. For example, those who use nitric oxide in automotive racing or rocketry applications know it as NOS (Alai). In this usage, nitric oxide is applied as a powerful oxidizer, allowing a fomites engine to combust ball upoline more rapidly, with an associated increase in horsepower (Winter). This form of nitrous oxide is packaged with many additives to not only better its performance but also to deter its abuse (Erowid).When abused recreationally however, nitrous oxide finds many more colorful nicknames, such as hippie crack and nangs (Erowid). It is a true gas, existing as a gas under atmospheric pressure at way temperature, although it assumes a liquid evidence when compressed in a gas cylinder (Alai). Nitrous oxide is a strong oxidizing agent with a density of 1. 9kg/m 3, and it has a linear molecular form consisting of 2 atoms of nitrogen and one atom of oxygen (Winter). Nitrous oxide has no color and has a sweet odor, familiar to anybody who has tasted whipped cream (Erowid).Nitrous oxide is commercially manufactured by high temperature ammonium nitrate to 240C. Impurities su ch as ammonia and nitric acid in addition to excess water vapor are removed by dint of an extensive gas scrubbing process. Food-grade nitrous oxide is often stored in white, 8-gram cylinders with a sealed metal puncture cap and packaged in boxes of 100 cylinders. Medical-grade nitrous oxide is stored in French-blue cylinders and is pressurized to 4400 kPa at room temperature. The Pin Index Safety System configuration for nitrous oxide cylinders is 3-5 (Banks and Hardman). HISTORY OF NITROUS OXIDE ABUSEBritish chemist and Presbyterian minister Joseph Humphrey first synthesized nitrous oxide gas in England in 1772. Priestly later published his tame in a 1776 journal, Experiments and Observations on varied Kinds of Air (Priestly). This publication proved exceedingly intriguing to the scientific community, psychoanalyseing to additional research and Humphry Davys influential 1800 book, Researches, Chemical and Philosophical Chiefly Concerning Nitrous Oxide. Throughout the remaind er of the nineteenth century, nitrous oxides usage as a recreational drug became increasingly popular.Traveling medical shows and carnivals featured affectionately named Nitrous Oxide Capers, in which attendees paid a dispirited fee to inhale a minutes worth of gas (Brecher). In 1844, Dr. Horace Wells, a British dentist, first demonstrated the use of nitrous oxide as a dental anesthetic. His initial testing on a patient at Harvard Medical School was unsuccessful, resulting in the public dismissal of nitrous oxide as a legitimate anesthetic. Nevertheless, nitrous oxide had a sudden resurgence in the dental community in the early 1860s, thanks to a series of dental institutions opened by lecturer and showman Gardener Quincy Colton.These practices utilized nitrous oxide as their primary form of dental anesthesia, henceforth standardizing its usage in the United States (Erowid). METHODS OF ADMINISTRATION Nitrous oxide is administered via inhalation of compressed gas. Users most frequen tly obtain nitrous oxide from small, 8-gram rearisters used to charge whipped cream dispensers. These canisters are readily available for grease ones palms in most restaurant supply stores, on the Internet, and in head shops across the nation (Narconon).Once obtained, the contents of the canisters are turn overd into empty whipped cream dispensers or into a aviate. A pressure release valve, or cracker, must be used in order to safely siphon the gas into a pilot (Erowid). These valves are also available for purchase online or in head shops (Narconon). Users with access to larger cylinders of nitrous oxide sometimes inhale the gas through a nasal hood or anesthesia mask, as used in dental surgery. However, this method is extremely dangerous without proper medical supervision, as users can inhale larger amounts of gas without access to fresh oxygen.As a result, the vast majority of nitrous oxide users prefer to use the aforementioned whipped cream dispenser or balloon methods of inhalation (Wagner, Clark, Wesche, Doedens, and Lloyd). Whipped cream canisters and standard latex party balloons have a maximum capacity of approximately three 8-gram cylinders. Depending on personal preference, users can postulate their vessel of choice with one, two, or three cylinders at a time (Creamright). Once the whipped cream dispenser or balloon is filled to the users liking, the gas inside is rapidly inhaled into the users lungs.The gas is often held in the lungs for twenty to sixty seconds to induce hypoxia and enhance the euphoric effects. The gas is then exhaled normally, and the user resumes unbendable respiration of room air (Erowid). IMMEDIATE EFFECTS Once inhaled, nitrous oxide is immediately absorbed through the lungs, dissolving directly into bank line plasma. at bottom ten to fifteen seconds, nitrous oxide molecules re engineer oxygen molecules in the users lungs, thereby stimulating a euphoric sensation. Users then experience a brief high usually