A 14 year old girl died recently, likely as a result of inhaling the inert gas helium. Though it has no psychoactive properties, helium does change the timbre and quality of the human voice -- and the girl and those she was partying with likely were using the gas just as an amusement, but they also combined drinking and pot smoking, and were using the gas straight out of a cylinder, causing freezing of lung tissues and lack of oxygen, which resulted in the girl's death. We discuss this, and inhaling in general, or huffing as its known, and also reported new off-label uses of the the stop-smoking medication Chantix (varenicline) for the treatment of other addictions.
HOWARD: Welcome to the CNS Podcast featuring Dr. Darryl Inaba, research director for CNS Productions, I am Howard La Mere. It looks like we’ve got a local story that became national news about the death of a young teenager from inhaling helium, which is not something that you hear about very often. We'll talk about that as well as news about Chantix, the quit smoking drug and gambling. Let's start with the local story.
DARRYL: It’s just such a tragic story and it is gaining a lot of national interest. Right here in the small town of Medford, Oregon we have big news of major drug problems involving a very young girl. Probably an unsophisticated drug user and drinker who was invited to a party…
HOWARD: 13 or 14, I think…
DARRYL: She was 14 years old and struggling with a new middle school, so she was excited to be invited to this party. On the way to the party, the article says, the group of kids got a hold of 4 wine coolers and I don’t know how naïve she was, but she drank 4 wine coolers before the party and then at the party, alcohol was provided by adults. The irresponsibility of adults allowing young people…as young as 14 or younger, to be in their home drinking and smoking pot, and then passing around a tank of helium just for fun. It’s just…I believe criminal ...and it’s going to be prosecuted as a criminal thing. It is illegal for young kids to smoke. It’s illegal for young kids to drink until they’re 21 and it is reprehensible furnish them with pot and other drugs to recreate with. So, sadly, it seems like this very young woman is an example of what science has discovered about adolescents and their reaction to alcohol and drugs. They initially have greater tolerance and a decreased sensitivity to the adverse effects of alcohol. An adult who drank 8 drinks as quickly as she did in that amount of time, would be suffering adverse effects. They would be have the whirlies, they’d be sick and have a hangover . But kids, especially those prone to addiction, don't have the capacity to experience a lot of the negative things that older people experience when they drink too much, so that is probably the reason she was able to drink more than she probably should have. It lowered her inhibitions and her parents said she succumbed to peer pressure or she was very sensitive to peer pressure so when the helium tank came around she took a hit. Helium is not a classic substance of abuse - everybody has probably inhaled some from a balloon as a kid. It is used recreationally, not because it makes you feel loaded but ..
HOWARD: It makes you talk like Mickey Mouse.
DARRYL: Donald Duck…It’s Donald Duck. It messes with your vocal cords and makes you talk funny and kids often do that at parties to just have fun and laugh at each other. The people in this case with didn’t have any real experience with helium. There was a mask connected directly to the helium tank and the kids were taking direct helium hits which is dangerous in itself because helium expands…it is a gas…it sucks out the heat and can cause freezing and other tissue damage to the lungs. There are severe health consequences from the pressure of the gas hitting your lungs and your blood vessels.
HOWARD: Not to mention not getting any oxygen.
DARRYL: Absolutely. I should mention that in Oregon helium comes in a tank with a mask. In some states that’s a suicide kit - people who want to commit suicide get a helium tank, put the mask over their nose and mouth and pretty soon all the oxygen in your has been expelled. But in this incident - it wasn't about getting high - it was just about sounding funny…probably to augment the drinking and marijuana use. Unfortunately this young woman developed an embolism - whether or not she was susceptible to embolism because of weight issues or because she had varicose veins or other medical conditions I don't know. She suffered a pulmonary embolism and died immediately, which is very tragic and sad. This does point out the dangers that inhaling gases…
HOWARD: That was my next question. Where does helium fall in relation to
the other things that are used as inhalants?
DARRYL: Well, most the other things that are used are used to get a buzz or to change consciousness, change the way you think and feel. A person can inhale anything…gasoline, butane lighter fluid (without torching it of course), just the butane gas.
HOWARD: You don’t want to singe your eyelashes! No, you don’t want to do that!
