ACampaigntoPreventInhalantAbuse BureauofSubstanceAbuseServices MassachusettsDepartmentofPublicHealth 31EfJbb DEflS aaoi 3 Here's Your Updated Inhalant Abuse Prevention Kit, Inhalant abuse is a silent epidemic that can only be stopped when parents, educators and the gen- eral public get involved before our children do. This kit contains the information and strategies you can use to reduce inhalant abuse in your community. H4 ~2- d CD M O CD ere are activities you can do in ybtlr coriSiginity to help increase public awareness and prevent |nlfalan£|ibuse: CP CD Review these materials. They contain the most recent Massachusetts data on inhalants fand other drugs of abuse as well as strategies for inhalant abuse prevention. New this year is the bulletin, Nitrous OxideAlert. Know the facts about inhalant abuse. 2 Get the word out to adults! Distribute inhalant prevention materials to parents, educators, youth workers, and other concerned individuals. All handouts can be easily copied but materials marked "Adults Only" should not be given to youth as this has en- couraged experimentation with inhalants. Contact your local newspapers, ca- ble TV, and radio stations to carry the message. 3 Educate Youth, Distribute copies of Inhalants Poison Your Body. (Additional free copies are available at 617-623-2080 or by e-mail: [email protected]. The main prevention message is inha- lantsarepoisons! Avoid equating inhalants with drugs unless teens are already making that association. Avoid telling youth what products may be misused, how they are abused, or that they can get you "high." Teach about the safe use of products. Choose a science-based approach to comprehensive sub- 4stance abuse prevention.* Choose Safer Products for your home, school, and com- munity program. Purchase safer products and reduce access to sol- vents, gasses and aerosol cans. To obtain a list of substitute products, contact us at [email protected] or 61 7-623-2080. Visit our website at http://www.state.ma.us/dph/inhalant. If you have any questions or need additional informa- tion, please contactthe Massachusetts Inhalant Abuse Task Force at CASPAR Youth Services (617-623-2080) or send E-Mail to [email protected]. For information about science-based programs, call 1-800-327-5050 to locate your nearest Massachusetts Prevention Center. 4ihingstodopub9C0/0I ACampaigntoPreventInhalantAbuse BureauofSubstanceAbuseServices MassachusettsDepartmentofPublicHealth Criminal Justice Practitioners: What You Can Do About Inhalant Use Become aware of the problem. Inhalants are common household, school, and office products inhaled by youth to get "high." While they are being used as "drugs/' they are, in real- ity, poisons. Inhalant users are at risk for suffocation, accidents, burns and Sudden Sniffing Death Syndrome (cardiac and/or respiratory arrest). Damage to the nervous system, lungs, liver, and kidneys can also occur. Youth are generally not aware ofthe dangers of inhalant use and need to be educated. It is also important that parents are educated about the hazards of inhalant use so that they can monitor their children. Know what to look for. Abusable gas- and solvent-based products are found everywhere. They include typewriter correction fluid, air freshener, gasoline, glue, dry erase and permanent markers, and any product packaged in an aerosol can. Examples ofparaphernalia are aerosol cans, paper and plastic bags, rags, and soda cans. Gases include propane (used for barbecues), butane (gas lighter refills), nitrous oxide (from tanks and whipped cream containers), halo-genated hydro- carbons (from air conditioners) and any propellant from an aerosol can. Gases may be inhaled from tanks or aerosol cans, or they may be transferred to plastic bags or balloons and inhaled. Slang terms for inhalant abuse, though uncommon in Massachusetts, include sprayers, sprayheads, spray, huffing, sniffing, and bagging. Substances that are smoked (such as tobacco, marijuana, or crack cocaine) orsnorted (such as cocaine) arenot considered inhalants. Inhalant intoxication looks similar to alcohol intoxication (initial euphoria followed by central nervous system depression), with