Nitrous Oxide
NITROUS OXIDE
OFFICIAL NAMES: Nitrous oxide
STREET NAMES: N2O, nitrous, laughing gas, whippets, whip-its, hippie crack
DRUG CLASSIFICATIONS: Not scheduled
OVERVIEW
Nitrous oxide is a gas with anesthetic (numbness-causing) and (painkilling) analgesic properties. It was first discovered in 1772 by English scientist, theologian, and philosopher Joseph Priestly. Priestly was also the man who co-discovered oxygen (which he termed "phlogisticated air"). In 1776, he wrote about the discovery of N2O, which he called "nitrous air."
The first scientist to discover the unique anesthetic and intoxicant effects of nitrous oxide was Sir Humphry Davy, an English physiologist whose self-experimentations with the gas became legendary. In Davy's book Researches, Chemical and Philosophical: Chiefly concerning nitrous oxide, or dephiogisticated nitrous air, and its respiration (1800) he suggests that nitrous may be a useful anesthetic in surgical situations, and "appears capable of destroying physical pain."
However, despite Davy's writings on the subject, nitrous oxide had no serious medical use for another four decades. Instead, nitrous, now nicknamed "laughing gas," enjoyed popularity as a way for the English upper classes to entertain themselves at social gatherings. Among those who regularly inhaled the gas for its pleasurable and uninhibiting properties were the poets Robert Southey and Samuel Taylor Coleridge, and the author Peter Roget (of Roget's Thesaurus). Laughing gas was also demonstrated in theaters and at festivals; in 1824, a run of performances at London's West End Aldelphi Theatre entitled "M. Henry's Mechanical and Chemical Demonstrations" showed the effects of nitrous oxide on audience volunteers to a disbelieving crowd.
Meanwhile in America, laughing gas was appearing in traveling medicine shows and carnivals. Gardner Quincy Colton, a former medical student, presided over one of these nitrous oxide demonstrations in Hartford, Connecticut, in December of 1844. One of the audience volunteers who had just inhaled the gas injured his leg without feeling any pain. In the audience was dentist Horace Wells, who took note of this and immediately seized on the idea that nitrous oxide might be a powerful anesthetic in the operating room.
Enlisting Colton to bring his nitrous oxide equipment to the dentist's office, Wells used himself as the test subject. Colton administered the gas while a dentist colleague and friend of Wells' pulled a tooth from his mouth. The experiment was successful; Wells woke up shortly after and reported feeling no pain from the procedure. Buoyed by this success, Wells began using nitrous oxide as an anesthetic in his dental practice.
In January 1845, at the Harvard Medical School and the Massachusetts General Hospital, Wells made a presentation in which he used a bag of nitrous oxide to sedate the patient before removing a tooth. Unfortunately, the bag was withdrawn too soon, and the patient complained of pain after the procedure, so the experiment was considered a failure. Nitrous would remain an entertaining oddity until Gardner Colton, the medical school dropout and traveling showman who first introduced the gas to Wells, returned it to medicine in the early 1860s. Starting his own business, Colton provided anesthetic services for dentists using 100% pure nitrous oxide gas. His business proved successful.
In 1868, Chicago dentist Dr. Edmund Andrews published a paper reporting his use of an 80%/20% mix of nitrous and oxygen on patients undergoing dental surgery. The mixture allowed for a longer period of unconsciousness for lengthy procedures. Later that same year, a UK company, Coxeter and Sons, developed a gas mask and tank system for the administration of nitrous oxide and other gases during surgery. Also that year, another English firm, Barth, compressed N2O into cylinders. By 1871, companies in both America and the UK had succeeded in producing compressed and liquid nitrous oxide in cylinders.
By the end of the century, nitrous oxide had also gained popularity as a anesthesia for women in labor, remaining a standard anesthetic choice for that purpose in the United Kingdom.
Unfortunately, the laughing gas parties and parlor tricks of the early 1800s have evolved into abuse, and nitrous oxide is one of many commonly abused inhalants in the United States. The National Inhalant Prevention Coalition reports that one in five American children have used an inhalant by eighth grade.
CHEMICAL/ORGANIC COMPOSITION
The chemical symbol for nitrous oxide is N2O (shorthand for two atoms of nitrogen joined with one atom of oxygen). The gas itself is clear and colorless, with a slightly sweet odor and taste.
