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Months later, Bryar’s autopsy raised a possible contributing factor in his death — three canisters of nitrous oxide found next to his corpse, with tubing for inhalation still attached.

Cannulas can also bend, restricting the flow of insulin, and the pump can sometimes become disconnected from the tubing without the user noticing.

For the throngs of young western travellers on South East Asia’s backpacker trail, Vang Vieng has become famous for what is called “tubing.”

“To combat the river tubing deaths they demolished a bunch of the riverside bars that were selling buckets of vodka to people floating by,” one Western diplomat in the region told the BBC.

In another enclosure, Mozart, a three-legged gray fox with no spleen, peered warily from a tunnel of corrugated tubing.