Inhalants (including nitrous oxide or 'NOS')

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What Are They?

The term inhalants describes a variety of chemicals that when inhaled have a mind-altering effect. There are literally hundreds of inhalants, including everyday products such as household cleaners and aerosols, as well as industrial and medical products. The most commonly abused in New Zealand are the whipped cream dispensers called whippets or chargers pictured below (canister inside purple cracker). Although the wide range of chemicals can have different effects on the brain and body, inhalants generally fall into four categories: volatile solvents, aerosols, gases, and nitrites.

Volatile solvents are liquids that vaporise at room temperatures. They are found in many inexpensive, easily available products used for common household and industrial purposes.

Aerosols are sprays that contain propellants and solvents.

Gases include medical anaesthetics as well as gases used in household or commercial products. Medical anaesthetic gases include ether, chloroform, halothane, and nitrous oxide, commonly called "laughing gas." Nitrous oxide is the most abused of these gases.

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."

What Are the Common Street Names?

Common slang for inhalants includes "NOS," "laughing gas" (nitrous oxide), "snappers" (amyl nitrite), "poppers" (amyl nitrite and butyl nitrite), "whippets" (fluorinated hydrocarbons, found in whipped cream dispensers), "bold" (nitrites), and "rush" (nitrites).

How Are They Used?

Inhalants can be breathed in through the nose or mouth in a variety of ways: [2]

• "Sniffing" or "snorting" fumes
• Spraying aerosols
• Sniffing from a plastic or paper bag ("bagging")
• "Huffing" from an inhalant-soaked rag stuffed in the mouth
• Inhaling from balloons

Most abusers are teens who may use inhalants as an easily accessible substitute for alcohol, and are not aware that with inhalants there is a very high risk of death compared to other drugs abused.

How Many Teens Use Them?

A 1990 survey found that less than 1% of New Zealanders had used inhalants in the past 12 months.[3] Abuse of inhalants often starts early.[2] 2% of teens aged 15 to 17 reported having tried solvents, with no use in the past 12 months for women over 17 and men over 19 years of age. This survey did not include young people under 15 years of age, but did confirm that solvent use is usually confined to children and teenagers.

Young people who take up glue sniffing often come from troubled backgrounds. They may have family problems, troubled relationships, or problems at school. They miss school, sometimes leave home, take to sleeping out, sometimes become street kids, and don't lead normal lives. They need help and support.

What are the Common Effects?

Most of us don't think of spray paint, glue, household cleaners, and the like as drugs because we're used to seeing such products under the kitchen sink, in the bathroom, or on the grocery shelves. Young people, our age, are among those most likely to abuse these toxic substances, only we are not always aware of the risks involved... in the year 2003, six healthy, young people died in Wellington alone when their hearts stopped from inhaling butane.

Nearly all inhalants (other than nitrites) produce a high by depressing the central nervous system, in much the same way as other depressants, such as alcohol and sedatives. Like other drugs of abuse, inhalants trigger the release of dopamine in the brain. Dopamine creates good feelings - for a short time.

Initial Effects

The problem is, once dopamine starts flowing, the user can feel the urge to do more... and more... and more. Repeating this process can lead to addiction, and addiction is a brain disease.

When someone abuses an inhalant, the lungs rapidly absorb the inhaled chemicals into the bloodstream, quickly distributing them throughout the brain and body. Within minutes of inhalation, users feel a high that resembles alcohol intoxication with an initial excited feeling, then drowsiness, disinhibition, lightheadedness and agitation.

Effects on the Brain

Inhalants often contain more than one chemical. Some chemicals leave the body quickly, but others can stay there a long time, absorbed by fatty tissues in the brain and central nervous system.[7]

One of these fatty tissues is myelin, an important and protective cover that surrounds many of the body's nerve cells (neurons). Brain cells communicate using neurotransmitters that travel around in nerves. Myelin is a protective cover around the nerve and helps nerve fibres carry their messages to and from the brain. Damage to myelin can damage nerve fibres in a way that is clinically similar to the effects of multiple sclerosis.[2] Toluene, a chemical found in aerosols and solvents, can produce euphoria and giddy feelings, and it can also break down myelin. When this happens, nerve cells cannot transmit messages, resulting in muscle spasms and tremors or even permanent difficulty with basic actions like walking, bending, and talking. [6]

Inhalants also can damage neurons in a part of the brain called the hippocampus by preventing nerve cells from getting enough oxygen. [7] The hippocampus helps control memory, so someone who repeatedly uses inhalants may lose the ability to learn new things or may have a hard time carrying on simple conversations. [7]

Damage from long-term use of inhalants can slow or stop nerve cell activity in some parts of the brain. This might happen in the cerebral cortex, the part of the brain that solves complex problems and plans ahead. If inhalants get into the brain's cerebellum, which controls movement and coordination, they can make someone move slowly or clumsily. [7]

Long-Term Health Effects

Regular abuse of inhalants can result in serious harm to vital organs, including the brain, heart, kidneys, and liver.[2] It can cause heart damage, liver failure, and muscle weakness.[8] The vaporous fumes can change brain chemistry and may be permanently damaging to the brain and spinal cord. [8] Certain inhalants can also cause the body to produce fewer types of all blood cells, which may result in aplastic anemia (a condition in which the bone marrow is unable to produce blood cells). [8] Frequent long-term use of certain inhalants can cause a permanent change or malfunction of nerves, called polyneuropathy. [8]