Nitrous oxide is synthesized, or produced, by heating ammonium nitrate (NH4NO3) and then condensing out the water and filtering impurities. The gas is then compressed and turned into liquid for storage in tanks, cylinders, or cartridges.
Commercial grade nitrous oxide—such as that used in food and beverage dispensing, fuel injection, and chemical and semiconductor manufacturing—may contain a number of impurities, including the toxic chemicals sulphuric acid, ammonia, and nitric oxide.
Nitrous oxide should not be confused with nitric oxide, or NO, another gas that dilates the blood vessels (but is an air pollutant).
Ingestion methods
Depending on its intended use, nitrous oxide may be purchased in varying "grades," or degrees of purity.
Medical grade nitrous oxide is a prescription drug sold as a compressed liquid in cylinder tanks. Its buyer requires appropriate credentials to obtain it (which are governed by state law). Nitrous oxide used for other legitimate applications, such as manufacturing and auto racing, is often sold in a "denatured" form. Denatured nitrous contains chemicals that render it unfit for human consumption.
N2O is used as an aerosol propellant in cans of whipped cream and some other food and beverage products. These products are also a source of N2O for some nitrous abusers.
A food-grade version of the gas is also sold in small metal cartridges as a propellant for whipped cream cans and dispensers (hence the name slang name "whippets"). These small, bullet-shaped charging cartridges are legal. Because of their accessibility, portability, and low-cost, whippets are the most common means of taking the drug among nitrous oxide abusers.
Sometimes, masks or plastic bags are filled with laughing gas and then placed over the mouth and/or head. This practice carries a particularly high risk for serious injury and possible death, because the user can lose consciousness and suffocate on the mask or bag. Suffocation can also occur when nitrous oxide is consumed in large quantities in a poorly ventilated space, such as a car or closet, or when the user doesn't breathe in a sufficient amount of oxygen during prolonged use.
THERAPEUTIC USES
As an anesthetic, nitrous oxide has many legitimate uses. In dentistry it is used to calm patients and lower their anxiety (a process known as conscious sedation).
American obstetricians used nitrous oxide as a common pain management tool for women in labor through the early 1970s. Today, the anesthetic has been largely replaced in the United States, but a 50/50 mix of nitrous oxide and oxygen is still the anesthetic of choice for women in labor in the UK—over 60% use the gas for pain relief.
Nitrous oxide's ability to reduce anxiety is useful for uncomfortable or painful medical procedures. Some studies have also shown that children over the age of six experience less discomfort and mental distress when given nitrous oxide during short but painful medical procedures.
And somewhat ironically, nitrous oxide appears to have some use as an treatment for withdrawal symptoms. Several South African studies have demonstrated the usefulness of nitrous oxide in treating withdrawal symptoms and reducing cravings during alcohol, marijuana, and nicotine detoxification. And in early 2002, a small study published in Clinical Psychiatry found that the gas may also be helpful in helping smokers kick the habit. Researchers found that 92% of patients who inhaled a 50%/50% mixture of nitrous oxide and oxygen for 20 minutes on the day they quit smoking experienced decreased cravings for cigarettes over the following three days. Further studies are needed to determine the role that nitrous oxide may have in smoking cessation and substance abuse treatment.
USAGE TRENDS
Nitrous oxide is difficult to categorize. Technically, it is an inhalant, yet there are several characteristics that set the drug apart from the typical volatile substances that inhalant abusers favor. First, N2O is not as readily accessible as hair spray, glue, household cleaners, and other off-the-shelf huffing chemicals of choice. Secondly, since nitrous oxide is an actual prescription anesthetic, it may have more perceived prestige among users who would look down at most volatile substance abuse as "kid's stuff."
According to the National Institute on Drug Abuse (NIDA), nitrous oxide is showing up more frequently at raves, mixed-and-matched with other club drugs like ketamine, ectasy/MDMA, GHB, and LSD. There have also been cases of nitrous oxide abuse in healthcare professionals. Nurses, anesthesiologists, and other medical personnel with easy access to the drug may be at risk of developing dependence problems. According to the American Association of Nurse Anesthetists (AANA), over 15% of anesthesia providers (including anesthesiologists and certified registered nurse anesthetists, or CRNAs) are substance abusers.
This abuse is not unique to the United States, either. In late 2001, an investigation was launched into the birthing unit staff at Australia's Wollongong Hospital. Ten Australian midwives and a physician allegedly took part in a series of "laughing gas parties," illicitly indulging in the hospital's supply of nitrous oxide and the sedative temazipan.
