Inhalants

Chapter 14

Introduction

• Volatile substances introduced via the lungs.

• Most cause intoxicating and/or euphorigenic effects.

• Many of these substances were never intended to be used by humans as drugs; consequently, they are not often thought of as having abuse potential.

• Inhalants are among the most commonly used drugs by adolescents.

• A widespread misconception is that inhalant abuse is a harmless phase that occurs commonly during normal childhood and teenage development and as such is not worthy of significant concern.

Introduction (continued)

Potential Consequences

• “Sudden Sniffing Death Syndrome” (SSDS): A condition characterized by serious cardiac arrhythmia occurring during or immediately after inhaling

• Brain damage

• Damage to heart, kidney, liver, and bone marrow

Considerations

• Synergistic effects

• Lipid (fat) composition

• Developmentally immature users

History

• In 1776, British chemist Joseph Priestley synthesized nitrous oxide, a colorless gas with a slightly sweet odor and no noticeable taste.

• Priestly and Humphry Davy suggested correctly that the gas might be useful as an anesthetic, and experiments were conducted to test this possibility.

History (continued)

• Abuse of inhalants came to public attention in the 1950s when the news media reported that young people were getting high from sniffing glue.

Legislation

• Inhalants are generally not regulated as are other drugs of abuse.

• Some states have adopted laws preventing the use, sale, and/or distribution to minors of various products abused commonly as inhalants.

Types of Inhalants

• Volatile substances

• Anesthetics

• Nitrites

Volatile Substances

• Includes aerosols, art or office supplies, adhesives, fuels, and industrial or household solvents.

• Some abusers inhale vapors directly from their original containers (called sniffing or snorting).

• Some abusers inhale volatile solvents from plastic bags (called bagging) or from old rags or bandannas soaked in the solvent fluid and held over the mouth (called huffing).

Potential Effects of Inhaling Volatile Substances

• Can cause irritation of airways causing coughing and sneezing.

• Low doses often bring a brief feeling of lightheadedness, mild stimulation followed by a loss of control, lack of coordination, and disorientation accompanied by dizziness and possible hallucinations.

• In some instances, higher doses can produce relaxation, sleep or even coma.

Potential Effects of Inhaling Volatile Substances (continued)

• If inhalation is continued, dangerous hypoxia may occur and cause brain damage or death.

• Other effects include hypertension and damage to the cardiac muscle, peripheral nerves, brain, and kidneys.

• Chronic abusers of inhalants frequently lose their appetite, are continually tired, and experience nosebleeds.

Aerosols• Include spray paints, deodorant and hair sprays,

vegetable oil sprays for cooking, and fabric protector sprays

• Often abused not because of the effects produced by their principal ingredients but rather because of the effects of their propellant gases

• Can be dangerous because these devices are capable of generating very high concentrations of the inhaled chemicals

Toluene• Found in some glues, paints, thinners, nail

polishes, and typewriter correction fluid

• A principal ingredient in “Texas shoe shine”

• Detectable in the arterial blood within 10 seconds of inhalation exposure

• Highly lipid soluble

• Can cause brain damage, impaired cognition and gait disturbances

• Liver and kidney damage have been reported

Butane and Propane

• Found commonly in found in lighter fluid, hair and paint sprays.

• SSDS, and serious burn injuries (because of flammability) have resulted from abuse

Gasoline• A mixture of volatile chemicals, including

toluene, benzene, and triorthocresyl phosphate (TCP)

• Because of its widespread availability, young people, particularly in rural settings, sometimes abuse gasoline

Gasoline (continued)• As a mixture of chemicals, its intentional

inhalation can be especially dangerous.

- Benzene is an organic compound that causes impaired immunologic function, bone marrow injury, increased risk of leukemia, and reproductive system toxicity.

- TCP is a fuel additive that causes degeneration of motor neurons.

Freons

• Freons and other related agents are used in refrigerators, air conditioners, and airbrushes.

• Inhalation can cause not only serious liver damage but also SSDS.

• Inhalation can cause freeze injuries.

Anesthetics (e.g. Nitrous Oxide)

• “Laughing gas”: frequently used in outpatient procedures

• Can also be sold in large balloons or small cylindrical cartridges used as charges for whipped cream dispensers

Nitrous Oxide• Significant abuse problems of nitrous oxide are

infrequent, but there are occasional reports of severe hypoxia or death due to acute overdoses

• Can cause loss of sensation, limb spasms, altered perception and motor coordination, blackouts resulting from blood pressure changes and reduced cardiac function.

Nitrites• Cause vasodilation

• Prototype, amyl nitrite, has been used in the past to treat angina

• Abuse has decreased dramatically

Why Abused?

• Legally obtained

• Readily available

• Inexpensive

• Easy to conceal

• Lack of information about potential dangers

Who Abuses?• Primarily adolescents, but even small children.

• More adolescent males than females.

• Chronic inhalant users frequently have a profile like that associated with other substance abusers. That is, often they live in unhappy surroundings with severe family or school problems, they have poor self-images, and sniffing gives them an accessible escape.

Signs of Inhalant Abuse

• Often collect an unusual assortment of chemicals (such as glues, paints, thinners and solvents, nail polish, liquid eraser, and cleaning fluids) in bedrooms or with belongings

• Have breath that occasionally smells of solvents

• Often have the sniffles similar to a cold but without other symptoms of the ailment

Signs of Inhalant Abuse (continued)

• Appear drunk for short periods of time (15 to 60 minutes) but recover quickly

• Do not do well in school and are usually unkempt

• Sitting with a pen or marker near nose

• Constantly smelling clothing sleeves

Signs of Inhalant Abuse (continued)

• Hiding rags, clothes, or empty containers of the potentially abused products in closets, boxes, and other places

• Possessing chemical-soaked rags, bags, or socks

• Abusable household items missing

Dangers of Inhalants

• Sudden sniffing death syndrome

• Damage to brain, liver, kidney, heart

• Choking on vomit

• Accidents associated with “intoxication” and fires