Nitrous Oxide

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Nitrous Oxide

What Kind of Drug Is It?

Nitrous oxide is a type of anesthetic, a substance used to deaden pain. It can alleviate pain without causing a loss of consciousness. Best known by the nickname "laughing gas," nitrous oxide is used primarily by dentists to keep patients comfortable during painful procedures. It can also be used in combination with other drugs as a general anesthetic. When administered by trained medical professionals, the gas is considered a safe and effective form of anesthesia.

As a recreational drug—a drug used solely to get high, not to treat a medical condition—nitrous oxide is classified as an inhalant. (An entry on inhalants is available in this encyclopedia.) Inhalants contain dangerous vapors, which are gases or fumes that can be irritating or physically harmful when breathed in. Vapors from inhalants produce psychoactive, or mind-altering, effects when breathed in through the mouth or nose.

More than 1,000 different household and industrial products—all readily accessible to consumers of any age—are sniffed or huffed for their intoxicating effects. Glues, paints, markers, nail polish, correction fluid, and shoe polish are among the most commonly abused inhalants.

Among young teens, nitrous oxide is typically obtained from canned whipped cream available at grocery stores. Nitrous oxide gas is used to propel, or to drive out, the whipped cream from the can. Sales of nitrous oxide to older teens and adults usually occur at dance clubs and all-night dance parties called raves or through Internet transactions.

Official Drug Name: Nitrous oxide, dinitrogen oxide, nitrogen oxide

Also Known As: Balloons, buzz bombs, cartridges, hippie crack, laughing gas, nitrous, whip-its, whippets, whippits

Drug Classifications: Not scheduled

Overview

In the 1700s and the 1800s, chemists, doctors, and dentists in Europe and the United States experimented with three different anesthetic gases: nitrous oxide, ether (EETH-uhr), and chloroform (KLOR-uh-form). These compounds revolutionized surgical and dental procedures. While under the influence of an anesthetic gas, a patient's perception of pain is altered. Nitrous oxide, ether, and chloroform all dull or block painful sensations. They also produce a rather intense high.

The intoxicating side effects of the gases, however, led to their use and abuse as recreational drugs. A research report titled "Inhalant Abuse," prepared by the National Institute on Drug Abuse (NIDA) and updated in 2005, noted that "nitrous oxide is the most abused of these [three] gases."

Nitrous oxide is a gas with both anesthetic and analgesic (pain relieving) properties. It was first discovered in 1772 by British scientist, theologian, and philosopher Joseph Priestley (1733–1804). Earlier, Priestley had identified oxygen, which he termed "phlogisticated (floh-JISS-tih-kay-ted) air." The term "phlo-gis-tic" comes from a Greek word meaning "flammable."

Nitrous Demonstrations: An Unusual Form of Entertainment

Although Priestley is credited with discovering nitrous oxide, another scientist recognized the potential value of its numbing and intoxicating effects. This man was Sir Humphry Davy (1778–1829), a British chemist who experimented with the gas on himself and his friends. In a book Davy wrote on the subject in 1800, he suggested that nitrous oxide's ability to dull pain might make it a useful anesthetic in surgeries. But, as Julie M. Fenster noted in Ether Day: The Strange Tale of America's Greatest Medical Discovery and the Haunted Men Who Made It, "no one took his suggestion."

And so, despite Davy's writings on the subject, nitrous oxide was not put to use in the medical field for another four decades. Apparently, according to historical sources, pain was such an accepted part of medical intervention during the early nineteenth century that neither scientists nor doctors seriously considered trying to ease it. Instead, nitrous oxide, which had earned the nickname "laughing gas," enjoyed popularity as a way for the British upper classes to entertain themselves at social gatherings. "The gas was soon offered at dinner parties instead of wine," wrote Fenster. It was even demonstrated in theaters and at festivals. In 1824, crowds in London were amazed by a show called "M. Henry's Mechanical and Chemical Demonstrations." The highly successful performances showed the uninhibiting effects of nitrous oxide on audience volunteers eager to try the gas.

