Nitrous Oxide (Dinitrogen Monoxide, Dinitrogen Oxide, Entonox)
Pronunciation: NIGH-truhs OX-eyed
Chemical Abstracts Service Registry Number: 10024-97-2
Formal Names: Dinitrogen Monoxide, Dinitrogen Oxide, Entonox
Informal Names: Fall Down, Gas, Hippie Crack, Hysteria, Laughing Gas, Nitro, Nitrous, Nitrous Acid, Noss, Pan, Shoot the Breeze, Tanks, Thrust, Whippets
Type: Inhalant. Federal Schedule Listing: Unlisted USA Availability: Nonprescription, but sales and usage are controlled in some jurisdictions Read more
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Pronunciation: NIK-uh-teen (also pronounced NIK-uh-tin)
Chemical Abstracts Service Registry Number: 54-11-5
Formal Names: Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco
Informal Names: Chip (cigarette mixed with PCP), Fry Daddy (cigarette mixed with crack cocaine)
Type: Stimulant (pyridine alkaloids class).
Federal Schedule Listing: Unlisted
USA Availability: Generally available to adults as a component of tobacco products; nonprescription and prescription in pharmaceutical format
Pregnancy Category: C or D (depending on pharmaceutical format) drugsencyclopedia.net/nicotine/nicotine-habitrol-nicoderm-niconil-nicorette-nicotiana-rustica-nicotiana-tabacum-nicotrol-prostrop-tobacco/#more-28″ class=”more-link”>Read more
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Pronunciation: NIGH-truhs OX-eyed
Chemical Abstracts Service Registry Number: 10024-97-2
Formal Names: Dinitrogen Monoxide, Dinitrogen Oxide, Entonox
Informal Names: Fall Down, Gas, Hippie Crack, Hysteria, Laughing Gas, Nitro, Nitrous, Nitrous Acid, Noss, Pan, Shoot the Breeze, Tanks, Thrust, Whippets
Type: Inhalant.
Federal Schedule Listing: Unlisted
USA Availability: Nonprescription, but sales and usage are controlled in some
jurisdictions
Uses.
This drug has been known since the 1720s. Some authorities describe nitrous oxide as an opioid; some persons even use the gas to counteract effects from stimulants. Nitrous oxide actions and its recreational use are similar to those of other inhalants. Recreational use is illegal in some jurisdictions but has a venerable history. The writer Samuel Taylor Coleridge, thesaurus compiler Peter Mark Roget, and potter Josiah Wedgwood were all eighteenthcentury notables who relaxed with nitrous oxide.
Although this substance is a pharmaceutical product, it also occurs naturally. For instance, eating lettuce generates enough nitrous oxide that scientists can measure it in a person’s breath. Large quantities are produced by wild prairie grass. Humans do not receive enough nitrous oxide from such natural sources to be affected, however. The substance is also produced by the human
body. One study found the amount to increase as oral hygiene declined. As with the amounts produced by grass and lettuce, the level created by the body is too small to have any known effect on a person. From a global environmental perspective, however, nitrous oxide is a gas that promotes the greenhouse effect and ozone layer destruction, and concern exists about medical
usage affecting the world’s climate. Medical sources are estimated to create 2% of the atmosphere’s supply. Such usage may seem insignificant in that regard, but the gas is so durable in the atmosphere that any artificial source has been described as an environmental hazard.
Medically this drug is used as an anesthetic and to relieve pain ranging from dental work to migraine headache and cancer. In a medical context nitrous oxide is considered a reliable sedative. Experimental usage to treat anxiety has been successful, and one authority has noted a therapeutic antidepressant action. The substance has been used to help persons break entazocine addiction. Researchers report success in using the gas to ease alcohol,
nicotine, and opioid withdrawal and to reduce craving for alcohol, tobacco, and marijuana among addicts. The latter three substances are so different from one another that nitrous oxide’s ability to reduce craving for all of them is remarkable. Some medical practitioners claim that a single dose of the gas actually eliminates craving for those substances, but that claim sounds much
like those made for other “miracle cure” addiction treatments over the years but that turned out to be overly optimistic.
