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12 Montrose Voice / August 20,1982
Inhalants: Quick Route to Danger, Says FDA
Editor's note: the following article—in an
expanded version—was originally published in the "FDA Consumer, "May. 1980.
Admittedly, this article contains "official" Food and Drug Administration
thought. Nevertheless, we thought our
readers would be interested.
By Annabel Hecht
Food and Drug Administration Public
Affairs Staff
Inhaling certain substances to get "high"
has been risky all the way back to antiquity, and is no leBS dangerous in modern
times. Adding to the problem today are a
couple of substances that have enjoyed a
certain amount of social acceptance: butyl
nitrite, sold as a "room odorizer," and
nitrous oxide, better known as "laughing
gas." They are examined in this article.
The Food and Drug Administration, or
FDA, says it is very much concerned about
the increasing abuse of these two inhaled
substances.
Because the respiratory system provides a quick route to the bloodstream,
inhaling a volatile substance is like having it injected into the body. The effect can
be immediate with loss of consciousness,
heart irregularities, or even death. After a
time, those who inhale substances such as
solvents may develop organic brain syndrome, a condition characterized by loss of
muscular coordination, lethary, irritability, confusion, or disorientation. Inhaling
volatile substances also can lead to peripheral nerve injury, and liver and kidney
disease.
Long-range effects, which may not
show up for 10 to 30 years, include an
increased risk of developing cancer as well
as genetic changes.
The 70s saw a surge in the abuse of
nitrous oxide—mainly by health professionals and college-age youth—and of
butyl nitrite, close chemical kin to a drug
used to treat Bymptoms of angina pectoris
(a heart disorder).
Just who is sniffing this array of substances? Statistically their numbers are
small. The National Institute of Drug
Abuse (NIDA) estimates that about 7 million people over the age of 12 have experimented with or are chronic users of
inhalants. In contrast, 42 million have
tried or used marijuana. However, experts
in the drug abuse field believe that many
inhalers just don't get counted. For
instance, those most likely to abuse industrial solvents, often school dropouts or truants, aren't likely to be covered in school
surveys of drug abuse.
In the past, surveys frequently did not
include questions about inhalants, or they
lumped everything under "glue sniffing."
In addition, inhalant users seldom seek
medical attention for problems related to
their sniffing habit, so they don't often
show up in emergency room reports.
The picture that emerges ofthe abuse of
butyl nitrite and nitrous oxide is much different than that of industrial and commer
cial solvents.
When amyl nitirite was made an over-
the-counter drug in 1960, it became a
prime candidate for abuse. Called
"poppers" because of the sound made
when the mesh-covered glass vials or
ampules were crushed prior to inhalation
of the fumes, these drugs gave the user a
quick "high."
FDA reclassified amyl nitrite as a prescription drug in 1969 and butyl nitrite
became more readily available. First popular in homosexual communities, butyl
nitrite is now used both as a sexual stimulant and euphoriant in heterosexual circles. Sold as a "room odorizer" or "liquid
incense" under a variety of names that are
suggestive of its odor—Banapple Gas,
Locker Room, Rush, Jac Aroma, Satan's
Scent, Locker Popper—butyl nitrite is
available in novelty stores, some record
stores, and "head" shops that cater to
drug-oriented youth.
How many people are using butyl nitrite
is difficult to say. It is estimated, on the
basis of sales data published in the press,
that 4 to 10 million vials of the drug are
sold each year. Primary users are older
teenagers and young adults of both sexes.
From what is currently known, there
have been some deaths from butyl nitrite
and several of these resulted from ingestion of the substance. Users generally
experience headaches, dizziness, perspiration, and flushing of the face. Less common reactions include nausea, vomiting,
and fainting. There is a risk that over a
time the heart and blood vessels could be
damaged. Inhaling nitrites could be fatal
to people with heart disease.
Nitrous oxide is even older than amyl
and butyl nitrite. Discovered accidentally
in 1773 by Joseph Priestly, nitrous oxide
was one ofthe first volatile substances to
be abused. In the 18th and 19th centuries
"ether frolics" and demonstrations of
"laughing gas" were common parlor
games among the upper classes. The fact
that the participants in these events were
feeling no pain eventually led to the reali
zation that these gases have a legitimate
use in medicine. Ironically, Dr. Horace
Wells, the man who introduced nitrous
oxide to dentistry in 1844, died as a result
of chloroform abuse.
Today, nitrous oxide has a number of
commercial uses including that of general
anesthetic, particularly in dental offices;
propellant to manufacture whipped
cream; rocket fuel; and leak detector. Only
the first two package forms are believed to
be abused.