the same patterns of poor judgment, lack of coordination, and disinhibition. Visual and aural hallucinations often occur. Inhalant users who have been surprised, scared, or chased are at increased risk for heart arrhythmias and fatal heart attacks. Chronic users may be underweight and have rashes around their mouth and nose. They may have hand tremors and problems with memory and thinking. Know who is using. Among Massachusettssixth-grade children, inhalants are thesecond most abused substance after alcohol (lifetime use). Amongseventh- and eighth-grade children, inhalants are the third most frequently used substance (lifetime use). It's happening in all parts of the Com- monwealth and among all types of children. However, the highest proportion of lifetime and current use is among eighth- and ninth-grade children. Use may start as early as the third grade and tends to taper off in high school when other drugs are more available.1 Youth use inhalants while alone or in groups. Older teens and adults may use inhalants with alcohol and other drugs. There have also been reports ofinhalant use while driving. Know the laws. The inhalation of vapors and gases from common, legal products, such as household, school, and office products to get "high" is illegal in Massachusetts (Massachusetts General Law 270-18). Amyl nitrite, referred to as "poppers" and used medically to relieve the pain ofangina, comes in an ampule2 and requires a prescription. Butyl nitrite and isobutyl nitrite, 1Massachusetts Dept. ofPublic Health, Trends inSubstanceAbuseAmong Public School Students: Triennial Prevalence Survey, 1984-1999," Massachusetts Department of Public Health, 2000. See "What We Know about Inhalant Abuse in Massachusetts/'anotherfact sheetintheABreathAway,ACampaign toPreventInhalantAbuseseries fora summaryof data from this report (Available from CASPARYouth Support Services, 617-623-2080.) 2 An ampule is a cloth-covered container, smallerthana thimble. When it is crushed, the liquid is released and wets the doth. The vapors are then inhaled. . sold as "Rush" or "Locker Room/' are sold illegally as room odorizers in sex paraphernalia shops and are Class D Controlled Substances (Massachusetts General Law 94C; Section 31). Solvent- based glues and cements sold to minors must contain an irritant (such as oil of mustard), and the law requires that minors present proper identification and register in a permanently bound log (Massachusetts General Law 270-19). Policing Strategy: Massachusetts General Law 270-18 is a misdemeanor with the power of arrest. It requires that a police officer observe the use of inhalants for the purpose of producing "intoxication, euphoria, excitement, exhilaration, stupefaction, or dulled senses or nervous system" in order to arrest a person. Once it has been determined that the product is being used illegally, charges may also be brought for purchase, sale, and possession. Be on the alert for drivers appearing to be driving erratically who may be operating the vehicle under the influence of inhalants. Juvenile court strategy: If you suspect or know of inhalant, alcohol, or other drug use, a substance abuse assessment should be performed by a court clinic or local substance abuse clinic. (Contact the Massachusetts Substance Abuse Information and Education Helpline at i-800-327- 5050 or 617-445-1500 to find a community outpatient clinic nearby. These clinics provide free care for indigent clients; others receive care based on a sliding fee or insurance coverage.) Even if it turns out to be a false alarm, your actions send a clear message about substance use. If inhalants, alcohol, or other drugs are a concern, the court maystipulate that a court-involved juvenile follow through on the recommendations of the assessment. In instances where urine tests for drugs are being used, specific tests can be ordered for inhalants. If you are concerned about a child's behavior, be sure to follow up. Ask about inhalants and be specific about why you are concerned. Don't dismiss your gut feelings that something is not right. Remember, one of the attractions of inhalants is that adults are not aware of themand don't