In former times, nitrous oxide was used to fight ear afflictions. For many years the substance was believed to make hearing more acute, but tests of hearing ability while using the compound show no improvement—and volunteers in those tests even felt they had lesser ability to detect soft sounds.
Nitrous oxide can increase pressure in the middle ear, and a case report tells of treatable hearing loss caused by the drug. Hearing defect has been reported from recreational use as well.
Typical nitrous oxide actions are tingling, numbness, dreaminess, euphoria, dysphoria (the opposite of euphoria), altered sensory perceptions, changed awareness of the body, and different experience of time flow. Although nitrous oxide is not classified as a hallucinogen, some descriptions of experiences are indistinguishable from hallucinations, particularly if a user is talented at creating internal imagery. Some persons claim to achieve mystical insight
while under the drug’s influence. Intoxication from a dose lasts only a few minutes.
Drawbacks.
The substance disrupts learning ability. That action has been exploited medically to promote amnesia of unpleasant procedures. In a typical experiment volunteers who inhaled a low dose of the drug showed worsened reaction time, worsened ability to do arithmetic, and general sedation accompanied by nervous system depression (as opposed to stimulation). Interference with driving ability has been noted one-half hour after a dose. In another experiment volunteers felt stimulated; in still another experiment some individuals were sedated, and others became stimulated. One group became weary, uneasy, and confused. Short-term exposure can cause dizziness, nausea, vomiting, and breathing difficulty. Some recreational users quickly inhale
as much nitrous oxide as possible and hold their breath. This technique causes a sudden change of pressure inside the lungs and can rupture small interior structures needed for breathing. Blood pressure can go up or down, depending on dosage. Users can lose consciousness, which may be hazardous in a recreational context due to falls or inability to shut off the gas source. The
substance deactivates vitamin B12, an effect that can cause numbness and difficulty in moving arms and legs. Other results can be impotence and involuntary discharge of urine and feces. Nitrous oxide interferes with blood clotting, and long-term exposure has caused blood abnormalities. Persons with chronic industrial exposure have more kidney and liver disease than usual.
Nitrous oxide can become very cold when released as a gas from a pressurized container, cold enough to cause frostbite upon meeting skin or throat.
Breathing nitrous oxide without an adequate supply of oxygen can be fatal; a little in a closed space or a lot from a face mask can suffocate a user. Although nitrous oxide is called nonflammable, when inhaled it can seep into the abdominal cavity and bowels, mixing with body gases to create a flammable combination. If ignited the result would be like setting off an explosive inside the body; the danger is real enough that surgical personnel administering
nitrous oxide as an anesthetic have been warned about it.
As with many other drugs, effects of nitrous oxide can be influenced by changes in setting. For example, volunteers who knew what to expect performed better on tests than persons who had no information about what nitrous oxide would do to them.
Abuse factors.
In tests of the drug’s appeal, people in general chose nitrous oxide no more often than placebo; such lack of preference is a classic sign of low addictive potential. One experiment revealed a catch to such findings, however: Volunteers who enjoyed nitrous oxide effects chose it more often than placebo, and volunteers who disliked the drug actions chose it less often
than placebo. Thus, overall in the general population the drug might be no more attractive than placebo, but nonetheless some persons may find it captivating.
Such a finding is consistent with drugs having high abuse potential, such as heroin; so the fact that persons typically find no attraction in nitrous oxide does not prove low abuse potential for nitrous oxide. Its nickname “hippie crack” suggests that users have recognized an abuse potential. Nonetheless, a medical practitioner who administered the gas as a drug addiction
treatment said that in 15,000 cases not a single addict indicated subsequent craving for nitrous oxide; such a patient population would be expected to show particular susceptibility if given a substance with abuse potential. The same practitioner notes that regardless of theoretical possibilities, 200 years of experience demonstrate that nitrous oxide is among the least abused drugs.
Tolerance develops in rats. Human experimentation documents tolerance developing to some effects (such as euphoria and pain relief) but not necessarily to all.
Drug interactions.