lasting be tween thirty seconds and two minutes with a standard dose (Erowid).Symptoms of nitrous oxide abuse include duncish speech, impaired coordination and balance, difficulty thinking clearly and processing information, unresponsiveness to verbal and painful stimuli, and occasionally loss of consciousness. Assuming the user returns to regularly breathing room air after the initial gas inhalation, these symptoms should subside within two minutes. The onset and peak effect timing of nitrous oxide is determined by the sum consumed (Narconon). Nitrous oxide inhalation impacts the function of numerous physiologic systems.First, nitrous oxide decreases tidal volume and increases respiratory rate following activation of the central nervous system. myocardial depression and an increase in central sympathetic outflow also occur following nitrous oxide inhalation. Inhaled nitrous oxide may produce the second gas effect, as nitrous oxide has a more rapid rate of diffusion across alveolar basement membranes than nitrogen gas. This rapid exit of nitrous oxide from the alveoli initiates a concentration of other alveolar gases, thereby accelerating the uptake of nitrous oxide into the bloodstream (Banks and Hardman).The primary method of nitrous oxide elimination is via the exhalation from the lungs. Nitrous oxide exits the body whole unchanged in chemical formula and structure. Small amounts of nitrous oxide diffuse through the skin and the renal system, and anaerobic bacteria in the GI pathway reduce any outstanding nitrous oxide into nitrogen gas (Erowid). ACTION ON THE BRAIN Nitrous oxide causes vasodilatation, resulting in an increase in cerebral blood flow and causing a corresponding increase in intracranial pressure (Erowid). Unlike most inhalants, nitrous oxide does not augment the effects of non-depolarizing neuromuscular blockers.Accordingly, nitrous oxide does not produce the same neuromuscular depression experienced with other inhalant abuse. Nitrous oxide activate s opioid receptors in the periaqueductal grey of the midbrain, stimulating a release of norepinephrine and activation of 2-adrenoceptors in the dorsal horn of the spinal cord (Banks and Hardman). LONG TERM EFFECTS Risks involved in nitrous oxide inhalation circulate primarily around displacing oxygen. Although nitrous oxide does not bind with hemoglobin and instead dissolves into the blood, continued inhalation of pure nitrous oxide without supplemental oxygen can lead to hypoxia.Nitrous oxide-induced hypoxia is especially dangerous because users may not realize that they asphyxiating themselves the impulse to breathe is triggered by a build-up of carbon dioxide, rather than a lack of oxygen (Banks and Hardman). Aside from hypoxia, there are relatively few physiologic dangers associated with nitrous oxide abuse. The most significant of these effects is Vitamin B depletion and deficiency. This can potentially lead to ague or chronic paresthesia, the sensation of pins and needles, and can inhibit the activity of methionine synthetase, thereby interfering with DNA synthesis in leukocytes and erythrocytes.However, Vitamin B and Folate supplements can oppose these side effects (Banks and Hardman). Nitrous oxide can also induce potentially dangerous airspace expansion in the body, such as pneumothorax or gut obstruction, due to its rapid diffusion properties. Other potential side effects include respiratory depression, apnea, hypotension, cardiac arrhythmias, dizziness, neuropathy, nausea, vomiting, ileus, bone marrow depression, and malignant hyperthermia. Pregnant women should not use nitrous oxide, as the gas diffuses into the placenta and can cause fetal depression (Erowid).A few cases of frostbite on the vocal cords have been record following direct inhalation of nitrous oxide from a canister (Banks and Hardman). Also, nitrous oxide users are at risk of traumatic fall injuries such as disoriented extremities and concussions due to impaired balance and pos sible loss of consciousness (Narconon). STATISTICS Nitrous oxide abuse is most common among younger adolescents aged 16-17, although abuse does occur among former(a) individuals. A 2011 study from the University of Michigan showed that 13% of 8th grade students reported abusing inhalants at least once (National Institute on Drug Abuse).A similar study from the University of Virginia revealed that nitrous oxide was one of the top v cognitive contents abused by adolescent inhalant users (Narconon). According to the Substance Abuse and Mental Health Services Administration, the place of inhalant abuse increased steadily from 3. 4 percent at age 12 to 5. 3 percent at age 14, then declined to 3. 9 percent by age 17 from 2002-2006. Data from this study also showed that adolescents age 12 to 17 represented 48 percent of all substance abuse treatment admissions reporting inhalants. Among these adolescent admissions reporting inhalant abuse, 45% had a concurrent psychiatric disorder (SA MHSA). Erowid. com, a popular website that provides information on psychoactive drug use, conducted a series of online surveys in September 2009 in a study examining the possible presence of contaminants in nitrous oxide chargers. One of the surveys asked regular nitrous oxide users their preferred method of inhalation 46% preferred using a cracker with a balloon, 34. 