recognize their illegal use. Ifyou have questions about a substance, call the Massachusetts Poison Control Center at 617-232-2120 or i-800-682-921 1. If you suspect a young person is in crisis because of inhalant intoxication, experts recommend taking these steps: • Lay the person on his or her side to prevent aspiration ofvomit. • Call an ambulance. • See that he or she gets fresh air. • Remain calm and supportive because scaring or agitating the person may increase the risk of Sudden Sniffing Death Syndrome (cardiac and/or respiratory arrest). • Minimize distractions and try to keep the person from moving. • Stay with the person until he or she receives medical attention. Don't tolerate any experimentation. Even limited inhalant use can be fatal. Studies show that almost one-third ofthe deaths from inhalant use were among first-time users. Seek an alcohol and drug assessment and take appropriate action. Make sure youth are getting the message about the dangers ofall substance use including inhalant use. The primary message is that inhalants are poisonsandare dangerous like other poisons. Careshouldbetakentonotdismissinhalantuseasharmlessexperimentation. Ifyou aretalking to a child or teenager about inhalants, stress whatthe dangersare, notwhat products may be ABUSEDORHOWTHEYMAYBEABUSED. For more information: Contactyour local Massachusetts Prevention Center forvideos and written information (call 1-800-327-5050 or 617-445-1500 for the location), the Massachusetts Poison Control Center(617-232-2120or 1-800-682-921 1)ortheMassachusettsInhalantAbuseTaskForce(617-623-2080) Rev.Feb26,200 F:\Myfflej\lnhalanB\CunentHandoutSet\RevWom 1999dau\WHATYOU3.LAW.wpd ACampaigntoPreventInhalantAbuse BureauofSubstanceAbuseServices MassachusettsDepartmentofPublicHealth Massachusetts Laws about Abuse Inhalant Law Massachusetts General Chapter 270 Crimes Against Public Health Section 18. Substance having property ofreleasing toxic vapors No person shall intentionally smell or inhale the fumes of any substance having the property of releasing toxic vapors, for the purpose of causing a condition ofintoxication, euphoria, excitement, exhilaration, stupefaction, or dulled senses or nervous system, nor possess, buy or sell any such substance for the purpose ofviolating or aiding another to violate this section. This section shall not apply to the inhalation of anesthesia for medical or dental purposes. Whoever violates theprovisions ofthis sectionshallbepunishedby a fine of not more than two hundred dollars or by imprisonment for not more than six months, or both. Any personwho is discovered by apolice officer or special police officer in the act of violating this section may be arrested without a warrant by such police officer or special police officer, and held in custody, in jail, or otherwise, until a complaint is made against him for such offense which complaint shall be made as soon as practicable and in any case within twenty- four hours, Sundays and legal holidays excepted. Section 19. Glue or cement; sale to minors; smelling deterrent ingredients Any person who sells glue or cement to a minor shall require such minor to properly identify himself and write his name and address legibly in a permanently bound register. The seller shall keep such register available for police inspection for a period of six months after the last sale is recorded therein. No suchglue or cement shallbe soldto aminorunless itcontains allyl isothiocyanate (oil of mustard) or some other equally effective and safe deterrent against smelling or inhaling the fumes ofsuch glue or cement. As used in this section, "glue" or "cement" shall mean any glue or cement that contains a solvent or chemical having the property of releasing toxic vapors. Whoeverviolates theprovisions ofthis sectionshallbepunishedby afine of not more than two hundred dollars or by imprisonment for not more than six months, or both. Digitized by the Internet Archive 2014 in https://archive.org/details/breathawaycampaiOOmass_0 ACampaigntoPreventInhalantAbuse AUDIENCE: Adults Only BureauofSubstanceAbuseServices MassachusettsDepartmentofPubCcHealth The Massachusetts Department of Public Health