In an experiment comparing light drinkers of alcohol to moderate drinkers, the moderate drinkers found nitrous oxide more appealing. One group of researchers found that alcohol boosts nitrous oxide effects and that the drug combination creates effects produced by neither substance alone. Those researchers concluded, however, that the combination was not
potent enough to have more appeal than nitrous oxide alone. That conclusion assumes, of course, that drug abusers base their conduct on rational analysis of scientific findings. In a similar experiment comparing users and nonusers of marijuana, when given a choice neither group preferred nitrous oxide more than a placebo, but nitrous oxide effects felt stronger to marijuana users. In rats ketamine boosts effects from nitrous oxide. In a human medical context
that combination is routine and appears safe, but the combination causes brain damage in rats. Persons using morphine or other opiates can experience muscle rigidity when inhaling nitrous oxide, a situation that can interfere with breathing.
Cancer.
Studies do not indicate that nitrous oxide causes cancer in animals. Whether the drug causes cancer in humans is unknown. Genetic damage similar to the amount from daily smoking 10 to 20 cigarettes has been found in health care workers routinely exposed to minuscule amounts of nitrous oxide; such damage might have a potential for causing cancer.
Pregnancy.
Fertility is lower in female rats exposed to nitrous oxide than in rats having no exposure. Lower fertility has also been observed among female health care workers with occupational exposure to the gas, and reduced fertility is also reported for males. Offspring of male mice exposed to nitrous oxide have weighed less than normal and have not matured as fast as normal.
Birth defects resulted from an experiment exposing pregnant rats to the gas for 24 hours. When given to pregnant women during childbirth the drug builds up in the fetal blood and brain; one authority recommends administering oxygen to any newborn whose mother received nitrous oxide while giving birth. As the twenty-first century began researchers reported that the
gas might cause permanent fetal and newborn brain damage, a finding in contrast to previous understanding of the drug. Occupational exposure to nitrous oxide is associated with smaller infants and lower birth weight and may increase likelihood of spontaneous abortion. Pregnant and breast-feeding health workers are advised to avoid rooms where nitrous oxide residues may
contaminate the air. Sperm abnormalities and lower fertility have been noted in male rats exposed to nitrous oxide. Wives of men exposed to the gas have shown a higher spontaneous abortion rate, compared to wives of men with no exposure. The compound is not detected in milk of nursing mothers.
Additional information.
“Nitrous acid” is an unstable nitrite substance. The nickname “nitrous acid” is sometimes used for nitrous oxide, but they are different substances.
Additional scientific information may be found in:
Block, R.I., et al. “Psychedelic Effects of a Subanesthetic Concentration of Nitrous Oxide.”
Anesthesia Progress 37 (1990): 271–76.
Danto, B.L. “A Bag Full of Laughs.” American Journal of Psychiatry 121 (1964): 612–13.
Dohrn, C.S., et al. “Subjective and Psychomotor Effects of Nitrous Oxide in Healthy
Volunteers.” Behavioural Pharmacology 3 (1992): 19–30.
Linden, C.H. “Volatile Substances of Abuse.” Emergency Medicine Clinics of North America
8 (1990): 559–78.
Temple, W.A., D.M. Beasley, and D.J. Baker. “Nitrous Oxide Abuse from Whipped
Cream Dispenser Chargers.” New Zealand Medical Journal 110 (1997): 322–23.
Yagiela, J.A. “Health Hazards and Nitrous Oxide: A Time for Reappraisal.” Anesthesia
Progress 38 (1991): 1–11.
Zacny, J.P., et al. “Examining the Subjective, Psychomotor and Reinforcing Effects of
Nitrous Oxide in Healthy Volunteers: A Dose-Response Analysis.” Behavioural
Pharmacology 7 (1996): 194–99.
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Pronunciation: NIK-uh-teen (also pronounced NIK-uh-tin)
Chemical Abstracts Service Registry Number: 54-11-5
Formal Names: Habitrol, Nicoderm, Niconil, Nicorette, Nicotiana rustica, Nicotiana tabacum, Nicotrol, Prostrop, Tobacco
Informal Names: Chip (cigarette mixed with PCP), Fry Daddy (cigarette mixed with crack cocaine)
Type: Stimulant (pyridine alkaloids class).
Federal Schedule Listing: Unlisted
USA Availability: Generally available to adults as a component of tobacco products;
nonprescription and prescription in pharmaceutical format
Pregnancy Category: C or D (depending on pharmaceutical format)
Uses.