"A New Era in Tooth-Pulling!"

Meanwhile in the United States, laughing gas was featured in traveling medicine shows and carnivals. Gardner Q. Colton (1814–1898), a former medical student, made a good living by giving public demonstrations of nitrous oxide. In New York City in 1844, he organized the "Grand Exhibition of Nitrous Oxide" on Broadway, charging the then-outrageous price of twenty-five cents per ticket. Colton moved his act to Hartford, Connecticut, later that year. Dr. Horace Wells (1815–1848), a dentist in Hartford, attended the nitrous exhibition with his wife. The evening's entertainment changed Wells' life forever.

Both Wells and his wife were among the volunteers from the audience who tried the laughing gas. The couple apparently engaged in some silly antics after sampling the nitrous oxide, but Wells was actually more interested in the effects of the gas on another member of the audience. A local man named Sam Cooley had seriously gashed his legs on a piece of furniture while stumbling around the stage on his nitrous high. His knees were bleeding badly, but he felt no pain. In fact, he didn't even realize he had been hurt. Wells was stunned by the effect of the gas and concluded that nitrous oxide might be useful as a medical anesthetic. In Wells' own often-quoted words, it was the beginning of "a new era in tooth-pulling!"

In keeping with the tradition of scientific experimentation in the nineteenth century, Wells used himself as a test subject. He devised a test case involving his dental colleague and friend Dr. John Riggs, who agreed to extract a tooth from Wells' mouth. The experiment took place on December 11, 1844. Wells asked Colton to set up his nitrous oxide equipment at the office Wells shared with Riggs. Wells administered the gas himself and soon nodded off from its effects. Riggs immediately pulled a sore wisdom tooth from Wells' mouth. The nitrous oxide had worked. Wells woke up shortly after the procedure and reported feeling no pain.

Considering his test a success, Wells began using nitrous oxide—quite successfully—as an anesthetic in his dental practice. When people heard about the new dental procedure, Wells' business increased. He was confident that painful dentistry would soon become a thing of the past.

A Demonstration Gone Bad

In January of 1845, before an audience of experts from the Harvard Medical School and Massachusetts General Hospital, Wells attempted to demonstrate the anesthetizing effects of nitrous oxide. He used a bag of the gas to sedate a patient before removing a tooth. However, the bag was withdrawn too soon, and the patient awoke before the procedure was complete. The experiment was considered a failure, and Wells was devastated. He never fully recovered from the disastrous demonstration and committed suicide in 1848. More than a decade later, in the early 1860s, the medical community came to understand and accept nitrous oxide as a valuable tool. It was finally being used not as a prop in a traveling sideshow, but as the anesthetic that Wells had suggested.

Modern Uses

By 1871, companies in both the United States and Great Britain were producing compressed nitrous oxide in cylinders. As of 2003, according to the Compressed Gas Association (CGA), nearly 90 percent of the nitrous oxide manufactured in the United States is intended for medical and dental applications. Another 5 to 8 percent is used in the food industry. Other legitimate uses for nitrous oxide include the manufacture of airbags, semiconductors, and fuels that boost horsepower in race car engines.

About Those Other Gases …

Ether is a flammable liquid with the chemical formula C₄H₁₀O. (Flammable means that the substance is capable of catching fire and burning quickly.) The intoxicating effects of ether have been known since the thirteenth century. It was first used as an anesthetic beginning in the mid-1800s, but its high flammability made it dangerous for medical use. The word ether comes from the Greek term meaning "to ignite" or "blaze."

Because ether is a liquid at room temperature, it can be swallowed, or the fumes from the liquid can be inhaled. In the 1760s, it was often dispensed by doctors by the drop onto a lump of sugar or mixed with water and used as a tonic. The use of ether as a recreational drug increased when users realized that it produced intoxication without a hangover. For a time, ether was actually consumed in place of alcohol, but many accidental fires occurred when drinkers sipped on their ether cocktails with a cigarette in hand.