Bureau of Substance Abuse Services BULLETIN Inhalant Abuse Alert Introduction: This bulletin is being issued to alert education, healthcare, and other youth-serving professionals about the little-known problem of inhalant abuse among youth. In 1999, 17.3% of Massachusetts students in grades 7-8 reported trying inhalants at least once and 5.7% used inhal- ants in the last thirty days. Inhalants are the third most abused substance (after alcohol and to- bacco) for Massachusetts seventh- and eighth- graders.1 What is Inhalant Abuse: Inhalant abuse is the intentional breathing in of gas and vapors with the goal of getting high. It does not refer to snorting cocaine or smoking substances such as tobacco, marijuana, crack cocaine or opium. There are over 1,000 common household, school, and industrial products that can be abused. Typical substances include gasoline, paint thinner, nail polish remover, typewriter correction fluid, butane (cigarette lighters), propane (barbecues), halogenatedgases(airconditioners andfire extinguishers), nitrous oxide(laughing gas), permanent and dry erase magic markers, many glues and adhesives, and aerosol cans containing paint, de- odorant, hair spray, stain guards, air freshener, insecticides, and whipped cream. For questions about the toxic effects of a substance, contact the Massachusetts Poison Control Center at 617-232-2120 or 1-800682-9211. How Inhalants are Used: Aerosols are often sprayed into a plastic or paper bag and the vapors are inhaled from the bag, or they can be directly sprayed into the mouth or nose. Solvents can be poured on a rag orsleeve and the vapors inhaled. Solvents and aerosols can be put into a soda can or other container and the vapors can be breathed directly. Correction fluid can be painted on the finger nails and inhaled. Permanent magic markers and dry erase markers are directly inhaled. Nitrous oxide is usually inhaled from a balloon. Who is at Risk: Studies bythe Massachusetts Departmentof PublicHealthshowthatallyouth are at risk for inhalant abuse. The proportion of students reporting inhalant abuse is highest among eighth- and ninth-gradeyouth. Aftertenth grade usetendsto decrease.1 Patterns of Abuse: There are many patterns of use, depending on the age, ethnicity and size of the community. Some inhalant users report experimentation as early as the third or fourth grade. Often, they learn about inhalants from a friend or family member, television, or through word-of- mouth, but rarely are they aware of the dangers. Inhalants may be used alone or with a small group of peers. They are attractive to children because they are easyto obtain, free or inexpensive, difficult to detect, and many adults are not aware of the problem and don't take use seriously. Unlike other substances, inhalants are legal to possess for their intended use; although in Massa- chusetts, the possession, use, purchase or sale of these products for the purpose of causing intoxi- cation is illegal [Massachusetts General Law, Chapter 270-18]. Effects of Inhalant Use: Inhalants produce an effect within seconds that may lastfrom fifteen to forty-five minutes. These substances generally act as central nervous system depressants. After an initial euphoria, a depressed state follows that can be accompanied by sleepiness or sleep. Inhal- ants lower breathing and heart rates and impair coordination andjudgment. Dosages are repeated to maintain intoxication. Dangers of Use: Inhalants can cause severe and permanent damage to the brain, peripheral nerves, kidneys, liver, bone marrow, and other organs. Some inhalants cause chromosome and fetal damage much like Fetal Alcohol Syndrome. More than any substance, inhalants can cause sudden death resulting from heart arrhythmia and suffocation. Chronic inhalant users can develop physical addiction (with tolerance and withdrawal symptoms) and psychological dependence. Signs: There are several signs anssociated with inhalant abuse. If you suspect a child or adolescent is abusing inhalants, watch for: o Discarded product containers ° Bags, rags, gauze, or soft drink cans used to inhale the fumes ° Traces of odors of paint, gasoline, or glue Physical