A Richmond ER doctor is warning about the dangers of inhaling nitrous oxide (N2O) after treating a 20-year-old woman who experienced hallucinations stemming from daily use of “whippits.”
According to a report published this month in the B.C. Medical Journal, Dr. Matthew Mo Kin Kwok — one of the report’s authors — treated a young Asian woman who came to emergency at Richmond Hospital because she was worried for her safety.
The woman was experiencing auditory and visual hallucinations, agitation and had issues walking, according to the report.
The high from whippits, which produces a dissociative state, typically lasts one to two minutes, according to the report.
As a result of her hallucinations, she was also concerned about an imaginary “transmitting” device in her throat, which she believed was making her legs weak and from which she heard voices telling her to kill herself.
N2O easily accessible
Commonly known as “laughing gas,” N2O is used in a medical setting for purposes such as anaesthesia or sedation.
It’s also commercially available in canisters known as whippits, which are used as a foaming agent in whipped cream dispensers. Whippets can be purchased over-the-counter or online regardless of age, medical history or intended use.
The N2O in over-the-counter whippits is the exact same as what’s used for medicinal purposes.
The woman had no history of psychiatric or medical illness, according to the report, had stable vital signs and showed no sign of head trauma. Other medical tests came back normal.
However, said the report, she told doctors that she inhaled nitrous oxide on a daily basis.
“She had increased her use recently and was inhaling gas from approximately 100 whippits per day,” reads the report.
The patient told doctors she bought the canisters legally using a shopping app and showed the physician the website she used when making the purchases. She did not report any other prescription or recreational drug use.
“A psychiatrist, a neurologist and an addiction medicine physician assessed the patient in consultation and agreed that she was psychotic as a result of N2O use,” reads the report.
And according to the report, the authors found that a package of 100 canisters could be purchased online for less than $100, or $1 per canister.
Lack of reporting a concern
According to the report, there were multiple barriers when it came to reporting the woman’s case.
First, it was difficult to determine which authority to report the case to. For example, if the use of the chemical was medicinal, health care providers would need to report to the Canada Vigilance Program.
But if the chemical comes from a product used for whipped cream, the case should be reported to Health Canada Consumer Products and Cosmetics.
But the response from those authorities was also an issue.
“In response to our report, a Health Canada representative explained that consumer products and cosmetics would document the misuse but only take further action if the (nitrous oxide) canister had faults or hazards regarding its intended use, which is making whipped cream,” reads the report.
The report’s authors were “surprised” to learn that no cases of nitrous oxide misuse had been reported to Health Canada and only one case of substance abuse was reported to the Canada Vigilance Program.
The authors also contacted the B.C. Drug and Poison Information Centre, which informed them that the organization had received 14 calls about nitrous oxide toxicity from misuse of whippets or similar commercial products between 2015 and 2019.
“Since our investigation determined that Health Canada received only one report of N2O misuse in this period, many incidents appear to have gone unreported,” reads the report.
In 2017, the News reported how a 23-year-old Richmond man was almost paralyzed after overdosing on N2O, having bought the gas on WeChat.
At the height of his addiction, the man inhaled more than 1,000 eight-gram cartridges of nitrous oxide every day for two months.
He also said he experienced delusions, such as someone chasing him while he was driving or someone was going to hurt him.
According to Kwok’s report, Health Canada considers N2O to be an “unscheduled non-prescription professional use” product.
“This raises an important question,” reads the report. “If N2O used medicinally is deemed to require health care provider involvement, why is the purchase of N2O used commercially not restricted in any way given the potential impact on consumers?”
Some possible solutions to a lack of awareness around N2O toxicity and its possible serious effects, according to the report, are adding safeguards to minimize harm and encouraging intervention from authorities to prevent misuse.
In a release from Vancouver Coastal Health, Kwok also said both doctors and the public need to be more aware of the possible outcomes of inhaling whippits.
“When people present at the emergency department with unexplained neurological symptoms it’s important for clinicians to consider nitrous oxide as a possible cause,” said Kwok.
“It’s also important for users to know that using this product outside a supervised medical setting can cause serious health effects.”
BC Eyeing Record Influenza Vaccine Rollout – CFNR Network
British Columbia is looking to break records when it comes to this year’s influenza vaccine rollout, according to Minister Adrian Dix.
Dix says that the province has received 2.4 million doses of vaccines, 200 thousand more than last year.
Experts are expecting a flu season for the record books as well, after Covid lockdowns nearly killed off all spread last year.
In recent years, British Columbia has been accustomed to closer to 1.5 million doses, but the province is expecting more demand as Covid restrictions begin to loosen.