DARRYL: All kinds of paint materials, white- out, even keyboard cleaner…the gas spray used to clean the lint and stuff off your keyboard, that’s even led to deaths and abuse. I must mention that …deaths from inhaling helium, other than suicide, number only about 2, maybe at the most 3 over the period of a couple of years. It is extremely rare and that’s why it generated so much interest. It’s rarely abused and used primarily as fun - not to get high. The other inhalants are used for a psychic effect or an effect on the brain to get stimulated or giddy. It just lowers your inhibitions to get giddy to then get you into a full blown psychedelic type of high. A lot of inhalant abusers, like the psychedelic high, but ultimately most inhalants are depressants and put you out into a coma and put you to sleep and people die because they just quit breathing. So, and inhalants are usually abused for the psychoactive effects. In the case of helium, it’s abused just for the fun and the laughter it provokes from sounding like Donald Duck for a few moments. The tragic thing about this case was because a tank was used, the pressure that created may have triggered the embolism. Most people who inhale nitric oxide or inhale helium, do so by filling a balloon and then inhaling from the balloon, which has much less pressure and causes less freezing and other effects caused by expanding gas. That is a much safer way, and the fact that they were using it right from the tank indicates they weren’t too sophisticated in the dangers of inhalant abuse.
HOWARD: That’s a sad story. What else did we want to talk about? Oh, let’s talk about the use of Chantix, which is the fairly new quit smoking drug that actually interferes directly with the brain’s ability to assimilate nicotine... and its use as a cocaine treatment.
DARRYL: Exactly, Howard. Every drug that has been approved for the treatment of addiction by FDA standards has to first be researched for a specific effect and Chantix was researched for nicotine. Varenicline is its chemical name, and although it was positioned to control nicotine, the pharmaceutical company was targeting the reward/reinforcement pathway of addiction. They were targeting one component of the compulsivity of the drive to use that effects the nucleus accumbens, the medial forebrain bundle - we talk about that in "Roots of Addiction". Every drug that causes addiction, impacts that area of the brain and impacts the same receptors, so if a drug effectively works to treat nicotine addiction, it could possibly work very well to treat cocaine addiction, methamphetamine addiction, opiate addiction, and even gambling and process addictions. So that’s what’s happening now as practitioners begin to use varenicline to treat someone who is a smoker and a cocaine addict, they are seeing the drug lower the cocaine addiction in the same way it affects nicotine. It suppresses the pleasure of smoking and of using cocaine because it affects the same receptors…the nicotinic receptors that are part of the reward/reinforcement circuitry of addiction which decreases craving. So a person doesn't have that craving or need to seek out the pleasure he or she gets from using cocaine. I don’t think nicotine causes any great pleasure, but it does certainly cause reinforcement or creates a state of consciousness that people crave and seek out. It's easy to put a cigarette in your mouth in the morning and know exactly what you’re feeling because you’re now in a drug induced state of consciousness. The drug helps block out the craving and will do so with cocaine and I think will do so with other drugs. We’re seeing a similar situation with Naltrexone, which was first approved for opiates then the FDA approved it for alcohol, and now everybody uses it for a lot of different addictions from cocaine, methamphetamine, other opiates and also for process addictions for gambling and for autistic head banging, for cutting and for things like that. And we probably will see Chantix as well as other approved anti-craving medications used to treat a plethora of addictions and related disorders.
HOWARD: I would think that in the initial testing phase, these off label uses would have come forward. Maybe they did. But I find it interesting that it’s only now making its way into the news.
DARRYL: It takes a little bit of courage. I mean off label use is okay if there’s a lot of evidence and the medication is working. But if you’re the first one to do it, I don’t know if you want to announce that you’re doing it. And especially if you have… the genetics in the wrong place, Chantix causes a significant psychosis. People get very suicidal. They get crazy. They feel totally detached from the world and that scares a lot of people. So, say… a doctor decided to try it on a cocaine addict without any (even anecdotal) evidence and the patient had a reaction - the cocaine addict could sue him for using a drug that wasn’t really approved for cocaine addiction. So, they go slowly and when they’ve established enough numbers and see that it’s working - then they talk to colleagues and share information at conferences or gatherings of other doctors, pretty soon the word gets out and the doctors verify each other - that's when we start hearing about how Chantix is being used for cocaine addiction.
HOWARD: So, you say it (Chantix) works for gambling too?