Dentists are also at risk. The Talbott Recovery Center, a nationally recognized drug treatment facility that specializes in the rehabilitation of healthcare professionals, suggests that addiction may develop due to the nature of a dentist's work (i.e., long and sometimes tedious procedures, relative isolation, and the stress of dealing with anxious patients), combined with open access to anesthetic drugs. The Journal of the California Dental Association reports that the most commonly abused drugs among dentists are alcohol, hydrocodone, and nitrous oxide.
Scope and severity
An annual survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that 8.27 million Americans have used nitrous oxide illicitly (not for medical purposes) at least once in their lifetime.
Inhalant abuse as a whole is a growing crisis worldwide. An international study funded and published by NIDA in 1995 ("Epidemiology of Inhalant Abuse: An International Prospective"), reports increasing inhalant abuse in Mexico, Latin America, Nigeria, Asia, the United Kingdom, and Australia. In Latin America alone, over half of the estimated 40 million street children abuse inhalants (primarily glues and solvents).
Age, ethnic, and gender trends
Inhalant abuse starts early. As of 2000, approximately 2.1 million, or 8.9%, of American youths aged 12 to 17 had used some form of inhalant at some time in their lives. "Monitoring the Future," an annual survey of drug use among youth and young adults conducted by the NIDA and the University of Michigan, reports that one in five eighth graders surveyed in 2000 had used inhalants at least once in their lives, and one in 20 reported use in the prior month. Inhalants are the second most popular class of drugs for eighth graders (marijuana is first) and the third most popular (after marijuana and amphetamines) for tenth graders.
One-third of all inhalant abusers admitted to treatment programs in 1999 had first used inhalants by the age of 12, with an additional 24% reporting first use by age 14. Overall, the general use of inhalants decreases with age, with 9% of eighth graders reporting inhalant use in the past year compared to just 2% of young adults (in the "National Household Drug Use Survey 2000").
Nitrous oxide use, however, follows the opposite trend. In 2000, 456,000 children ages 12–17 reported use in the prior 12 months, in comparison to over 2.6 million between the ages of 18 and 25, and 5.1 million adults age 26 or older. This may be due to N2O's growing status as a club drug.
MENTAL EFFECTS
Nitrous oxide depresses the central nervous system (CNS). It also affects the activity of neurotransmitters—the CNS chemicals that enable nerve impulses, or signals, to travel from neuron to neuron and regulate thought processes, behavior, and emotion. Once inhaled, it enters the lungs and is carried through the body via the bloodstream. Users experience an immediate feeling of giddiness (not unlike alcohol intoxication), a "floating" and disconnected sensation, dizziness, mental confusion, and slurred speech. In strong enough concentrations, N2O can cause also short-term memory loss (dissociative amnesia).
Psychological dependence on nitrous oxide can lead users to try riskier and often fatal methods of increasing their intake of the drug, such as filling garbage bags with the gas and putting them over their heads. Memory loss, difficulties with work or school, learning problems, and preoccupation with obtaining the drug are all common features of psychological dependence.
PHYSIOLOGICAL EFFECTS
In addition to the mental effects described above, nitrous oxide impairs motor control and causes a partial insensitivity to pain. Users may lose consciousness at high doses. The intoxication from nitrous is typically short-lived—sometimes lasting under a minute.
Harmful side effects
The biggest risk of nitrous oxide use and abuse is hypoxia, or insufficient oxygen intake. Most abusers take the gas at high concentrations without an oxygen mix. High levels of nitrous oxide in the body can make a person unconscious or even stop breathing. Nitrous oxide displaces oxygen (pushes it out), so there is less of it in the bloodstream. Because the blood carries oxygen throughout the body to "feed" tissues and organs, diminished oxygen capacity can result in brain damage. Lack of oxygen can also cause a loss of consciousness and death by suffocation.
It is this oxygen deprivation that sometimes causes a bluish tinge on the lips of chronic nitrous abusers. After the initial high of nitrous wears off, chronic users may also experience such varied side effects as nausea, visual disturbances (seeing spots), feelings of claustrophobia, fatigue, and difficulty concentrating.
In cases of severe abuse, published studies have described chronic symptoms such as impairment of the nervous system, tingling and/or numbness of the hands and feet, and uncontrolled muscle twitching and movement. These side effects may be related to the depletion of vitamin B12 and folate caused by nitrous oxide abuse. They are usually reversible if nitrous use is stopped.