It was not until the nineteenth century that ether caught on as an inhalant. So-called "ether frolics," or parties, became quite popular in the 1820s. The ether high was often compared to a spiritual experience. In fact, the term ethereal refers to the heavens or regions beyond the bounds of Earth.

Dr. William T. G. Morton first administered ether as a general anesthetic on October 16, 1846, at Massachusetts General Hospital. That day has since become known as "Ether Day."

Chloroform is a toxic (poisonous) liquid with a chemical formula of CHCl₃. This colorless anesthetic, discovered in 1833, is volatile, meaning it easily converts to a vapor. It is no longer used as a general anesthetic because of its dangerous side effects, which include serious damage to the liver.

Chloroform is an age-old tool of the trade among villains in films and television shows. In typical "bad-guy" style, a villain douses a cloth with chloroform and then approaches an unsuspecting victim from behind, placing the chloroform-soaked cloth over the person's nose and mouth. When inhaled, the fumes from the cloth quickly knock out the victim, leaving him or her defenseless.

However, the laughing gas parties and public demonstrations of the early 1800s evolved into a serious problem of abuse that has persisted into the twenty-first century. The gas is often sold at dance clubs and raves in balloons. Whipped cream cartridges, nicknamed "whippets," also contain nitrous oxide. These cartridges are sold through restaurant supply companies but are frequently purchased for illegal use.

What Is It Made Of?

Nitrous oxide is a compound made from nitrogen and oxygen. Its chemical formula is N₂o The gas itself is clear and colorless, with a slightly sweet odor and taste. Nitrous oxide should not be confused with the potentially toxic gas known as nitric oxide (NO). Nitric oxide is found in the atmosphere as an air pollutant. It is also found in very small amounts in the human body, where it helps to move oxygen to the tissues and transmit nerve impulses.

Nitrous oxide is best described as a liquefied gas. It is synthesized from a compound found in fertilizers and explosives. This compound, ammonium nitrate (NH₄NO₃), forms steam and nitrous oxide when heated. The nitrous oxide is then processed and turned into a liquid form for storage in tanks, cylinders, or cartridges.

Pure nitrous oxide is deadly. The gas must be mixed with oxygen to be used safely as an anesthetic.

How Is It Taken?

N₂O is used as an aerosol propellant in cans of whipped cream and some other food and beverage products. These products are a primary source of nitrous oxide for some abusers.

Depending on its intended use, nitrous oxide can be purchased in varying "grades," or degrees of purity. A food-grade version of the gas is sold to restaurants and caterers in small, bullet-shaped, metal cartridges. These cartridges are perfectly legal for use in the food preparation industry. Nitrous abusers refer to them as "whippets." One whippet delivers enough nitrous oxide to produce a three- to five-minute high. To release the nitrous oxide from a whippet, the high-pressure seal on the canister is pierced with a device called a "cracker." The resulting hole then emits a stream of nitrous oxide gas, which users inhale directly or use to inflate a balloon. Mishandling the cracker or piercing the wrong part of the canister can result in explosions and serious injuries.

Dealers often sell nitrous oxide to users at concerts, clubs, and raves. Instead of using small food-grade canisters, however, they use huge medical-grade nitrous tanks to dispense the gas into balloons. (Medical grade nitrous oxide is considered a prescription drug. These tanks can only be purchased legally by qualified medical personnel.) Nitrous-filled balloons sell for $3 to $5 apiece. One large cylinder of nitrous oxide can fill enough balloons to generate $20,000 to $30,000 in sales.

Sometimes, users fill plastic bags with nitrous oxide gas and then place the bags over their mouths or heads. This method of use carries a particularly high risk for serious injury and possible death. The user can easily lose consciousness and suffocate on the bag. Suffocation can also occur when nitrous oxide is consumed in large quantities in poorly ventilated spaces, such as closed-up cars or closets.