Tobacco’s history is mentioned on page 18. Nicotine is the addictive drug component of tobacco and is found in other plants as well. Nicotine is one of the more hazardous drugs, and dosage via tobacco smoke adds still more peril. Although nicotine has medical uses, characteristics of the natural product tobacco fall within the criteria of a Schedule I controlled substance. Nonetheless, federal law explicitly excludes tobacco from such control, making the tobacco industry legal. At the time this book was written debate was under way about limiting adult access to nicotine products, a restrictive effort requiring changes in law.
Traditional medical uses of the drug include treatment of insect bites, skin and intestinal parasites, vomiting, earache, toothache, runny nose, hernia, and heart pain. Although tobacco smoking worsens a gastrointestinal inflammation called Crohn’s disease, medical practice uses nicotine skin patches, oral capsules, or suppositories to treat inflammation of the colon and rectum caused by ulcerative colitis. Nicotine chewing gum has been used successfully to treat finger or toe sores deriving from Buerger’s disease, an affliction in which blood vessels get blocked off (and which, despite the usefulness of pharmaceutical nicotine, seems to be worsened by smoking). Pharmaceutical nicotine helps some persons suffering from the tics of Tourette’s syndrome.
Researchers have found cigarette smoking to reduce the likelihood of getting preeclampsia, a potentially serious disease of late pregnancy in which women suffer fluid retention, high blood pressure, and too-high urine protein levels.
Cigarette smoking is also associated with a lower probability of getting Parkinson’s or Alzheimer’s disease. Even though “association” does not demonstrate cause and effect, some experiments using pharmaceutical nicotine to treat those afflictions show positive results. Such results, however, have not yet given nicotine a generally accepted role in treating those diseases. Nicotine reduces hunger pains and raises blood sugar, effects that help users eat less (Native Americans have traditionally chewed tobacco to better endure circumstances involving little food, water, or rest). Nicotine initially raises blood pressure, but continued dosage will lower it.
Drawbacks.
Tobacco smoking can lead to lung cancer and heart disease. Many other afflictions are attributed to tobacco smoking: bronchitis, emphysema, cataracts, mouth cancer, pancreas cancer, bone density loss (making broken bones more likely), abdominal aortic aneurysm (a sac ballooning out from the blood vessel wall), brain aneurysm, and gastroesophageal reflux (recurrent backward flow of acid and partially digested food from the stomach to the esophagus, making esophageal cancer more likely). One study noted that smoking tends to produce changes causing women to go through menopause at a younger age than nonsmokers. Laboratory tests imply that smokeless tobacco promotes tooth decay. Still more unwanted actions are known, partly because tobacco has simply been studied so intensively that more is known about it than is known about many other substances. Whether nicotine itself causes afflictions produced by tobacco is uncertain. For example, some investigators suspect that heart disease in smokers comes from carbon monoxide and tar constituents of smoke rather than the nicotine.
In adults 40 mg to 100 mg of pharmaceutical nicotine can produce fatal poisoning; an equivalent dose through cigarettes would require a person to quickly smoke several packs. Smaller dosages can be dangerous for children who play with nicotine patches or gum or who consume tobacco.
Abuse factors.
As with many drugs, persons often find nicotine unpleasant at first but learn to ignore bad sensations and focus upon effects that are enjoyed. Experiments examining differences that users perceive in various drugs find that some sensations from nicotine, amphetamine, and cocaine are similar, so similar that in one experiment persons receiving injections of nicotine typically identified it as cocaine. A user can establish a physical dependence
with nicotine, causing withdrawal symptoms if dosage stops:
nervousness, tenseness, crankiness, lightheadedness, broken sleep, weariness, distractedness, tremors. These symptoms often last a few days, sometimes longer, and can relate to a person’s expectations (a psychosomatic component).