Because of the extreme cold temperature of nitrous oxide, frostbite of the face, mouth, throat, and hands may occur. In many cases, the injury is made worse by the anesthetic affect of the drug; the nitrous user may do further damage to the skin because he or she does not initially feel the frostbite.
Anyone inhaling gas directly from a nitrous tank valve is vulnerable to frostbite and possible lung damage, in addition to the various side effects already mentioned.
Also, if nitrous users inhale the gas standing up, they will more likely than not fall down—hard—possibly breaking a limb or suffering a head injury.
Also, working with any compressed gas may be dangerous. Although nitrous oxide itself is not flammable, the pressurized contents can explode and cause serious injury if a gas tank or cylinder is improperly stored, or is dropped, knocked over, or punctured.
Long-term health effects
Chronic nitrous oxide abuse can remove a lot of vitamin B12 from the bloodstream. B12 (cobalamin) is necessary for the creation of blood cells and neurotransmitters, as well as the protective layers that cover nerves. This results in nerve damage and pain; balancing, walking, and concentration difficulties; mental impairment; mood disturbances (such as depression); and other physical problems. Chronic nitrous oxide use may also interfere with the production in bone marrow of white blood cells and red blood cells. Treatment with intramuscular injections of B12 may reverse these symptoms.
As a consequence of B12 depletion, levels of folic acid may also be reduced in chronic N2O abusers. Again, supplements may help.
Nitrous oxide abuse may also lead to spontaneous abortion in pregnant women. It also interferes with DNA synthesis. For these reasons, it is not given to pregnant women, particularly in the first two trimesters. Heavy, ongoing nitrous oxide exposure during pregnancy has caused birth defects in animal studies, as well.
It is important to note that there have been no harmful physiological effects observed in infants born to mothers who are administered nitrous oxide and oxygen during labor itself, as the gas is quickly metabolized. However, a few long-term studies have shown a possible link between heavy nitrous oxide use during labor and the later development of opiate and methamphetamine addiction of offspring in adulthood.
Long-term nitrous oxide exposure may also cause infertility. Several studies of dental workers and midwives who had been exposed to low levels of the gas in the workplace found that their fertility was reduced in direct relation to the level and length of exposure. Equipment to limit nitrous oxide levels can be installed in a doctor's office to reduce this risk.
Individuals with certain chronic illnesses and 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 under any circumstances.
REACTIONS WITH OTHER DRUGS OR SUBSTANCES
When used along with other CNS depressants (such as alcohol) nitrous oxide can stop the user's breathing, which can be fatal.
Anyone with the condition phenylketonuria (PKU), a metabolic disorder, should be particularly careful about nitrous oxide use. Individuals with PKU require a diet that is high in protein in low in animal fats, which frequently results in a vitamin B12 deficiency. Nitrous oxide can remove even more B12 from these individuals' bloodstreams, possibly causing mental impairments, as well as severe nerve and brain damage.
TREATMENT AND REHABILITATION
In 1999, 7.8 million Americans reported the illicit use of nitrous oxide at least once in the prior 12 months. Yet according to SAMHSA, substance abuse treatment admissions for all inhalants accounted for only slightly over 1,300 of the almost 1.6 million substance abuse treatment admissions that same year.
Inhalant treatment numbers are low because inhalants are accessible and legal. They are easy to hide, use, and abuse in secrecy. And because they are legal, users often don't consider them a "real drug." Adults sometimes consider inhalant use a phase that adolescents will "grow out of" in time. Interestingly enough, the majority of inhalant users who reported illicit use of nitrous oxide are 18 and older—with most of them over the age of 25 (according to data in the "National Household Survey on Drug Abuse 2000").
Specialized treatment programs targeted at inhalant abusers are still rare in the United States, although many general drug treatment programs can
and do successfully treat these patients. Unfortunately, inhalant abusers suffer a higher rate of "relapse" (a return to drug use) than abusers of other drugs, in part because legal inhalants are widely available in just about any store.
As of early 2002, there were only a handful of specialized inhalant abuse treatment centers in the United States, including programs in Texas, Wisconsin, South Dakota, and New Mexico.
Several treatment programs in the United States have been designed for healthcare professionals with substance abuse problems. Facilities like the Talbott Recovery Center in Atlanta, Georgia have customized rehab programs for physicians, pharmacists, dentists, and nurses. These programs focus on long-term recovery, as well as on returning the patient to their healthcare career or a suitable alternative.