Are There Any Medical Reasons for Taking This Substance?

As an anesthetic, nitrous oxide has many legitimate uses. Its ability to reduce anxiety, restlessness, and fear makes it especially useful in the field of dentistry. Adults and children over the age of six have been shown to experience less discomfort and mental distress when given nitrous oxide during short but painful medical or dental procedures.

Scooby and Shaggy Rile Viewers

Nitrous oxide abuse became a hot topic in 2004, when recreational use of the gas showed up in a kids' film. In a one-minute-long scene from the PGrated Warner Bros. movie Scooby-Doo 2: Monsters Unleashed, one of the main characters, Shaggy, sniffs nitrous oxide from a whipped cream can and jokes about it. Seeing Shaggy do whippets is "supposed to make kids laugh," wrote Sue Marquette Poremba on the Preteenagers Today Web site. "It's supposed to be harmless fun. … That's the problem."

The scene in question begins with Shaggy and Scooby going to the kitchen. Shaggy opens the refrigerator and takes out a can of whipped cream. He shakes it up, sprays some cream into Scooby's mouth, and smiles broadly while Scooby's mouth fills up with the cream. Shaggy then takes a "hit" off the whipped cream canister. He breathes in the nitrous oxide without dispensing any cream, then hiccups. Shaggy then acts drunk and silly, saying that he needs to go outside to get some fresh air.

Concerned parents contacted the National Inhalation Prevention Coalition (NIPC) about the Scooby-Doo whippet spoof. Many were upset and believed that the film company was being insensitive to people who had lost loved ones due to inhalant abuse. One parent was especially concerned that the joke might go right over some adults' heads, yet lead children to copy the behavior. Harvey Weiss, the NIPC's executive director, brought attention to the issue in an "NIPC Inhalant Update Alert." Weiss urged Americans to view the scene from the film as a wakeup call, stating: "Our efforts should be to advance people's understanding about the dangers of inhalant use so they are recognized as a broad public health issue."

American obstetricians—physicians specializing in the birthing process—used nitrous oxide as a common pain management tool for women in labor until the early 1970s. By the early twenty-first century, however, the anesthetic had been replaced by newer drugs in the United States. However, a half-and-half mixture of nitrous oxide and oxygen was still being used in the United Kingdom to ease the pain of childbirth.

In a 2005 article for The Age, Julie Robotham reported on a group of Australian doctors who believed that nitrous oxide should no longer be used as a base for general anesthetics. According to an international study involving more than 2,000 patients, the use of nitrous oxide "doubles the rate of serious vomiting and pneumonia after surgery," explained Robotham. Both of these side effects can result in a patient's death.

Usage Trends

Nitrous oxide is among the substances of abuse categorized as inhalants. It gained popularity on the dance club circuit because of its supposed aphrodisiac effects. It is also preferred over other inhalants such as spray paints, shoe polish, markers, and glue because it does not leave stains on skin and clothes.

Food-grade nitrous oxide chargers, better known as "whippets," are available by the box or the case and are sold on the Internet. David Holthouse commented in a Phoenix New Times article, "The cardboard boxes [of whipped cream chargers] are decorated with images of fancy desserts and fresh berries, next to warnings not to … directly inhale the contents." Whippets were blamed for the death of a twenty-year-old Virginia Polytechnic Institute student in 1999. The student suffocated after inhaling nitrous oxide from whipped cream cartridges he had purchased through an online merchant.

Patterns of Inhalant Abuse

The Office of National Drug Control Policy (ONDCP) Web site notes in its "Inhalants: Drug Facts" publication that "typically, first use of inhalants occurs between late childhood and early adolescence." According to the "2003 National Survey on Drug Use and Health (NSDUH)"—the latest survey data available in 2005—more youths age twelve and thirteen used inhalants than marijuana between 2002 and 2003. (An entry on marijuana is available in this encyclopedia.)