DARRYL: It may.
HOWARD: Or is that something that is being looked at...
DARRYL: …this is just pure projection on my part. We’ve seen the same processes of the brain, involving the same circuitries with gambling addictions as we have seen with meth addiction, cocaine addiction and opiate addiction - all the other addictions, alcoholism. Gambling will be defined as an addiction and a related disorder in DSM V (Diagnostic and Statistical Manual of Mental Disorders) when it is released in 2013. The disorder may be affected by the use of Chantix to block the craving. You know, it will probably be effective…Chantix will probably be effective in those process disorders that are just like addiction and work through the same pathways in the brain. But that does bring into my mind the other story that impressed me this week and that was a discovery that’s really… not really a new discovery, but it’s touted as new. Researchers at Kyoto University in Japan did PET scans of the brains of 19 healthy men after they completed a task involving gambling. They found that norepinephrine or a noradrenalin decreased transporter mechanism affects the response to losing money. The PET scans showed fewer of these transporter mechanisms that pull the noradrenalin that’s released from an axon of one brain cell to impact the synapse and to cause a synapse. Transporter mechanisms are those mechanisms within the axon that then recycles the norepinephrine, pulls it back into the axon for use again. But they found that there was a decreased amount of transporter mechanisms. Other research on pathological gamblers showed that what that it resulted in higher levels of noradrenalin in specific parts of the brain that coincided with gamblers having a less arousal and a diminished disappointment with losses. They don’t consider losses as gravely as someone who is not a gambling addict - most of us who lose 50 bucks will say "we’re out of here! We don’t want to play this game." Why throw more money at a casino when we're losing. Pathological gamblers, lose a thousand, two thousand bucks and …they don’t react to it and therefore, they stay involved with it.
HOWARD: Well, …I would think there would have to something on the other side ... a positive force that’s driving someone to continue.
DARRYL: Well if you’re feeling no negative effects from losses, then that could be a positive force driving you to do it. Otherwise you wouldn’t do it.
HOWARD: Well, then there’s the belief that if they just keep playing they’ll make their money back.
DARRYL: Yes, the gambler’s illusion, so to speak…that ... if you flip a coin 50 times and it turns up heads 60% of the time - it's time to bet tails because you think it’s going to coming up tails more often, but in actuality, each flip is its own flip and each flip produces 50/50 odds , so overall you'll lose again if you change your bet.
HOWARD: Stick with the same pony.
DARRYL: There are 2 different types of gamblers we talk about in our book - Uppers, Downers and All Arounders, a significant number of gamblers are those who tune out during the action of the game, they’re totally in a void. They’re sort of zombie out, in a hypnotized state - not even paying attention to what they’re doing and maybe the adrenaline metabolism or adrenaline transporter mechanism has something to do with that, because if they zone out, they don’t have to think about the problems that they’re having. They don’t think about paying their rent...they don’t think that their losses... are going to make them unable to make their car payment or anything else and so they just zone out and keep in the action. The interesting thing about this though is the Japanese researchers – led by Hidehiko Takahashi of the Kyoto University is saying this opens the door for the development of new medications to treat addictive pathological gambling. Medications that may increase the transporter activity or decrease the effects of noradrenalin in that part of the brain and therefore help gamblers experience more normal reactions to losses and break them of their pathological activity with gambling.
HOWARD: Well, that’s an interesting….that’s an interesting possibility there.
DARRYL: Well, …the part of the brain that we’re talking about right now is really the unconscious. It is the vasoganglia, it’s the medial forebrain bundle, it’s the limbic system - the mesial cortex, that’s the unconscious, unfeeling, unthinking part of the brain and so this is what medicine is doing now, you know. No degree of counseling or education is going to impact that area of the brain. And for those with an addiction, to drugs or gambling, medications must be developed to disrupt what the addicted brain is vulnerable to. This is in line with the new look at the pathology or the disorder or I like to call it the anomaly of the addicted brain.
HOWARD: Very interesting. In all the cases a lot of it seems to be illuminated by the advances in technology that reveal how the brain works and what it’s doing at a much deeper level than we previously knew or could see. Anyway, that’s about all the time we have for today. We hope that you’ve enjoyed this discussion and will return again soon. If you have comments, questions or suggestions, we would certainly like to hear them. Email firstname.lastname@example.org.