symptoms of abuse may include: o Facial rash ° Irritated or glazed eyes and dilated pupils ° Blisters or soreness around the nose, ° Frequent unexplained coughing mouth, or on the lips ° Hand tremors o Runny nose and frequent sniffing ° Unusual harsh breath odor A person who is intoxicated from sniffing inhalants may exhibit: o Extreme mood swings ° Increased irritability and anger ° Uncontrolled laughter o Violent outbursts ° Grandiose and hostile speech ° Nausea, loss of appetite, vomiting o Bizarre risk-taking o Hallucinations and convulsions What do you do if you suspect a young person is in crisis as a result of inhalant intoxication? Experts recommend several steps: o Lay the person on his or her side to prevent aspiration of vomit. ° Call an ambulance, o See that he or she gets fresh air. o Remain calm and supportive. Agitating the person may increase the risk of Sudden Sniffing Death Syndrome, o Minimize distractions and try to keep the person from moving, o Stay with the person until he or she receives medical attention. Assessment Considerations: Because inhalants are seen by many substance abusers as "low 1) status" or "childish", children may be especially reluctant or embarrassed to admit use. 2) Many youth confuse "inhaling" with "smoking" or "snorting." For example, you might ask, "Have you ever inhaled anything to get high? For instance, the gases or fumes or vapors from household products or products used in a shop, art projects or a garage. am not talking about anything you I might smoke, like tobacco, marijuana, or crack or anything you might snort like cocaine." 3) Be- cause youth are generally not aware of the special dangers of inhalants, any child who has experi- mented with them even once should receive inhalant prevention education. Parent education is also essential. Treatment Considerations: 1) Individuals who are regular users of inhalants can take thirty to forty days or more to detoxify. Adequate detoxification is crucial to successful treatment. 2) Inha- lants can produce both psychological dependence and physical addiction. Withdrawal symptoms may include hand tremors, nervousness, excessive sweating, hallucinations, chills, headaches, abdominal pain, muscular cramps, and delirium tremens. 3) Inhalantabusers havevery high relapse rates. Aftercare and follow-up are extremely important.* Treatment Options: Through its network of community providers, the Massachusetts Depart- ment of Public Health supports outpatient and residential programs for youth who are abusing inhalants and other drugs. For information on programs, call the Massachusetts Substance Abuse Information and Education Helpline(617-445-1500 inthe Boston metropolitan area or 1-800-327-5050 statewide). Prevention Strategies: Telling youth about the names and types of abusable products increases the likelihood that some youth will experiment with inhalants. A key prevention message is that inhalants should be equated with poisons, pollutants, and toxins, and not drugs. Children should not be taught what products can be abused, rather the damaging effects of inhalants should be n stressed. Other strategies include teaching inhalant refusal skills; supporting positive youth devel- opment and leadership; and educating parents and other community members. For more informa- tion on inhalant prevention, contact your local Massachusetts Prevention Center (To find the loca- tion near you, call 617-445-1500 in the Boston metropolitan area or 1-800-327-5050 statewide) or the Massachusetts Inhalant Abuse Task Force (617-623-2080). Sources: MassachusettsDept.ofPublicHealth."TrendsinSubstanceAbuseAmongPublicSchoolStudents:TriennialPrevalenceSurvey, 1984-1999."2000 t"Riedel.Steven."Inhalants'.AGrowingHealthConcern."BehavioralHealthManagement,May-June1995.VI5.N3.P28(3). "ABreathofDeath." Adolescence.September1993 ttGroves. Mark Sniffingand Huffing:AComprehensiveGuideforthePreventionand TreatmentofChildren'sInhalantAbuse, TheEdenStatewideChildrens' ChemicalHealthServicesProtect.Minneapolis.MN.1996(Phone:612-874-9441). Rev:Feb26.2001 ACampaigntoPreventInhalantAbuse BureauofSubstanceAbuseServices MassachusettsDepartmentofPublicHearth