But general statistics on the broad category of inhalant abuse do not necessarily reflect the rate of nitrous oxide abuse. The 2003 NSDUH reports that less than one third of 1 percent of U.S. twelve and thirteen year olds reported using nitrous oxide as a recreational drug in their lifetimes. However, the rate of glue and/or shoe polish inhalation among youths in the same age group was nearly fifteen times higher than that, at about 4.3 percent.

Heavy nitrous abusers tend to be eighteen years of age or older. This may be due to N₂O's growing status as a club drug. According to NIDA, nitrous oxide use occurs frequently at raves, where it is often mixed with other club drugs such as ketamine, ecstasy (MDMA), GHB, and LSD (lysergic acid diethylamide). (Separate entries on each of these drugs are available in this encyclopedia.) By the early 2000s, nitrous oxide had gained popularity as a drug that enhanced sexual pleasure. It was even featured in a 2004 episode of the television series CSI: Miami as the cause of death in an otherwise healthy young woman.

Abuse in the Medical and Dental Fields

There have also been cases of nitrous oxide abuse among healthcare professionals. Dentists and anesthesiologists with easy access to the drug seem to be at a higher risk than the general public of developing nitrous-related dependence problems. Dependence is the belief that a person needs to take a certain substance in order to function.

Substance abuse is also especially high among healthcare professionals who administer anesthesia in a hospital setting. According to the American Association of Nurse Anesthetists (AANA), about 15 percent of anesthesia providers are substance abusers. "Nurse anesthetists are dying … from accidental overdose or from suicide," reported Carlos "Rusty" Ratliff in "Anesthetists in Recovery: Chemical Dependency in the Profession." Like dentists, certified registered nurse anesthetists have large supplies of nitrous oxide readily available to them. Consequently, nitrous oxide is one of the drugs these professionals may end up abusing.

Dental Highs

In an article posted on the American Dental Association (ADA) Web site titled "Escaping Addiction: The Door to Freedom," Dr. Thomas L. Haynes discusses the topic of addiction among dentists. "The access to large amounts of nitrous oxide," noted Haynes, along with the stress and isolation of the profession, increases the risk of abuse. "Many a dentist has been found lifeless in the office," he continued, "the N₂O mask still strapped to the face."

"Chemical Dependence in Anesthesiologists," a document developed by the ASA TaskForce on Chemical Dependence, addresses the problem of drug abuse among anesthesiologists. Although addicted medical doctors typically become hooked onopioids such as fentanyl, nitrous oxide was mentioned by the ASA as another potential drug of abuse. (An entry on fentanyl is available in this encyclopedia.)

Calling Attention to a Serious Problem

NIDA began an intensive campaign against inhalant abuse in 2005. This action was prompted by the results of the 2004 Monitoring the Future (MTF) study, an annual survey of drug use among young people in the United States. The MTF survey is conducted by the University of Michigan with funding from NIDA. Findings for 2002 through 2004 indicate that inhalant abuse among eighth-grade students was on the rise during that period. As of 2004, approximately 17.3 percent of eighth graders in the United States had abused an inhalant at some time in their lives. That represents an increase over the 2003 figure of 15.8 percent. This "upward trend in use," according to the MTF report, was accompanied by a "decline among eighth graders in the perceived risk of using inhalants."

Effects on the Body

Nitrous oxide acts as a depressant on the human body. Once inhaled, the gas enters the bloodstream through the lungs. The blood then carries it throughout the rest of the body. It reaches the brain quickly, affecting vital functions such as breathing and heart rate. It also alters other mechanisms of the nervous system, such as the activity of neurotransmitters that regulate thought processes, behavior, and emotions.

A single balloon filled with nitrous oxide can bring on a shortlived but intense high. The overall effects of the gas depend largely on the user's frame of mind. It can further stimulate an already excited user, or it can sedate a more relaxed user. Symptoms of a nitrous oxide high include giddiness, a loss of balance, slurred speech, twitching, mental confusion, and an inability to feel pain. After the effects of the gas wear off, users may experience side effects such as nausea (upset stomach), restlessness, tiredness, difficulty concentrating, and the appearance of spots before their eyes.