Drug rehabilitation programs may be either "inpatient" or "outpatient." Inpatient, or residential, drug programs require a patient to live at the hospital or rehab facility for a period of several weeks to several months. Outpatient programs allow patients to spend part of their day at the treatment facility, and return home at night. Nitrous oxide is rapidly eliminated from the body, and abuse of N2O alone is not associated with withdrawal. This means that a lengthy detoxification period (removal of the drug from the body) is typically not required.
However, if the patient has also been abusing other inhalants, the detoxification period could conceivably take up to 40 days, depending on the chemicals involved. Withdrawal symptoms in inhalant abusers may include nausea, vomiting, muscle pain and cramping, chills and sweats, irritability, tremors, headaches, and hallucinations. Depending on the severity of the symptoms and the patient's physical condition, the controlled environment of a residential setting may be preferred for the detox period.
After detox, the primary goals of treatment are abstinence (i.e., quitting the drug) and long-term recovery. Recovery is the life-long process of avoiding not just drug use, but the unhealthy behaviors and thought patterns that trigger it as well. An effective drug rehabilitation program focuses on changing these patterns of behavior and teaching recovering patients coping skills. Drug education on the long-term physical and mental effects of substance abuse is also part of a rehab program.
"Relapse"—using a drug again after a period of sobriety or abstinence—may occur if the emotional and behavioral issues surrounding drug use aren't under-stood. Some of the methods used to understand them include individual psychotherapy, behavioral therapy, cognitive-behavioral therapy, group therapy, and family counseling.
Individual psychotherapy
One-on-one counseling that explores the emotional issues underlying a patient's drug dependence and abuse. Individual psychotherapy is particularly when there is also some type of mental disorder, such as depression or an anxiety disorder along with the drug abuse.
Behavioral therapy
Behavioral therapy focuses on replacing unhealthy behaviors with healthier ones. It uses tools such as rewards (positive reinforcement for healthy behavior) and rehearsal (practicing the new behavior) to achieve a drug-free life.
Cognitive-behavioral therapy
Like behavioral therapy, cognitive-behavioral therapy (CBT) also tries teaching new behavioral patterns. However, the primary difference is CBT assumes that thinking is behind behavior and emotions. Therefore, CBT also focuses on—and tries to change—the thoughts that led to the drug abuse.
Family therapy
Family members often develop habits and ways of coping (called "enabling") that unintentionally help the addict continue their substance abuse. Group counseling sessions with a licensed counselor or therapist can help family members build healthy relationships and relearn old behaviors. This is particularly important for adolescents in drug treatment, who should be able to rely on the support of family.
Group therapy
Group therapy offers recovering drug abusers a safe and comfortable place to work out problems with peers and a group leader (typically a therapist or counselor). It also provides drug abusers insight into their thoughts and behaviors through the eyes and experiences of others. Substance abusers who have difficulty building healthy relationships can benefit from the interactions in group therapy. Offering suggestions and emotional support to other members of the group can help improve their self-esteem and social skills.
Self-help and twelve-step groups
Self-help organizations offer recovering drug abusers and addicts important support groups to replace their former drug-using social circle. They also help create an important sense of identity and belonging to a new, recovery-focused group.
Twelve-step groups, one of the most popular types of self-help organizations, have been active in the United States since the founding of Alcoholics Anonymous (AA) in 1935. Narcotics Anonymous (NA), a group that serves recovering drug addicts, was founded in 1953. Like AA and other 12-step programs, NA is based on the spiritual philosophy that turning one's will and life over to "a higher power" (i.e., God, another spiritual entity, or the group itself) for guidance and self-evaluation is the key to lasting recovery.
The accessibility of self-help groups is one of their most attractive features. No dues or fees are required for AA and NA, so they are a good option for the uninsured and underinsured. Meetings are held in public places like local hospitals, healthcare centers, churches, and other community organizations, and frequent and regular attendance is encouraged.
In addition, 12-step groups work to empower members and promote self-esteem and self-reliance. NA meetings are not run by a counselor or therapist, but by the group or a member of the group. The organization encourages sponsorship (mentoring another member), speaking at meetings, and other positive peer-to-peer interactions that can help reinforce healthy social behaviors. Today, the internet and on-line support communities have added a further degree of accessibility to those who live in rural or remote areas.
