Epidemiology of Inhalant Abuse - Archives - National Institute on ...

used as anesthetics. Nitrous oxide is used as a propellant as well as an
anesthetic.
The alkyl nitrite products, <strong>of</strong>ten referred to as “poppers,” most <strong>of</strong>ten
contain isobutyl nitrite or isopentyl nitrite (i.e., “amyl nitrite”). They
always contain many isomers, as well as alcohols from the breakdown <strong>of</strong>
the nitrite esters. Mortality from nitrites, in the older population
particularly, could be underreported because deaths <strong>of</strong>ten have an
embarrassing erotic component (Gowitt and Hanzlick 1992), and the
unchanged compounds cannot be detected in blood. However, the
pr<strong>of</strong>ound methemoglobinemia particularly from oral ingestion (not
included in the mortality data) is confirmed readily in the laboratory
(Pierce and Nielsen 1989). Surveys <strong>of</strong> inhalant use by schoolage children
show very significant rates <strong>of</strong> experimentation with nitrites. One study
among further education students (age 16 and over, taking academic or
vocational courses) in the Wirral suggests use among 15-16 percent
(Foley and Todhunter 1992); another on the remote rural island <strong>of</strong>
Shetland (Shetland Health Board 1992) reports 9 percent. The nitrites
also seem to have become part <strong>of</strong> the “dance drug” scene along with
Ecstasy (i.e., methylenedioxyamphetamine, methylenedioxymethylamphetamine
or methylenedioxyethylamphetamine) (Gallup 1992). The
association <strong>of</strong> nitrite use with acquired immunodeficiency syndrome
(AIDS) and Kaposi’s sarcoma remains controversial (Haverkos 1990;
Newell et al. 1988).
Products may be classified in one <strong>of</strong> the following ways:
1. Fuel gases: <strong>Abuse</strong>rs principally inhale butane from disposable
cigarette lighter refills, but occasionally they use propane or butane
from industrial or domestic use (e.g., mobile home) (table 2). These
gases are produced either from natural gas fields or from the catalytic
cracking <strong>of</strong> higher petroleum products. They contain many
compounds depending on the source but mainly consist <strong>of</strong> methane,
ethane, propane, n-butane, and isobutane. There is no requirement to
purify these products for their legitimate (fuel) use, and 1, 3-butadiene
may occur legally at concentrations up to 1.0 percent v/v at present.
1, 3-butadiene is strongly suspected to be a human carcinogen (Bird
1990). Stenching agents, such as tetrahydrothiophene (THT), ethyl
mercaptan, or dimethyl sulphide are added in order to make leaks in
supply systems more readily apparent. These may give rise to
toxicity if the product is deliberately inhaled. One manufacturer is
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