al-Mu'akhkhir

that bitch is dead

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Roach

IntroductionNitrite inhalants are commonly abused substances in the United States, primarily by homosexual men and others who use nitrites to facilitate sexual intercourse and/or produce euphoria (1-4). Scientific interest in nitrites increased in the 1980s due to their possible links to AIDS (5-11). In this paper we review the history, applications, and prevalence of use of nitrite inhalants. We present the hypotheses linking their use to AIDS. We provide suggestions to physicians, community leaders, policymakers, and researchers on what they can do to limit the use of nitrites.

History and Clinical Uses
The alkyl nitrites (e.g., amyl, butyl, isopropyl) are colorless or yellow liquids at room temperature and are highly volatile. They are esters of nitrous acid that have a fruity odor (often described as unpleasant) and have been nicknamed "poppers" because of the sound made when glass capsules containing amyl nitrite are crushed (12).

The vasodilatory effect following inhalation of amyl nitrite vapor was described in 1859 and led to the first report of its clinical application to provide relief for angina pectoris in 1867 (13,14). In the 1880s, butyl nitrites were found to have similar vasodilatory qualities, but these compounds were never developed for clinical use (12).

Amyl nitrite was initially marketed as a prescription drug in the United States in 1937 and remained a prescription drug until September 1960, when the Food and Drug Administration (FDA) eliminated the prescription requirement. In the 1960s, nitroglycerin sublingual tablets, dermally applied ointments, and, later, transdermal patches began to replace amyl nitrite as the preferred treatment for angina pectoris. In the late 1960s, pharmacists and drug manufacturers noticed widespread purchases of amyl nitrite by apparently healthy young men. These over-the-counter purchases became the impetus for the FDA to reinstate the prescription requirement in 1968. Since then an underground market for amyl nitrite has emerged (15). For the last few years, there has been no medical advertising for pharmaceutical-grade amyl nitrite, and it is no longer listed in the Physician's Desk Reference (16).

Amyl nitrite remains available by prescription. The clinical indication listed in the package insert is angina pectoris (17). Amyl nitrite is used experimentally to treat cyanide poisoning. The drug produces methemoglobin, which has a high affinity for cyanide, and leads to the production of cyanomethemoglobin, releasing cyanide from cell mitochondrial cytochrome oxidase sites, where it is otherwise destructive (18).

When amyl nitrite became difficult to procure for nonmedical or recreational purposes during the 1970s, there was a proliferation of butyl nitrite products by nonpharmaceutical manufacturers (15). Butyl nitrites were marketed as "liquid incense" or "room odorizers." Because the labels on bottles containing butyl nitrites stated that they were not to be inhaled and no health claim was made, the FDA never had jurisdiction over this product as it does medicine and many foods.

The legal status of some key nitrite preparations has changed in the past few years. One development prompting this change has been the description of several acute and chronic adverse effects attributed to the abuse of nitrite inhalants (15). In response to those reports, the U.S. Congress enacted a ban on the manufacture and retail sale of butyl nitrites (except when used in specified chemical commercial processes) in the Anti-Drug Abuse Act of 1988 (Public Law 100-690, Section 2404). The law specified that the Consumer Product Safety Commission (not the FDA) would enforce the ban. However, to circumvent the clear intent of the law, nitrite manufacturers began to sell other nitrite alkyl congeners, such as isopropyl nitrite, as "new and improved" room odorizers. In 1990, Congress outlawed manufacture and sale of alkyl nitrites in the Omnibus Crime Bill (Public Law 101-647, Section 3202). Since then, at least one manufacturer has developed a cyclohexyl nitrite inhalant and marketed it diversely. According to chemical nomenclature, cyclohexyl nitrites are not in the same class as alkyl nitrites and therefore may not be banned under current federal law. Underground manufacturers and importers continue to market butyl and isopropyl nitrites illegally.

The acute toxicity of inhaled and ingested nitrites in humans includes skin irritations (especially around the nose and lips), tracheobronchial irritation, headache, hypotension, cyanosis, methemoglobinemia, intoxication, and, rarely, death (15). Other effects include development of habitual use patterns, tolerance, and burns resulting from inadvertent ignition of the vapor. The National Toxicology Program of the National Institute of Environmental Health Sciences evaluated mice and rats exposed short term (6 hr/day for 14 days and 13 weeks) to inhaled isobutyl nitrite at concentrations ranging from 0 to 800 ppm and noted several adverse effects. Rats exposed to greater than 600 ppm died during the 14-day studies. At lower exposure levels, the most striking lesion seen in mice was hyperplasia of the nasal mucosa and bronchial and bronchiolar tree. Methemoglobinemia was confirmed. Other adversely affected organs included the liver, spleen, thymus, and bone marrow (19).

