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 eighteenth-century 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 anti-

depressant action. The substance has been used to help persons break pentazocine 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

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