COVID-19 drives up demand for flu shots; N.S. to launch campaign later this week – CTV News Atlantic
With the colder winds of fall starting to blow, flu season will soon be on us again, but it seems scores of people are hoping to head off the sickness by getting a flu shot.
Unlike last year, when it was essentially pre-empted by COVID-19, experts say influenza will be back this year.
Just hours after getting a shipment and posting signage outside lineups started to form inside a north end Halifax pharmacy.
“We just got our flu shots, and people start showing up right away,” said pharmacist and store owner Ghada Gabr.
“I think this is going to be a lot of demand.”
It’s the same story a few blocks away, where pharmacist Greg Richard is expecting his first shipment of flu vaccine later this week.
With COVID-19 still around, customers like Kathy Lynch, who hasn’t had a flu shot in five years, is anxious to get one.
“I mean, I feel great. I’ve had no problem with either of the vaccinations, so, to put another layer on top is just the best thing, I think,” she said.
“People are eager to get their doses into them right off the bat,” said Richard. “They’re not looking to wait until November or December. So, I have a list of folks I’m going to reach out to as soon as they (the vaccines) arrive, and I anticipate to run through my stock pretty quickly.”
And it might very turn out to be the same thing across the country.
There’s word today Ontario has ordered an extra 1.4 million doses, with an aim to make the shots available to everyone by next month.
In Nova Scotia, the Health Minister says the official kickoff will come later this week, and supply should not be a problem,
“We do anticipate having enough vaccine for folks,” said Michelle Thompson.
“And I would really encourage people to ensure they have both their COVID-19 vaccine and the influenza vaccine this year.”
But, if early demand is any indication there might not be need for much encouragement.
A sign of the times as more and more of us take steps to avoid getting sick.
PG woman denied high dose flu shot, although her age and health condition makes her eligible – CKPGToday.ca
“I’m an advocate for my health and I want the best that there is–everybody should have what they need,” said Newman.
Today, the province announced it’s beginning its influenza immunization campaign.
“The influenza vaccine is for free for anybody over six months of age, for whom it’s recommended. But particularly for people who have underlying health conditions,” said Dr. Bonnie Henry, Provincial Health Officer
Newman’s condition requires a higher dose of the flu shot and she has been eager to get it. However, she says she’s been denied even though she’s eligible.
“I have Non-Hodgkin’s Lymphoma, which is a cancer of your lymphatic system–your germ fighting network. So as soon as the flu shots were available, I phone my pharmacy to get the high dose vaccine. I was told that the high doses were not available,” said Newman.
Because of her cancer, she’s also classified as a Clinically Extremely Vulnerable person (CEV). She has qualified for the high dose shot in the last three years. But after calling more than a dozen pharmacies and Northern Health, she was told she wasn’t eligible yet.
“It’s really hard to get answers. But when I’ve had it in the past and people in my situation have had the high dose in the past. I just don’t get why we cannot get it. Nobody can tell me. They don’t say it’s a supply issue or anything, so I just don’t understand,” said Newman.
According to ImmunizeBC’s website, First Nations communities, residents in long term care, residents in assisted living facilities, and who are 65 and older are able to receive the high dose for free.
This means Newman’s age alone qualifies her.
CKPG-TV reached out to the Ministry of Health for clarification as to why she wasn’t able to get a high dose shot. At the time that this article was written, this was the response that was given:
“As of today, the province is proud to announce the implementation of free publicly-funded influenza vaccines for those 6 months and older (those under 6 months aren’t eligible to receive this vaccine). FluZone HD, also referred to as the “high-dose influenza vaccine,” was never publicly-funded in BC until the federal government made it available in limited supply last year. With publicly funded FluZone HD, eligibility is restricted to residents of LTC/AL who are 65 or older. This year, eligibility was extended to people 65 or older residing in Indigenous communities. No pharmacy within Northern Health has a stock of publicly funded FluZone HD reserved for these eligible populations; they are administered through other means. Some pharmacies may pay for private-pay stock of FluZone HD. That is their prerogative and the Ministry is only responsible for publicly-funded stock. If those over 65 who do not live in an Indigenous community or are an LTC resident can receive a standard-dose influenza vaccine, they should accept it,” said Ministry of Health.
Newman says that she’s not undermining the importance of the other groups getting the high dose, she’s upset that the province didn’t plan for high-risk people like herself to get one.
“It just astounds me. To me, there’s no common sense. I know common sense is not so common, but what is right is right and you know I’ve already gotten my covid booster shot. I felt guilty getting that before some people in long care even got it. I just want what’s right for everybody.” said Newman.
She says she’s not going to give up on her fight and she thanks all healthcare workers for their fight against COVID-19.
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