PERSONAL AND SOCIAL CONSEQUENCES
Substance abusers become preoccupied with when and where they will be able to get their next dose. As drug use takes center stage in an abuse's life, relationships with family and friends frequently deteriorate. Although nitrous oxide and other inhalants are known for their relatively low cost, an N2O abuser may suffer financial hardships as a result of unemployment, automobile accidents, or poor performance at school.
Chronic inhalant use is related to poor academic performance. According to the "National Household Survey on Drug Abuse 2000," kids with a D average in school were three times more likely to have used inhalants in the prior 12 months than the A-average students surveyed.
Substance abuse in general is a far-reaching societal problem, impacting not only personal relationships and health but also contributing to crime, domestic violence, sexual assault, drop-out rates, unemployment, and home-lessness. It is also a factor in public health problems, like the spread of sexually transmitted diseases (STDs) and unwanted pregnancy. Chronic inhalant abuse can lead to serious birth defects.
Inhalant abuse is a financial drain on society as well. Indian Health Services estimates a cost of $1.6 million to treat a young adult with a history of inhalant abuse and all its associated physical, mental, legal, occupational, and social problems. The Office of National Drug Control Policy (ONDCP) estimates that illegal drugs cost the U.S. economy $160 billion in the year 2000, an annual increase of 5.8% between 1998 and2000. That estimate includes $14.8 billion in healthcare costs and $110.4 billion in lost productivity from drug-related illness, incarceration, and death.
The perception of inhalants as dangerous, harmful substances has risen among young people. In 2001,76.4% of tenth graders said they thought regular inhalant abuse a "great risk" to the user. And socially, inhalants are becoming risky as well, with 91.3% of tenth graders strongly disapproving of regular inhalant use among their peers. This may be due in part an to anti-inhalant advertising campaign launched in the mid-1990s by the Partnership for a Drug-Free America.
LEGAL CONSEQUENCES
Most states have laws regarding inhalant (or volatile substance) use and abuse on the books. In recent years, laws that are specific to nitrous oxide use and distribution have been written in many states. For example, in Connecticut, Arizona, Texas, and Michigan, it is illegal for anyone under the age of 18 to purchase nitrous oxide, even in food grade cartridges. In Arizona, anyone caught selling N2O to minors faces up to 18 months in jail and a $150,000 fine.
In Wisconsin, the minimum age for purchasing nitrous oxide is 21. However, state legislation passed in 1998 makes it illegal for anyone to inhale or even intend to inhale nitrous outside of medical or dental settings. Anyone who distributes or delivers nitrous to someone with the knowledge that they are using it for illicit purposes can also be charged under Wisconsin law. A number of states, including Texas, California, Ohio, and Iowa, have variations on this law.
Illicit use, or possession with intent to use, is typically a misdemeanor in most states, and may be punishable by a small fine. Knowingly selling nitrous for illicit use carries a heftier price tag; it is a felony in many states and can involve significant jail time and cash fines.
Legal history
Nitrous oxide is not a U.S. Drug Enforcement Administration controlled substance. Nitrous oxide is regulated at the federal level by the United States Food and Drug Administration (FDA), as a food-grade propellant, medical grade gas, and prescription drug. In the 1990s, in an attempt to curb growing abuse of nitrous oxide, a number of states passed laws placing strong safeguards and stricter penalties on its illicit use.
Federal guidelines, regulations, and penalties
Use of the medical grade gas is by prescription only, and regulated by the FDA. Compressed medical gas suppliers must register with FDA, and are subjected to facility inspections from FDA at least once every two years. Licenses required to purchase and administer nitrous oxide in the healthcare setting is regulated on a state level.
Theft of nitrous oxide tanks from medical and other facilities is not uncommon. Some industry trade groups are working with state legislatures to pass stricter regulations on nitrous sales and theft-prevention guidelines in an effort to deter abuse.
See also Inhalants
RESOURCES
Books
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.
Periodicals
Johnston, Lloyd D., et al. Monitoring the Future: National Survey Results on Drug Use, 1975-2000. Vols. I and II. Bethesda, MD: National Institute on Drug Abuse, 2001.
Organizations
National Inhalant Prevention Coalition, 2904 Kerbey Lane, Austin, TX, USA, 78703, (512) 480-8953, (512) 477-3932, (800) 269-4237, [email protected], <http://www.inhalants.org/>.
National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213, Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.nida.nih.gov>.
Paula Anne Ford-Martin