How Nitrous Oxide Works

Nitrous oxide alters the user's perception of time. Because the effects of a single "hit" last only three minutes or so, some abusers inhale the gas many times over the course of a few hours. Such attempts to maintain a nitrous high can be fatal, since continued

breathing of the gas causes respiratory depression. In addition, the possibility of brain damage increases when the brain does not receive sufficient amounts of oxygen.

Abusers also run the risk of vomiting and losing consciousness while intoxicated by nitrous oxide. Unconscious individuals are not able to clear their own airways of vomit. This increases the possibility of death by choking. Even if vomiting does not occur, an individual who loses consciousness from an overdose of nitrous oxide is likely to stop breathing. In addition, pure nitrous oxide takes the place of oxygen in the lungs. This process could result in asphyxiation—death or unconsciousness caused by the inability to breathe—unless the unconscious person is quickly moved to an area with fresh air. According to the CGA, death frequently occurs when abusers of the gas "attempt to achieve a higher state of euphoria [happiness and well-being]" by breathing "pure N₂O in a confined space—in a small room, inside an automobile or other vehicle cab, or by placing their head inside a plastic bag."

Death by overdose of nitrous oxide is very difficult to recognize. It leaves no telltale signs for a coroner or medical examiner to identify. Under normal circumstances, blood carries oxygen to the tissues and organs of the body. But nitrous oxide pushes oxygen out of the blood. Without a sufficient supply of oxygen in the bloodstream, the tissues and organs of the body cannot function properly. Damage to the brain and other organs may result. Long-term abuse of nitrous oxide can also interfere with the production of blood cells in the bone marrow.

Additional Dangers

As nitrous oxide takes the place of oxygen in the lungs, a deficiency in vitamin B₁₂ may result. This sparks a series of negative effects within the body. The user's red blood cell count decreases, leading to anemia (uh-NEE-mee-uh), a condition in which the blood is lacking in oxygen-carrying red blood cells. Nerve damage may also occur, leading to difficulty walking as well as tingling, numbness, or pain in the arms and legs. These side effects are usually reversible if nitrous use is stopped.

People who have a genetic disorder called phenylketonuria (fenn-uhl-kee-tuh-NORR-ee-yuh) should be particularly careful about nitrous oxide use. Phenylketonuria (PKU) is an inherited disorder that interferes with the breakdown of a certain protein called phenylalanine (fenn-uhl-AL-uh-neen). The protein is found in milk, eggs, and other foods. Individuals with PKU require a special diet that can cause a vitamin B₁₂ deficiency. Because nitrous oxide can remove even more B₁₂ from the bloodstream, the possibility of nerve and brain damage is especially high under these circumstances.

Nitrous users who inhale the gas while standing risk falling down and possibly breaking a limb or suffering a head injury. In addition, injury to the face, mouth, throat, and hands may occur because of the extremely low temperature of nitrous oxide. In an article for the Phoenix New Times, David Holthouse warned, "When N₂0 is released from a whippit, it's cold enough to flash-freeze spittle." Sometimes, users who get hurt while high on nitrous oxide are completely unaware of their injuries because of the numbing effect of the gas.

Improper handling of any compressed gas tank or cylinder can also cause injuries. Attempting to inhale a gas like nitrous oxide directly from a large gas cylinder can damage the lungs beyond repair. The force of the gas entering the lungs is so powerful that the air sacs in the lungs actually burst. Victims die in a matter of seconds due to internal bleeding. Inhaling any compressed gas is especially risky for people with ear problems, as the pressure of the gas may damage the inner ear.

N₂O Plus Pre-Existing Conditions Can Equal Death

Individuals with certain medical conditions may also suffer severe and potentially fatal side effects from the use of nitrous oxide. For example, anyone with a history of pulmonary hypertension, asthma, airway obstruction, head injury, or chest infection should not take nitrous oxide under any circumstances.