4% preferred inhaling directly from a whipped cream dispenser, 11. % percent preferred a whipped cream dispenser with a balloon, 1. 7 % preferred a cracker with a bag, 0. 7% preferred a whipped cream dispenser with a bag, and 5. 0% preferred other methods (Erowid). Nitrous oxide is not physiologically addictive, although certain individuals can use it compulsively. While psychological addiction is possible, the only symptom of climb-down is the desire to inhale more nitrous oxide (Dartmouth College). Furthermore, statistics on inhalant-related deaths are difficulty to determine, as most deaths are severely under-repor ted.Most of the time, death is attributed to cardiac or respiratory failure subsequent to inhalant abuse. Studies from the Texas Commission on Alcohol and Drug Abuse between 1990 and 1993 revealed an average of 15 inhalant abuse-related deaths per year in the state of Texas. Of those deaths, 94% of victims were male, and 91% were Caucasian, on average (National Inhalant measure Coalition). Most recreational nitrous oxide-related deaths are caused by hypoxia when users affix masks without oxygen or place bags over their heads to concentrate the gas (Erowid). EFFORTS TO ADDRESS ABUSEThe topic of inhalants has been addressed by multiple small grass-roots efforts in local communities, but has also seen national discussion. Although no national legislation is in place restricting the sale, consumption, and distribution of nitrous oxide, several states and municipalities have passed laws in an attempt to curb usage. Most of these laws specifically range underage consumption and sale of n itrous oxide to minors (Center for Cognitive Liberty & Ethics). For example, the Article 34 Title 7 3380. 5a-5b of the New York State Controlled Substances Act states a) No person shall use nitrous oxide for purposes of causing intoxication, inebriation, excitement, stupefaction or the dulling of the brain or nervous system of himself or another. (b) No person shall sell any canister or other container of nitrous oxide unless granted an exemption pursuant to this subdivision. In no event shall any canister or other container of nitrous oxide be sold to a person under the age of twenty-one years. Any person who violates any provision of subdivision four or five of this section shall be guilty of class A misdemeanor (New York State Legislature).A number of non-governmental organizations such as the National Inhalant Prevention Coalition work to educate the public on the facts and dangers of inhalant abuse. These organizations frequently lobby on the state and federal level in attempt to pass more sumptuary anti-inhalant abuse legislature. These preventative efforts have helped to several states integrate inhalant abuse education into primary and secondary school health education curricula (National Inhalant Prevention Coalition). Works Cited Alai, Nili N. Nitrous Oxide Administration. Ed. Rick Kulkarni.Medscape Reference, 30 Jan. 2012. Web. 4 Mar. 2013. . Banks, Amelia, and Jonathan G. Hardman. Nitrous Oxide. British Journal of Anaesthesia Continuing Education in Anaethesia, Critical Care, and Pain (2005) 1-4. Web. 4 Mar. 2013. . Brecher, Edward M. The Consumers Union Report on Licit and Illicit Drugs. Consumer Reports Magazine 1972. Web. 4 Mar. 2013. . Drug Facts Inhalants. Inhalants. National Institute on Drug Abuse, Sept. 2012. Web. 4 Mar. 2013. . Erowid Nitrous Oxide Vault. Erowid, 21 Feb. 2013. Web. 4 Mar. 2013. . Frequently Asked Questions. Nitrous Oxide Whipped Cream Chargers. Creamright, 2013. Web. 4 Mar. 2013. . Nitrous Oxide (Laughing Gas). Hea lth Promotion. Dartmouth College, 21 Jan. 2009. Web. 4 Mar. 2013. lthttp//www. dartmouth. edu/healthed/groups/dapa/otherdrugs/no. html. Nitrous Oxide. Nitrous Oxide. Narconon, 2013. Web. 4 Mar. 2013. . Priestly, Joseph. Experiments and Observations on Different Kinds of Air. Vol. 2. London n. p. , 1776. 6 vols. Web. 4 Mar. 2013. . Public Health. Laws of New York. New York State Legislature, n. d. Web. 4 Mar. 2013. . Statistics on Inhalants Show Young Teens at Risk. SAMHSA News. SAMHSA, Mar. 2008. Web. 4 Mar. 2013. . US Nitrous Oxide Laws. State Laws Concerning Inhalation of Nitrous Oxide. Center for Cognitive Liberty & Ethics, May 2002. Web. 4 Mar. 2013. . View Point. National Inhalant Prevention Coalition Quarterly Newsletter.National Inhalant Prevention Coalition, 2013. Web. 4 Mar. 2013. . Wagner, Scott A. , Michael A. Clark, David L. Wesche, David J. Doedens, and Alan W. Lloyd. Asphyxial Deaths from the Recreational Use of Nitrous Oxide. Journal of Forensic Sciences 37. 4 ( 1992) 1008-15. Web. 4 Mar. 2013. . Winter, Mark. Nitrous Oxide. WebElements Periodic Table of the Elements. WebElements, n. d. Web. 4 Mar. 2013. .