Inhalants: Extent Of Use And Complications

About 12 1/2 million ADOLESCENTS in this country say that they have sniffed INHALANTS—usually volatile solvents such as spray paint, glue, or cigarette lighter fluid—at least once in their lives, according to the National Institute on Drug Abuse (NIDA) in its 1997 MONITORING THE FUTURE study, a national survey of 8th-, 10th-, and 12th-grade students (also called the HIGH S CHOOL SENIOR SURVEY). In fact, results from a number of surveys suggest that among children under 18, the level of use of inhalants is comparable to that of stimulants and is exceeded only by the level of use of MARIJUANA, ALCOHOL, and CIGARETTES.

The abuse of inhalants, which include a broad array of cheap and easily obtainable household products, is frequently viewed by the public as a relatively harmless habit and not in the same high-risk category as drugs such as alcohol, COCAINE, and HEROIN. Some people tend to view inhalant "sniffing," "snorting," "bagging" (when fumes are inhaled from a plastic bag), or "huffing" (when an inhalant-soaked rag is stuffed in the mouth) as a kind of childish fad to be equated with youthful experiments with cigarettes. But inhalant abuse is deadly serious. Sniffing volatile solvents, which include most inhalants, can cause severe damage to the brain and nervous system. By starving the body of oxygen or forcing the heart to beat more rapidly and erratically, inhalants have killed sniffers, most of whom are adolescents.

The difficulty people face in recognizing the scope and magnitude of the problem lies in the dearth of documenting information. Survey data on the prevalence of inhalant abuse are difficult to obtain for a number of reasons—and what information does exist may underemphasize the severity of the situation. No one knows how many adolescents and young people die each year from inhalant abuse, in part because medical examiners often attribute deaths from inhalant abuse to heart problems, suffocation, SUICIDE, or ACCIDENTS. What is more, no national system exists for gathering data on the extent of inhalant-related injuries, although medical journals have described the situation as serious. As serious as the situation may be, some researchers warn that doctors and emergency medical personnel are not adequately trained to recognize and report symptoms of inhalant abuse.

SCOPE OF THE PROBLEM

Inhalant abuse came to public attention in the 1950s when the news media reported that young people who were seeking a cheap "high" were sniffing glue. The term glue sniffing is still widely used, often to include inhalation of a broad range of common products besides glue.

With so many substances lumped together as inhalants, research data describing frequency and trends of inhalant abuse are uneven and sometimes contradictory. However, evidence indicates that inhalant abuse is far more common among all socioeconomic levels of U.S. youth than is typically recognized by parents and the public. For example, the National Institute on Drug Abuse's (NIDA's) Monitoring the Future survey shows that in 1997, 21.0 percent of 8th graders had used an inhalant in his or her lifetime.

Inhalants were used by equally high percentages of 10th and 12th graders, according to the NIDA survey. Lifetime inhalant use among 12th graders, which had increased steadily for most of the 1980s, leveled off somewhat at 16.1 percent in 1997; 10th graders also reported a lifetime inhalant use of 18.3 percent.

Inhalants are most commonly used by adolescents in their early teens, with usage dropping off as students grow older, unlike the case for other drugs. For example, while 5.6 percent of 8th graders reported using inhalants within the past 30 days, known as "current" use, only 2.5 percent of seniors reported current use of inhalants.

One major roadblock to recognizing the size of the inhalant problem is the ready availability of products that are inhaled. Inhalants are cheap, or even free, and can be purchased legally in retail stores in a variety of seemingly harmless products. As a result, adolescents who sniff inhalants to get high do not face the drug procurement obstacles that confront abusers of other drugs. Youthful inhalant abusers can easily buy airplane glue, hair spray, spray paint, cigarette lighter fluid, nail polish remover, or typing correction fluid.