Nitrous oxide should not be given to pregnant women in the early or middle stages of pregnancy. The gas can interfere with the baby's development and may cause the mother to lose the baby before it is born. Heavy, ongoing nitrous oxide exposure during pregnancy has been shown to cause birth defects in animals.

Reactions with Other Drugs or Substances

Nitrous oxide produces effects on the body similar to those of alcohol, which is a depressant. When used along with other depressants, nitrous oxide can slow the user's breathing rate to a dangerously low—and sometimes even deadly—level.

The increasing use of nitrous oxide in combination with other club drugs poses serious risks to users. In the event of a multiple-drug overdose, emergency medical personnel may not be able to identify the mix of drugs the patient has consumed. This further complicates emergency treatment and could delay lifesaving measures.

Treatment for Habitual Users

Abuse of nitrous oxide alone has not been shown to cause withdrawal symptoms—the physiological effects of terminating use of an addicting drug. Because of this, it is not considered an addictive or habit-forming substance. At the very least, however, the gas does appear to cause psychological dependency. "Supposedly, nitrous is nonaddictive," wrote Holthouse, but "habitual users have a [tendency] to sit around doing whippit after whippit until all the whippits are gone, then go buy more whippits."

Nitrous oxide is eliminated from the body rapidly. However, if the patient has been abusing other drugs as well, the detoxification period, in which one rids the body of the drugs' toxins, could take up to forty days, depending on the chemicals involved. After detox, the primary goal of treatment is avoiding future drug use.

Substance abusers need to identify the underlying causes of their drug use. To curb drug abuse, they may need to alter their lifestyles substantially. This may include not going to the same clubs or hanging out with the same circle of friends if they are continuing to use drugs illegally. It may mean finding a new supportive, drugfree network of friends. Nitrous oxide abusers, like other substance abusers, typically benefit from individual therapy that focuses on changing unhealthy patterns of behavior and developing better coping skills. Group therapy and self-help organizations can also assist in the recovery process. Discussing addiction in a group setting can help drug abusers gain insight into their own thoughts and behaviors through the eyes and experiences of others.

Consequences

There are few studies that focus specifically on the illicit use of nitrous oxide. Rather, the abuse of this gas is usually lumped into the general category of inhalant use. According to the 2003 NSDUH report, young adolescents who use inhalants tend to have more academic, social, and behavioral problems than those who do not. High school dropout rates and involvement in serious fights, thefts, and illicit drug use were especially high among inhalant abusers. These statistics reflect patterns seen among users of all inhalants, not just nitrous oxide.

Specifically, nitrous oxide abuse may cause mood swings and personality changes in heavy users. Users report that the gas decreases their inhibitions. People with lowered inhibitions tend to take more chances and engage in riskier behavior than they would if they were not high. Nitrous oxide is also viewed as an aphrodisiac (sex enhancer) in some social circles. Some users might engage in unsafe sex, thereby increasing their risk for contracting sexually transmitted diseases, including HIV (the human immunodeficiency virus), which can lead to AIDS (acquired immunodeficiency syndrome).

The Law

Nitrous oxide is regulated by the U.S. Food and Drug Administration (FDA) as a food-grade propellant, medical-grade gas, and prescription drug. In 1971, the state of Maryland began controlling its sale and distribution. In the 1990s, in an attempt to curb the growing abuse of the gas, a number of other states followed suit. Connecticut, Arizona, Texas, Michigan, and Wisconsin were among the states that passed laws placing strong safeguards and stricter penalties on the illicit use of nitrous oxide.

Selling nitrous oxide for use as a drug carries stiff penalties. Distributors face up to 15 years in prison and fines of up to $1.5 million. In 2001, an Arizona man was sentenced to a 15-month jail term and fined $40,000 for a nitrous oxide sale that resulted in the death of a Virginia college student.