The Massachusetts Department of Public Health Bureau of Substance Abuse Services BULLETIN Nitrous Oxide Alert Introduction: Nitrous oxide (N 0), also known as "laughing though this has decreased as more dental personnel have gas," is a colorless, odorless, w2 eak anesthetic gas that is become aware of the dangers.3 Restaurant workers may abdeuilntgs.aMbaunseydpefooprleitsarderuugn-laiwkaereeffoefcttshebdyantgeeernsagoefrsactainvde sotbutadiynhaNs20shforwonmtwhahtipnpiterdoucsroexaimdedmisapyenbseerasd.diActtivlee.as4t one inhalation (as a form of inhalantabuse) or chronic low level What are the workplace dangers? While medically ap- exposure (in medical, dental, and veterinary settings). The proved for patients when used as an anesthetic, health Massachusetts Department of Public Health is issuing this concerns have been raised for medical, dental, and veteri- bulletin to alert youth-serving professionals and the public nary personnel exposed to long term, low levels of nitrous about the dangers of chronic exposure and especially non- oxide in the workplace. The National Institute for Occupa- medically supervised use of this gas. tional Safety and Health (NIOSH) has concluded that, "ex- The Massachusetts Department of Public Health is seeking posure to N 0 causes decreased mental performance, au- 2 to reduce the accessibility of N 0 by enlisting the coopera- diovisual ability, and manual dexterity. Data from animal 2 tion of law enforcement, retailers, and wholesale distribu- studies demonstrate that exposure to N 0 may cause ad- 2 torsin curtailing the illegal use of nitrousoxide. Retailers are verse reproductive effects such as reduced fertility, sponta- asked to monitor the sale of whipped cream chargers and neous abortion, and neurological, renal, and liver disease." cannedwhipped cream. Wholesale distributors are asked to In medical settings where N 0 is utilized, NIOSH recom- 2 restrict sales and sell only to clearly identified legitimate mends scavenger systems to remove exhaled N 0 from the 2 users. People responsible for the sale of nitrous filled bal- air and maintain an ambient level of less than 25 parts per loons at concerts and sporting events, a clear violation of million.5 Massachusetts Law, should be prosecuted. What are the legal issues? In Massachusetts, inhalant Why is nitrous oxide dangerous? N20 is a central ner- abuse is illegal [Massachusetts General Law, Chapter 270- vous system depressant that is absorbed through the lungs 18. See www.state.ma.us/dph/inhalantl. However, the law and is rapidly distributed throughout the body. It can cause has been difficult to enforce because it requires a sworn health problems, accidents, and death. Frostbite damage to officer to witness the sale, purchase or use of an inhalant. the throat and vocal cords results when the gas is inhaled Recently, there has been a successful prosecution in the directly from high pressure tanks; it becomes very cold death of a Virginia student based on the Federal Food, when it changes from a liquid in the tank to a gas as it Drug, and Cosmetic Act. The owner of a web site was con- leaves the tank. Accidents result when impaired users have victed for selling the nitrous oxide in "whippets" as a drug.6 toppled heavy tanks onto themselves. Long term exposure, "Whippets" are whipped cream chargers-small metal car- even at very low levels, may result in infertility or a vitamin tridges about 2V2 inches long. B12 deficiency (which causes anemia and nerve degenera- What are the effects of nitrous oxide on the human tion, producing painful sensations in the arms and legs, an body? The painkilling and numbing qualities of nitrous unsteady gait, loss of balance, irritability, and intellectual oxide begin totake effectwhen the gas is atconcentrations deterioration).1 of 10 percent. At higher concentrations, approaching 50%, How does nitrous oxide cause death? Most deaths are a sense of well-being or euphoria is experienced. A person caused bysuffocation. Breathing the pure gas without suffi- experiencing the effects of nitrous oxide may: cient oxygen will produce asphyxiation. This occurs when o Have slurred speech the gas is