Compulsive use and mild withdrawal symptoms can occur with long-term inhalant abuse. Additional symptoms that long-term abusers have are weight loss, muscle weakness, disorientation, inattentiveness, lack of coordination, irritability, impaired vision, and depression. [2]

Nitrous oxide (NOS) interferes with the metabolism of B12 and folate.[9] B12 is a vitamin that is important for our wellbeing and happiness. Once B12 is depleted in the body, it can be difficult to build back up and maintain at a healthy level. Vitamin B12 works with folic acid in many body processes including synthesis of DNA, red blood cells and the myelin sheath that protects nerve cells. Severe depletion manifests as pernicious anaemia. But long before anaemia sets in, other conditions may manifest, like neurological problems (numbness, pins and needles, a burning feeling in the feet, shaking, muscle fatigue, sleep disorders, memory loss, irrational anger, impaired mental function and Alzheimer's) or psychological conditions (dementia, depression, psychosis and obsessive-compulsive behaviour). President Kennedy has been quoted saying he would never have become president without injections of B12.

Depending on the type of inhalant abused, many serious health effects can result. The table below lists the most common inhalants abused and their effects.

Amyl Nitrite, butyl nitrite	Poppers, video head cleaner	Sudden sniffing death syndrome, suppressed immunologic function, injury to red blood cells (interfering with oxygen supply to vital tissues)
Benzene	Gasoline	Bone marrow injury, impaired immunologic function, increased risk of leukaemia, reproductive system toxicity
Butane, Propane	Lighter fluid, hair and paint spray	Sudden sniffing death syndrome via cardiac effects, serious burn injuries (because of flammability)
Freon	Lighter fluid, hair and paint spray	Sudden sniffing death syndrome via cardiac effects, serious burn injuries (because of flammability)
Methylene chloride	Paint thinners and removers, degreasers	Reduction of oxygen-carrying capacity of blood, changes to the heart muscle and heartbeat
Nitrous oxide, hexane		Death from lack of oxygen to the brain, altered perception and motor coordination, loss of sensation, limb spasm, blackouts cause by blood pressure changes, depression of heart muscle functioning
Toluene	Gasoline, paint thinners and removers, correction fluid	Brain damage (loss of brain tissue mass, impaired cognition, gait disturbance, loss of coordination, loss of equilibrium, limb spasms, hearing and vision loss), liver and kidney damage
Trichlorethylene	Spot removers, degreasers	Sudden sniffing death syndrome, cirrhosis of the liver, reproductive complications, hearing and vision damage

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 by an otherwise healthy young person.

Butane (found in cigarette lighters and refills) makes the heart extra sensitive to a chemical that carries messages from the central nervous system to the heart. This chemical, noradrenaline, tells the heart to beat faster when someone's in a stressful situation-such as being scared suddenly. [7] If the heart becomes too sensitive to noradrenaline, a normal jolt of it may cause the heart to temporarily lose its rhythm and stop pumping blood through the body. Some inhalant users die this way. [7]

Nitrite abuse can also have specific negative health effects. Unlike most other inhalants, which act directly on the central nervous system, nitrites enlarge blood vessels, allowing more blood to flow through. Inhaled nitrites make the heart beat faster and produce a sensation of heat and excitement that can last for several minutes. Other effects can include dizziness and headaches.

While high on inhalants, users also can die by choking on their own vomit or by fatal injury from accidents, including car crashes. [2]

References

1. National Institute on Drug Abuse. NIDA InfoFacts: Inhalants Revised December 2004. Retrieved May 2005.
2. National Institute on Drug Abuse. NIDA Research Report: Inhalant Abuse NIH Publication No. 00-3818. Printed 1994. Reprinted 1996, 1999. Revised March 2005. Bethesda, MD: NIDA, NIH, DHHS. Retrieved May 2005.
3. Substance Abuse and Mental Health Services Administration. Results from the 2002 National Survey on Drug Use and Health: National Findings Office of Applied Studies, NHSDA Series H-22. DHHS Pub. No. SMA 03-3836. Rockville, MD: SAMHSA, DHHS. Printed 2003. Retrieved November 2005.
4. PRIDE Surveys. PRIDE Questionnaire Report for Grades 4 through 6 2003-04 PRIDE National Summary/Grades 4 thru 6. September 16, 2004. Retrieved June 2005.
5. Johnston, L.D.; O'Malley, P.M.; and Bachman, J.G. Monitoring the Future: National Results on Adolescent Drug Use; Overview of Key Findings Bethesda, MD: NIDA, NIH, DHHS, 2003. Retrieved January 2004.
6. Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2005). Drug Abuse Warning Network, 2003: Area Profiles of Drug-Related Mortality DAWN Series D-27. DHHS Publication No. (SMA) 05-4023. Rockville, MD: SAMHSA, DHHS. Printed 2005. Retrieved May 2005.
7. National Institute on Drug Abuse. Mind Over Matter: Inhalants Bethesda, MD: NIDA, NIH, DHHS. NIH Pub. No. 03-4038. Printed 1997. Reprinted 1998, 2000, 2003. Retrieved May 2005.
8. National Institute on Drug Abuse. Mind Over Matter: Teaching Guide. Inhalants Bethesda, MD: NIDA, NIH, DHHS. NIH Publication No. 00-3592. Printed 1997, 1998. Revised 2000. Retrieved May 2005.
9. Adanz