Nitrites abuse

Volatile nitrites abused for sexual stimulation transient dizziness, weakness, or other signs of cerebral hypoperfusion may develop following inhalation... 

Amyl nitrite abuse can be found in all ethnic groups, age levels, and genders. However, the predominance seems to be among older adolescents, white, from families with low to average incomes, male, and those who frequent dance clubs and raves. Most abusers use amyl nitrite in combination with other drugs. 

Bradberry, S.M. Volatile Nitrite Abuse Mechanisms of Toxicity, Features, and Management. Journal of Toxicology Clinical Toxicology (March 2000) 178. 

Nitrites carry special risks, even with modest use. Based on their research with animals, scientists suspect that nitrite abuse reduces the number of cells in the immune system. This possibly hinders the body s efforts to fight infectious diseases and resist the growth of tumors. 

The fact that there are so many different compounds abused as inhalants brings up question of how all of these compounds act on the brain. Do they all act in the same way The answer to this question will be discussed in Chapter 4. It has been argued by some researchers that inhalant abuse should be regrouped as solvent abuse, volatile anesthetic abuse, and nitrite abuse, since the populations that abuse these substances are different." Solvents are primarily abused by teenagers, anesthetics are generally abused by older professionals who have access to them, and nitrites are abused by populations older than teenagers. In the case of nitrites, as will be discussed later, the way the chemical acts upon the body appears to be quite different as well. In this book, the differences between these subgroups of inhalants will be discussed when useful. 

Toluene, volatile nitrites, and anesthetics, like other substances of abuse such as cocaine, nicotine, and heroin, are characterized by rapid absorption, rapid entry into the brain, high bioavailability, a short half-life, and a rapid rate of metabolism and clearance (Gerasimov et al. 2002 Pontieri et al. 1996, 1998). Because these pharmacokinetic parameters are associated with the ability of addictive substances to induce positive reinforcing effects, it appears that the pharmacokinetic features of inhalants contribute to their high abuse liability among susceptible individuals. 

Schroeder HG Acute and delayed chloroform poisoning. Br J Anaeseth 37 972—975,1965 Schwartz AM The cause, relief and prevention of headaches arising from contact with dynamite. N Engl J Med 235 541-544, 1946 Schwartz RH, Peary P Abuse of isobutyl nitrite inhalation (rush) by adolescents. Clin Pediatr 25 308-310, 1986... 

Organic solvents inhaled by abusers include gasoline, glue, aerosols, amyl nitrite, butyl nitrite, typewriter correction fluid, lighter fluid, cleaning fluids, paint products, nail polish remover, waxes, and varnishes. Chemicals in these products include nitrous oxide, toluene, benzene, methanol, methylene chloride, acetone, methyl ethyl ketone, methyl butyl ketone, trichloroethylene, and trichloroethane. 

Drug abuse and dependence Volatile nitrites, including amyl nitrite, are abused for sexual stimulation, with headache as a common side effect. 

Amyl nitrite, unlike other inhalants, are abused primarily because they are believed to enhance sexual pleasure and performance through loss of inhibition. However, abandoning inhibition leads to unsafe sex and a much greater risk for sexually transmitted diseases, including HIV, hepatitis A, gonorrhea, and syphilis. 

In 2000, California voters approved a ballot measure that allows state courts to sentence first- and secondtime drug use offenders to rehabilitative treatment rather than jail or prison. The measure, Proposition 36 (Prop. 36), also known as the Substance Abuse and Crime Prevention Act, took effect July 1, 2001. As of March 1, 2002, more than 15,000 individuals had been referred to treatment under Prop. 36. The law mandates probation and drug abuse treatment for offenders instead of jail time. Persons sentenced under Prop. 36 are required to spend up to a year in a state-approved treatment regimen. Treatment can include outpatient care, inpatient treatment at a halfway house, psychotherapy, and drug education and prevention classes. The law applies to persons convicted of possession of amyl nitrite without a prescription. 

Most abusers are drawn to inhalants for their psychoactive, or mind-altering, effects. Users of nitrites are the exception. The nitrites make up an inhalant subcategory that includes amyl, butyl, and cyclohexyl nitrites. These substances were nicknamed poppers because in the past, they were packaged in ampules. Users cracked the ampules to release the vapors. Nitrites are abused, internationally, because they produce a sexual rush, accompanied by a sense of power and exhilaration. 

Nitrites were highly popular in the United States in 1970s, particularly in the gay community. One study, published in 1988 in the National Institute of Drug Abuse Research Monograph Series, reported that by 1979 up to five million people used nitrites weekly. By the early 1980s, however, nitrite use dropped dramatically. In the United States, amyl nitrite became available solely by prescription in 1979. Also, nitrite use was associated with Kaposi s sarcoma, the most common cancer affecting people with AIDS. 

Nitrites, used to enhance sexual experiences, are in a different category in terms of their effects. When inhaled, nitrates dilate the blood vessels and speed the heartbeat. As a result, abusers feel warm and excited for several minutes. They may also become flushed and dizzy, and may develop a headache. 

Four types of inhalants are abused (1) anesthetic gases (2) industrial solvents, including a variety of hydrocarbons, such as toluene (3) aerosol propellants, such as various fluorocarbons and (4) organic nitrites, such as amyl or butyl nitrite. The mode of action of the inhalant anesthetics has been discussed in Chapter 25 General Anesthetics. 

Amifostine Amifostine is incompatible with many drugs such as acyclovir sodium, amphotericin, cefoperazone sodium, hydroxyzine hydrochloride, miconazole, minocycline hydrochloride, and prochlorpherazine edisylate.239 Care should be exercised when handling amyl nitrate, since it is highly flammable. Volatile nitrites, such as poppers, are abused and fatal adverse effects are reported.240,241... 

Direct central nervous system effects of volatile nitrites have not yet been determined. In the body, nitrites are rapidly broken down into alcohol and nitrite ions, so the parent nitrite drugs may not reach the brain in concentrations comparable to those found in the blood. In one study, isoamyl nitrite concentrations were measured in the brains of rats exposed to the compound by inhalation. The drug was found to inhibit the synthesis or release of some adrenal steroids in the hypothalamus that are involved with stress. To understand the abuse potential of volatile nitrites, many more studies are needed to establish direct effects of the drugs on the brain. 

Nitrites, which are mainly abused by older adolescents and adults, are typically used to enhance sexual function and pleasure. The use of these drugs has been shown to be associated with unsafe sexual practices. These practices put the users at a greater risk for contracting and spreading sexually transmitted diseases such as HIV and hepatitis. 

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