used without auxiliary oxygen or in a small enclo- o Have difficulty in maintaining his or her balance orwalking sure such as when a plastic bag is used as a hood, or in a o Be slowto respond to questions bathroom, closet, or car. Also, a user may be breathing the ° Be immune to any stimulus such as pain, loud noise, and speech gas from a plastic bag, lose consciousness, and choke on o Lapse into unconsciousness (at higher concentrations) the bag as it is sucked into the mouth. Another danger is If a person remains conscious and stops breathing the ni- choking on vomit while unconscious. Exposure to concen- trous oxide, recovery can occur within minutes. A person trations of N20 in excess of 10% combined with oxygen who is rendered unconscious by nitrous oxide is likely to deficiency will compromise a person's ability to think and stop breathing within a few seconds as a result of a de- act safely and has been a factor in deaths related to acci- pressed central nervous system-brain, brain stem, and spi- dents and car crashes. nal cord. This depression is caused by a combination of the What are the patterns of N 0 abuse? Most abusers are effects of nitrous oxide and the lowered oxygen content 2 using the gas occasionally. Nitrous is being used at parties, that occurs as pure N 0 displaces oxygen from the lungs 2 in dormitories, fraternities, and at concerts and sporting with each succeeding inhalation of the gas. The end result events. There are a number of reports ofabuse by dentists, is that the person can be asphyxiated. l Death usually occurs when abusers, in their attempt to ° Call an ambulance. achieve a higher state of euphoria, breathe pure N 0 in a o Staywith the person until he or she receives medical attention. confined space - in a small room or an automobile,2 or by ° CFoerntmeroraet 1i-n8fo0r0m-a2t2i2o-n1,22c2all[TtThYe: 1M-a8s8s8a-c2h4u4s-e5t3t1s3].Poison Control placing their head inside a plastic bag. Tragedy can occur Assessment Issues: 1) Because inhalants are seen by many very quickly. Prolonged exposure to high concentrations of substance abusers as "low status" or "childish," adults and N20 without supplemental oxygen, or a series of inhalations teenagers may be especially reluctant or embarrassed to (without breathing clean air between inhalations) can result admit use. 2) Many youth confuse "inhaling" with "smok- in death. This can happen in seconds. Since the narcotic ing" or "snorting." For example, you might ask, "Have you effectof a single breath of nitrous oxide is very brief (lasting ever inhaled anything to get high, such as the gases or for only seconds), abusers tend to repeatedly inhale in order fumes or vapors from household products or products used to stay "high," increasing the danger. With N20, there is no in a shop or a garage or in an art project. am not talking tcsHhoeoanntsswcaitdoaiuosospnenhseyosxfnsii,acttharioonoknudisncgooisnxotiridingemuamegsisepnttieonnigtin.ntfhooarltAehaiterhpehteoaprnuswrodaensrgnoafwst,hhaweobiulalsbldeuiorsess.ee?sr7 aocinrabhuoacsulretaanctpaksen,oyoptralhneiaynnomgyntayehyionuwnghomtoyiogbuhheatsmasiwemgaxohrpkteeesr,onifomlrietktnhetelteioksdebpaeIwcccioictcaoahl,indtmeaha.ner"gimej3ru)easvnBeaoen,f- Nitrous Oxide is readily available and can be obtained from once should receive inhalant abuse prevention education. many different commercial, medical, and retail sources. It is Parent education and involvement is also essential. found in homes, schools, restaurants, and medical and in- cdculasontsnreileaydlrsewegthutiliapntgpesedd.whUecsrreeedaimttoisfaonofdatmenwdhaeiiarpsyiplecydraecaccmer,sesaiitbmlisefcahonaudrngdenroistn TopitrcheteaurrtemtyeopfnetssuCobofsntisaninhdcaeelraaanbttuiasobenusws:heiNwciihtllrmoouafsytoernxeiqdbueeirapebaurtstreeoafatsmaewnelltalr.gaeIsrn ("whippets"). A small device called a "cracker" is used to Aadfdtietricoanr,e ainnhdalfaonltlowa-buupsearrse ehxatvreemveelryyimhpiogrhtanrtel.apse rates. break the seal on the cartridge and release the gas so it may be stored in a heavy duty balloon. The cartridges are Treatment Options: Through its network of community easily available at restaurant supply stores, kitchen