Debate exists about how addictive nicotine is. A study published in 1994 noted that about 33% of tobacco smokers become addicted. A study published in 2000 found that 20% to 60% of adolescent smokers are addicted. Many smokers with no interest in quitting can nonetheless substantially reduce their cigarette consumption with little difficulty. In contrast, many smokers wanting to stop find themselves unable to cease, and for them even pharmaceutical
nicotine can be an insufficient replacement for tobacco. Among such persons the persistence of a smoking habit suggests that something more than the drug nicotine is involved. Tobacco smoke contains thousands of chemical ingredients besides nicotine; perhaps some of the less-studied ones are important. In addition, the paraphernalia and mechanics of cigarette smoking provide a psychological buffer to users, allowing continual brief respites in interactions with other persons (such as breaking eye contact during a puff). Nicotine itself is a mild stimulant able to release adrenaline and increase pulse rate and blood pressure, with the physiological arousal produced by the drug masking physical arousal provoked by life’s tensions, thereby making smokers feel less nervous despite the stimulant effects. Smokers tend to have lower levels of body chemicals that are supplemented by antianxiety and antidepressant drugs.
Such pharmaceuticals, unfortunately, seemingly have little ability to help smokers quit their tobacco addiction.
As with any addiction, the power of nicotine and tobacco depends upon needs met by those substances. People do not smoke simply to avoid temporary withdrawal symptoms. If a person’s life is filled with situations that smoking eases like nothing else can, breaking the addiction is hard. If a person finds other ways of dealing adequately with those situations, desire for cigarettes can go away and never be bothersome again. Contrary to expectations of researchers, a laboratory test found nicotine to be no more appealing to exsmokers than to persons who have never smoked—a finding implying that life circumstances, and not just chemistry, determine this drug’s appeal.
Alcohol and illicit drug abusers reliably tend to be tobacco cigarette smokers, so reliably that the amount of tobacco use can be used to estimate the amount of cocaine and opiate usage by persons in drug abuse treatment programs.
An experiment found that persons smoked less tobacco when they had access to marijuana, suggesting that those persons used the two substances for similar purposes. Nonsmokers tend to avoid drug abuse, implying that smokers and nonsmokers use different strategies to cope with life’s challenges.
Cigarette smoking is more prevalent among schizophrenics, seriously depressed persons, and persons with low-grade psychiatric disturbance that may lack outward symptoms. Almost two thirds of smokers in one research project turned out to have a history of present or past psychiatric abnormality.
Among such individuals smoking may be a strategy of self-medication. One study found that withdrawal symptoms can depend on the extent to which the drug is used for self-medication.
Improvement has been measured in alertness, energy, and happiness as cigarette smokers start their day’s consumption in the morning. Conversely, cutting off a smoker’s supply of cigarettes produces measurable increases in fatigue, irritation, sadness, stress, and disorientation. New users do not get favorable effects sought by experienced users but instead have measurable nausea and general uneasiness. Among new users nicotine reduces job performance skills such as physical coordination and accuracy in memory tasks the opposite of what happens with experienced users.
Although pharmaceutical nicotine has various medical applications, its main use is for treatment of addiction to tobacco smoking. One authority aptly described nicotine chewing gum as the methadone of cigarettes, meaning that such a treatment strategy is intended to switch addicts from tobacco to pharmaceutical nicotine, just as treatment personnel seek to switch heroin addicts to methadone. Although such programs may have an official goal of eliminating a person’s addiction, in practice simply switching a person from a more harmful drug to a less harmful drug is often considered a success.Drug interactions. Nicotine interacts with commonly used medical drugs.
Antipsychotic drugs and the anti–blood clot medicine heparin flush from the body faster if a person uses nicotine. Nicotine also reduces the sedative effect of benzodiazepines and reduces pain relief from various opioids. Cigarette smoke acts as a monoamine oxidase inhibitor (MAOI), a type of chemical found in some antidepressants and that can have serious adverse effects when
used simultaneously with some medicines (though acute danger from cigarette interactions may be small). Caffeine seems to make nicotine more pleasurable.
Rat studies show that nicotine increases alcohol’s appeal and worsens pancreas inflammation caused by both drugs. Birth control pills increase the boost that nicotine gives to pulse rate, and some researchers speculate that such increase is related to the elevated risk of heart disease found among smokers who use birth control pills.
Cancer.
Tests indicate that pure nicotine (as opposed to smoke containing nicotine) does not cause cancer.
Pregnancy.