Until federal legislation is passed to prohibit the possession, inhalation, and distribution of nitrous oxide for purposes of intoxication, the CGA has proposed a list of recommendations regarding its use. The main goal of these recommendations is to keep the gas from falling into the wrong hands. Among the guidelines proposed by the CGA are:

restricting the sale of nitrous oxide to those who can prove they have a "legitimate use" for it
encouraging legitimate users to store containers of the gas and other equipment in a secured area
requiring medical and restaurant personnel to keep a careful count of used and unused cylinders
reporting any thefts to the police immediately.

For More Information

Books

Brecher, Edward M., and others. The Consumers Union Report on Licit and Illicit Drugs. Boston: Little Brown & Co., 1972.

Fenster, Julie M. Ether Day: The Strange Tale of America's Greatest Medical Discovery and the Haunted Men Who Made It. New York: HarperCollins, 2001.

Lobo, Ingrid A. Inhalants. Philadelphia: Chelsea House Publishers, 2004.

Menhard, Francha Roffe. The Facts about Inhalants. Tarrytown, NY: Benchmark Books, 2005.

Periodicals

Holthouse, David. "Softly into That Good Nitrous." Phoenix New Times (September 29, 1999).

Robotham, Julie. "Laughing Gas Unsafe, Say Doctors." The Age (May 5, 2005).

White, Josh. "Virginia Student's Death Leads to Drug Conviction." Washington Post (October 21, 2000).

Web Sites

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"About Inhalants." National Inhalant Prevention Coalition.http://www.inhalants.com/about.htm (accessed July 31, 2005).

ASA Taskforce on Chemical Dependence. "Chemical Dependence in Anesthesiologists." American Society of Anesthesiologists. 1999. http://www.asahq.org/publicationsAndServices/chemical.html (accessed July 31, 2005).

"CGA/NWSA Nitrous Oxide Fact Sheet" (November 3, 2003). Compressed Gas Association. http://www.cganet.com/N2O/factsht.asp (accessed July 31, 2005).

"Drugs of Abuse: 2005 Edition." U.S. Department of Justice, Drug Enforcement Administration.http://www.usdoj.gov/dea/pubs/abuse/index.htm (accessed July 31, 2005).

"Drugs of Abuse: Uses and Effects Chart" (June, 2004). U.S. Department of Justice, Drug Enforcement Administration.http://www.usdoj.gov/dea/pubs/abuse/chart.htm (accessed July 31, 2005).

Haynes, Thomas L. "Escaping Addiction: The Door to Freedom" (November, 2004). American Dental Association.http://www.ada.org/prof/resources/topics/topics_wellbeing_drcares_addiction02.pdf (accessed July 31, 2005).

"Inhalant Abuse: NIDA Research Report Series" (2005). National Institutes of Health, National Institute on Drug Abuse.http://www.nida.nih.gov/researchreports/inhalants (accessed July 31, 2005).

"Inhalant Use Is Associated with Other Substance Use and Delinquency" (March 17, 2005). U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.http://www.samhsa.gov/news/newsreleases/050317nr_inhalants.htm (accessed July 31, 2005).

"Inhalants: Drug Facts" (February, 2003). Office of National Drug Control Policy. http://www.whitehousedrugpolicy.gov/publications/factsht/inhalants/index.htm (accessed July 31, 2005).

"INHALANTS.DRUGABUSE.GOV." National Institutes of Health, National Institute on Drug Abuse.http://www.inhalants.drugabuse.gov/ (accessed July 31, 2005).

Johnston, Lloyd, et. al. "Overall Teen Drug Use Continues Gradual Decline, but Use of Inhalants Rises" (December 21, 2004). Monitoring the Future.http://www.monitoringthefuture.org/ and http://www.nida.nih.gov/Newsroom/04/2004MTFDrug.pdf (both accessed July 31, 2005).

"NIPC Inhalant Update Alert." National Inhalant Prevention Coalition.http://www.inhalants.com/alert_update.pdf (accessed July 31, 2005).

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