stores, providers, the Massachusetts Department of Public Health "head shops," hardware stores, and over the internet. supports outpatient and residential programs for people Whipped cream cans may be purchased or stolen from who are abusing inhalants and other substances. For infor- grocery and convenience stores or found in the home, mation on programs, call the Massachusetts Substance cooking programs or restaurants. Abuse Information and Education Helpline (617445-1500 in Large tanks of nitrous oxide are stolen from hospitals, deliv- the Boston metropolitan area or 1-800-327-5050statewide). erytrucks, and dental offices or purchased from commercial What can be done to prevent inhalant abuse? Telling gas suppliers under the pretext of legitimate use. Balloons youth the names and types of products that can be abused filled from the tanks are illegally sold at concerts and sport- increases the likelihood that some youth will experiment ing events or distributed at parties and in college dormito- with inhalants. A key prevention message is that products ries. Nitrous oxide cylinders range in size from roughly two should be used for their intended purpose and in a safe feet in height to more than five feet and are color-coded manner. Inhalants should be equated with poisons, pollut- light blue. Contents range from about six pounds to more ants, and toxins, and not drugs. Children should not be than sixty pounds of liquid in a large cylinder. Depending on taught what products can be abused or that they can be cylinder size and product purity, legitimate users pay be- used "toget high"; ratherthe damaging effectsof inhalants tween $40 and $75 per cylinder. The highest purity level, should bestressed. Other strategies include teaching refusal used in semiconductor processing, costs considerably more. skills; supporting positive youth development and leader- Welding supply companies and auto supply stores are an- ship; and educating parents and other community mem- other source of nitrous oxide tanks. These tanks are black bers. To learn more about comprehensive, science-based and the gas is denatured by adding sulphur dioxide. This prevention, contact your local Massachusetts Prevention product may be transfilled into smaller cylinders and sold Center (to find the location, call the Massachusetts Sub- without being labeled as denatured.7 stance Abuse Information and Education Helpline (617-445- What do you do rf you suspecta young person is using s1t5a0t0ewiidne)t.heAdBdoisttioonnalmetirnofpoorlmiattainonaraenadormat1e-r8i0a0l-s32c7a-n50b5e0 nitrous oxide use? Experts recommend several steps dur- obtained from the Massachusetts Inhalant Abuse Task ing a crisis: Force at CASPARYouth Services (617-623-2080), orvisit our ° aSened tgheatts fhreesohrasirh.e is quickly removed from the source of N20 web sitewww.state.ma.us/dph/inhalant. ° If not breathing, administer artificial respiration. 1. "Nitrous Oxide FactSheet." CompressedGasAssociationjvww.cqanet.com Arlington,VA[703-412-09001 Seealso, "OccupationalSafetyand HealthGuideline forNitrousOxide." Occupational Safetyand HealthAdministration fr/vww.oshasic.gov/SLTC/healthquidelines/nitrousoxide ] 2. Paulson, G.W. "Recreational MisuseofNitrousOxide." JournaloftheAmerican DentalAssociation. 1979March 98(3):410-1. 3. NIOSH [1996] "Controlof NitrousOxidein DentalOperatories." USPublic HealthService,CentersforDiseaseControl, National InstituteforOccupational Safety Publication No.96-107. Ea/ww.cdc.gov/niosh/nitoxide.html] 4. Gilman, M. "Review: NitrousOxidein Perspective."ClinicalNeuropharmacology(1992) 15:pp297-306. 5. NIOSH [1994]. "NIOSHAlert: RequestforAssistancein Controlling Exposureto NitrousOxide DuringAnestheticAdministration."US PublicHealth Service, Centersfor DiseaseControl, National InstituteforOccupational SafetyPublication No. 94-100,April 1994ia>ww.cdc.qov/niosh/noxidalrhtml1 6. Meadows, Michelle. "Investigators' Reports:Arizona Man SentencedforSelling NitrousOxide." FDAConsumerMagazine(May-June 2001)Federal Drug Administration, [http://www.fda.gov/fdac/depait/2001/301_irs.htmll 7. Compressed GasAssociation E/vww.cganet.com Arlington,VA[703-412-0900] l