Smoking reduces female fertility according to most studies of the topic, and studies of Canadian farm couples and of men in the Netherlands found an apparent reduction in male fertility as well. Pregnant women who smoke tobacco increase the chance of miscarriage, premature birth, smaller full-term infants, and sudden infant death syndrome (SIDS or “crib death”).
The children are more likely to have muscle tone abnormalities. Smoking harms male and female gametes, damages chromosomes, and can change DNA in ways linked with childhood cancer. Nicotine usage by a pregnant woman changes movements and heart action of a fetus. One researcher warns that nicotine patches or chewing gum may deliver even more nicotine to a
fetus than smoking would. Nicotine enters the milk of nursing mothers. Rat experiments indicate that fetal exposure to nicotine combined with newborn exposure to nicotine in milk increases the risk of offspring developing lung trouble similar to emphysema. Human birth defects have been attributed to tobacco smoking. Although a study of teenage tobacco smokers did not see
any increased incidence of birth defects in their infants, research based on animal experimentation and published in 1998 declared that nicotine causes defects in fetal brain development leading to problems in thinking and learning that may not become apparent until years after birth. The children tend to have lower scores on psychological measurements, somewhat reminiscent of “cocaine babies,” deficits that continue for years. Some investigators see a link between pregnant smokers and offspring with psychological problems.
Investigators tracking mothers and daughters for three decades found that daughters were more likely to take up smoking if their mothers smoked during pregnancy.
Additional information.
Scientific studies find that “passive smoking” threatens health of bystanders who inhale smoke from tobacco products and exhalations of smokers. A study of spontaneous abortions found them more likely in pregnant nonsmoking women who inhale environmental smoke and use a lot of caffeine or a moderate amount of alcohol. Infants from nonsmoker women who were exposed to tobacco smoke during pregnancy are more likely to have lower birth weight and persistent pulmonary hypertension. Offspring also exhibit the same kinds of lower psychological test scores that are seen in children of active smokers. Inhalation of smoke by infants is suspected of
contributing to SIDS. For sure, compared to children in nonsmoking households, infants of smokers are hospitalized more often for pneumonia and bronchitis. The level of environmental smoke necessary for ill effects is often unclear in scientific studies; a person working in a poorly ventilated smokey bar for eight hours a day will have a considerably different exposure than
someone in a nonsmoking household who sits outside once a week with a friend who smokes a couple of cigarettes.
Additional scientific information may be found in:
Brown, C. “The Association between Depressive Symptoms and Cigarette Smoking in an Urban Primary Care Sample.” International Journal of Psychiatry in Medicine 30 (2000): 15–26.
Brown, K.G. “Lung Cancer and Environmental Tobacco Smoke: Occupational Risk to Nonsmokers.” Environmental Health Perspectives 107 (1999, Suppl. 6): 885–90.
Colby, S.M., et al. “Are Adolescent Smokers Dependent on Nicotine? A Review of the
Evidence.” Drug and Alcohol Dependence 59 (2000, Suppl. 1): S83–S95.
Dursun, S.M., and S. Kutcher. “Smoking, Nicotine and Psychiatric Disorders: Evidence
for Therapeutic Role, Controversies and Implications for Future Research.” Medical
Hypotheses 52 (1999): 101–9.
Haustein, K.O. “Cigarette Smoking, Nicotine and Pregnancy.” International Journal of
Clinical Pharmacology and Therapeutics 37 (1999): 417–27.
Parrott, A.C., and F.J. Kaye. “Daily Uplifts, Hassles, Stresses and Cognitive Failures:
In Cigarette Smokers, Abstaining Smokers, and Non-smokers.” Behavioural Pharmacology
10 (1999): 639–46.
Robinson, J.H., and W.S. Pritchard. “The Role of Nicotine in Tobacco Use.” Psychopharmacology
108 (1992): 397–407.
Stolerman, I.P., and M.J. Jarvis. “The Scientific Case That Nicotine Is Addictive.” Psychopharmacology 117 (1995): 2–10.
Van Gilder, T.J., P.L. Remington, and M.C. Fiore. “The Direct Effects of Nicotine Use
on Human Health.” Wisconsin Medical Journal 96 (1997): 43–48.
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