Abuse of nitrous oxide as an anesthetic
has a long history. One medical historian
has recounted cases of misuse of the gas
by American medical students in the late
19th centry.
How many people in the health professions today may be abusing nitrous oxide
is not known, but reports in the medical
literature and other sources suggest that
anesthesiologists, doctors, nurses, dentists, and inhalation therapists are among
those who do.
When nitrous oxides is a propellant for
making "whipped cream," it is either in an
aerosolized spray can where it is considered a legitimate food additive, or in a
small 8-gram metal cylinder, intended to
be used with a dispensing machine. These
cylinders are popularly called
"Whippets," since that is the brand name
of one version of this product. The cylinders are being purchased—often at "head"
shops—by young people, particularly college students, who have no intention of
whipping anything edible. Paraphernalia
used with cylinders include ballons from
which the gas is inhaled. One man has
come up with a device called a "Buzz
Bomb," which combines the nitrous oxide
cylinder with a pipe for smoking.
Damage to health from abuse of nitrous
oxides is a problem however. Death can
result if the gas is inhaled with insufficient oxygen. Abuse of the gas over long
periods of time can result in nerve damage, including loss of balance, leg weakness, tingling, and numbness in the
fingers and toes. Shortness of breath, nausea, variations in heartbeat, and hearing
loss also have been reported as side effects
of nitrous oxide abuse. Studies of health
professionals who are exposed to the gas
in their work—dentists, dental technicians, anesthesiologists—have shown
that these people have increased risk of
kidney and liver disease, spontaneous
miscarriages, and other serious health
problems.
Controlling the abused products is one
approach in controlling inhalant abuse.
Obviously is would be impossible to ban
industrial solvents that serve a useful purpose, especially since those sniffing these
substances will simply turn to something
else. However, other steps can be taken
such as the addition of oil of mustard to
airplane glue to make it smell bad, a move
made voluntarily by glue manufacturers.
Warnings on labels is another way to
help stop product abuse. FDA took this
step in 1975 to curtail abuse of nonstick
frying pan sprays. When it was determined that aerosol cooking sprays were
food additives within the agency's jurisdiction, FDA called for the following warning on such product containers:
"Warning—Use only as directed. Intentional misuse by deliberately concentrating and inhaling the contents can be
harmful or fatal."
As for butyl nitrite, manufacturers of
the so-called room odorizers follow the
Consumer Product Safety Commission
(CPSC) labeling requiremens to the letter.
Despite extensive labeling and warnings
such as "Avoid prolonged breathing of
vapor," sales and abuse have not diminished. It would have to be proved that
injury or illness occurred under recommended conditions of use—that is, as a
room odorizer—before CPSC could take
additional regulatory action.
FDA has been aware ofthe recreational
use and abuse of butyl nitrite for several
years and is exploring what course of
action can be taken to halt this abuse. A
key issue is whether butyl nitrite is a drug
within the meaning ofthe Food, Drug, and
Cosmetic Act. Determing whether it qualifies depends on how it is labeled.
A butyl nitrite product properly labeled
as a room odorizer would not be considered
a drug, even though the person who
bought it did so to get "high." However, if
the manufacturer or distributor suggests
in labeling that the product is an aphrodisiac or euphoriant, the product could be
regulated as a drug.
In the meantime, many U.S. communities are seeking to impose legal bans or at
least to limit the sales of this product to
adults. Georgia and Connecticut, for
example, have established controls on
odorizer sales, and Houston has banned
their sale to minors.
Nitrous oxide as a medicinal gas is regulated as a prescription drug by FDA and
many of the states. Nitrous oxide as a
whipped cream propellant is regulated by
FDA as a food additive. Where the 8-gram
cylinders fit is not so clear. As in the case
of butyl nitrite, the agency is examining
the options for controlling nitrous oxide
abuse. In 1980, a meeting was held with
manufacturers of the gaB to discuss steps
that could be taken on a voluntary basis.
Changes in labeling on nitrous oxide containers were being considered. Materials
also were being prepared to alert the medical community to the danger or inadvertent or deliberate exposure to this gas.
Whatever regulatory steps eventually
are taken, FDA cautions those who have
access to nitrous oxide to use it only as the
manufacturer intended. Nitrous oxide is a
safe anesthetic in the hands of trained
medical and dental personnel and an
effective aerosol propellant. But experience now proves that abuse of nitrous
oxide is no laughing matter.
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