Nitrous oxide abuse

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. 

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. 

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. 

Layzer, R.B. Nitrous Oxide Abuse, Nitrous Oxide/N20, ed. E.I. Eger II, M.D. New York Elsevier Science Publishing Company, 1985, pp.249-257. 

Myelopathy associated with nitrous oxide abuse has been reported (22). 

Two cases of polyneuropathy and myelopathy associated with chronic nitrous oxide abuse have been reported (23,24). 

LiPuma JP, Wellman J, Stern HP. Nitrous oxide abuse a new cause of pneumomediastinum. Radiology 1982 145(3) 602. 

Iwata K, O Keefe GB, Karanas A. Neurologic problems associated with chronic nitrous oxide abuse in a non-health-care worker. Am J Med Sci 2001 322(3) 173-4. 

Iwata K, O Keefe GB, Karanas A Neurologic problems associated with chronic nitrous oxide abuse in a non-healthcare worker. Am J Med Sci 322 173-174, 2001 McNeely JK, Buczulinski B, Rosner DR Severe neurological impairment in an infant after nitrous oxide anesthesia. Anesthesiology 93 1549-1550, 2000 Meyer RE Anesthesia hazards to animal workers. Occup Med 14 225-234,1999 Moore NN, Bostwick JM Ketamine dependence in anesthesia providers. Psycho-somatics 40 356-359, 1999... 

Gillman MA. Nitrous oxide abuse in perspective. Clin Neuropharmacol 1992 15 297-306. 

B. Chronic nitrous oxide abuse may produce megaloblastic anemia, thrombocytopenia, leukopenia, peripheral neuropathy (especially posterior column findings), and myelopathy, similar to the effects of vitamin B,2 deficiency. 

Richardson PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas 2010 22(1) 88-90. 

Warning The misuse of nitrous oxide can cause death by reducing the oxygen necessary to support life. Nitrous oxide abuse can impair an individual s ability to make and implement life-sustaining decisions. 

Nitrous oxide abuse has become a significant problem resulting in theft of cylinders and attempts to purchase for illegitimate and, in may states illegal, use. It is recommended that nitrous oxide containers be stored in a secure area and policies be established to ensure sales are made only for legitimate uses. Additional recommendation are given in Effects of Exposure to Toxic Gases-First Aid and Medical Treatment [6]. 

Harper MH, Winter PM, Johnson BH, et al Withdrawal convulsions in mice following nitrous oxide. Anesth Analg 59 19—21, 1980 Hasin D,Nunes E, MeydanJ Comorbidity of alcohol, drug, and psychiatric disorders epidemiology, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 1-34... 

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. 

Central nervous system toxicity from either social abuse of nitrous oxide or extremely heavy occupational exposure has been characterized by symptoms of numbness, paresthesias, impairment of equilibrium, and difficulty in concentration. In severe cases, the patient becomes incontinent, impotent, and unable to walk. Neurological signs include ataxic gait, muscle weakness, impaired sensation, and diminished reflexes. 

The ultrashort-acting barbiturates methohexital (Bre-vital), thiamylal (Surital), and thiopental (Pentothal) are administered as an anesthetic before surgery. The barbiturate is injected into the patient s vein to induce anesthesia. The patient then receives a longer-acting anesthetic like nitrous oxide. The drugs are used in hospital settings and are not subject to abuse, according to the DEA. 

Inhalant abuse can also be a hazard in some occupations. People who work in the refrigeration industry may abuse Freon, hydrocarbons used in refrigerants and people working in medical fields may abuse nitrous oxide. A 1979 study, Abuse of Nitrous Oxide, published in Anesthesia Analgesia, found that 20% of dental and medical students had abused nitrous oxide. 

Anesthetics Nitrous oxide (NzO) or laughing gas, the most abused of the gases. Liquid anesthetic contains halothane and enflurane local anesthetic contains ethyl chloride. Vegetable oil cooking spray and whipping cream cartridges also contain nitrous oxide. 

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. 

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, N20 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. ... 

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. 

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. 

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. 

Dmg 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 NzO alone is not associated with withdrawal. This means that a lengthy detoxification period (removal of the drug from the body) is typically not required. 

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 NzO abuser may suffer financial hardships as a result of unemployment, automobile accidents, or poor performance at school. 

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