Prevalence of Nonmedical Nitrite Use
Alkyl nitrites are among the most commonly used inhalants in the United States. Other commonly abused inhalants are nitrous oxide, gasoline, glues, and solvents, such as paint thinners. The National Institute on Drug Abuse has collected information concerning nitrite inhalant use among high school seniors since 1979. Eleven percent of high school seniors interviewed in 1979 reported ever using nitrites. Use has decreased consistently among seniors since 1980, to 1.5% for the class of 1992 (20).

According to national surveys, self-reported amyl and butyl nitrite use varies by gender, region, and race. Male high school seniors reported higher rates of inhalant use and nitrite use than females. The proportion of males who used nitrites at least once was typically twice the percentage of females reporting lifetime use (20). The highest rate of nitrite use reported by high school seniors in 1979 was in the Northeast, and the lowest rate was reported in the West. Rates have decreased markedly in all regions, with the highest rates in 1992 reported in the North-Central United States and the lowest rates in the Northeast (21).

Nitrite use varies by race/ethnicity as well as geographic area. Although racial/ethnic data are not available for high school seniors, the Public Health Service-sponsored National Household Survey provides limited population-based estimates. Self-reported nitrite use in 1991 was highest for white males in each of six selected metropolitan areas for which data were analyzable. National estimates of use by females was 1.3% for white females in 1991, 0.7% for black females, and 0.8% for Hispanic females (22).

Nitrite use has been commonly reported among homosexual men for several decades, but less so for self-identified heterosexual adolescents and adults. In 1981, Centers for Disease Control and Prevention (CDC) investigators surveyed 420 men attending sexually transmitted disease clinics in New York, San Francisco, and Atlanta and found that 242 of 279 (86%) homosexual/bisexual men compared with 21 of 141 (15%) heterosexual men reported any use of nitrite inhalants within the previous 5 years (6). Almost all gay men enrolled in an AIDS case-control study conducted by CDC in 1981 reported use of nitrites (23). Other studies of gay men in the United States, Canada, and Europe found high rates of nitrite use (24-29). A multisite study demonstrated a marked decrease of nitrite use among gay men from 66% to about 35% between 1984 and 1989 (L. Jacobson, personal communication). Possible explanations for this trend include increased awareness of adverse effects, including concern about nitrites' possible links to AIDS, and decreased availability after nitrites were banned as consumer products (30).



just fyi

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SmokeaJoint

I had to get seven teeth pulled in middle school. No, it wasn't because of bad dental hygiene, I was growing double rows, adult teeth behind baby teeth. But on to the point. They gave me laughing gas because I have a needle phobia and wouldn't let them hit me with local anesthetic. Well, it was nice, felt good and didn't mind being stabbed or anything. But shit, it wasn't like it lasted that long. The effects wore off well before they started pulling teeth out of my skull. Prolly got a low dose, but why give a high one when they have Lidocaine?

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FourtySecondRip

about 2 years ago i had to get 4 crowns put in. well 2 new ones and my 2 old ones replaced. i had a few cavities too all the damage was done by drinking gatorade all day shit rots your teeth the second you take a sip and if you drink it slowly it just sits on your teeth for hours. anyway i had like 3-4 appointments lined up over like 10 day period. my dentist knew i was freaked out about all that work being done so he gave me a script for xanax for the mornings before appointments, vicoden for the pain in between them and then whooped my ass with nitrous during all the procedures. it was one of the most laid back weeks of my life haha. i had to get rides home after all of them tho. the dentist would always give the receptionist a heads up like 30 minutes before he was finished so my ride was there right after we finished so it wasnt bad. if i had to sit in the waiting room for 30-45 min waiting for ride after, i prob woulda said fuck it and either driven the .5 miles to my house or not showed up.

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Sir-Ex

lol i think terry called it, that bitch is so dead ..

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Smile

Ditch the cigs!!!!!!

Sir-Ex

well i'm flabbergasted

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Ditch the cigs!!!!!!