DANGERS OF INHALANT ABUSE

Despite the dangers associated with inhalant abuse, no central system exists in the United States for reporting deaths and injuries from abusing inhalants. A study by Dr. James C. Garriott, the chief toxicologist in San Antonio and Bexar County, Texas, examined all deaths in the county between 1982 and 1988 that were attributed to inhalant abuse. Most of the thirty-nine inhalant-related deaths involved teenagers, with twenty-one deaths occurring among people less than twenty years old. Deaths of males outnumbered those of females thirty-four to five. Many of the abusers met with a violent death possibly related to but not directly caused by the use of volatile solvents. Eleven deaths were caused by suicide (ten by hanging), nine by homicide, and ten by accident, including falls, auto accidents, and overdoses.

Most of those people who died in Bexar County had used toluene-containing products, such as spray paints and lacquers, Dr. Garriott reported. The next most frequent cause of death in the Texas study was the use of a combination of chemicals found in typewriter correction fluids and other solvents. Other abused substances that resulted in death included gasoline, nitrous oxide, and refrigerants, such as fluorocarbons (Freon). Freon now has been replaced with butane or propane products in most aerosols.

As reported in the Texas study, the solvent toluene is identified frequently in inhalant-abuse deaths and injuries because it is a common component of many paints, lacquers, glues, inks, and cleaning fluids. A 1986 study of twenty chronic abusers of toluene-containing spray paints found that after one month of abstinence from sniffing the paint, 65 percent of the abusers had damage to the nervous system. Such damage can lead to impaired perception, reasoning, and memory, as well as defective muscular coordination and, eventually, dementia.

In England, where national statistics on inhalant deaths are recorded, the largest number of deaths in 1991 resulted from exposure to butane and propane, which are used as fuels or propellants. Many researchers believe that abuse of butane, which is readily available in cigarette lighters, is on the increase in the United States.

A recent report of this particular inhalant problem in the Cincinnati region indicates that butane gas is the cause of enough deaths to foster national concern about the abuse of fuel gases, whether or not it is a passing form of inhalant abuse. Sniffers seem to go out of their way to get their favorite product; in certain parts of the country, Texas 'shoeshine'—a shoe-shining spray containing toluene—and silver or gold spray paints are local or current favorites.

Since the banishing of fluorocarbons, the most common sniffing death hazards among U.S. students probably are due to butane and propane. Doctors and emergency room staffs need to be aware that the profile of the teenager who inhales volatile solvents is not limited to ethnic lower socioeconomic classes. Many sources lead us to believe that abuse of these readily available inhalants has reached epidemic proportions, indicating an urgent need for preventive efforts.

WHO ABUSES INHALANTS?

One possible reason for the increased use of volatile solvents is that more girls are joining boys in sniffing solvents. Studies in New York State and Texas report that males are using solvents at only slightly higher rates than females. Among Native Americans, whose solvent-abuse rates are the highest of any ethnic group, lifetime prevalence rates for males and females were nearly identical, according to 1991 NIDA data.

There is a public perception that inhalant abuse is more common among HISPANIC youth than among other ethnic groups. However, surveys have not found high rates of abuse by Hispanics in all geographic areas. Rates for Hispanics may be related to socioeconomic conditions. Hispanic youths in poor environments may use solvents heavily, but the usage rates in less stressful environments are lower.

In fact, inhalant abuse shows an episodic pattern, with short-term abuse outbreaks developing in a particular school or region as a specific inhalant practice or product becomes popular in a fashion typical of teenage fads. This episodic pattern can be reflected in survey results and can overstate the magnitude of a continually fluctuating level of abuse.

Inhalant abusers typically use other drugs as well. Children as young as fourth graders who use volatile solvents will also start experimenting with other drugs—usually alcohol and marijuana. Adolescent solvent abusers are POLYDRUG users prone to use whatever is available, although they show a preference for solvents. Solvent abuse is held in low regard by older adolescents, who consider it unsophisticated, a childish habit.

It is not just juveniles who are abusing inhalants. Reports in the mid-1990s indicate that college-age and older adults are the primary abusers of butane and nitrous oxide.

(SEE ALSO: Poverty and Drug Use)

BIBLIOGRAPHY

HORMES, J. T., FILLEY, C. M., & ROSENBERG, N. L. (1986). Neurologic sequelae of chronic solvent vapor abuse. Neurology, 36(5), 698-702.

SHARP, C. W., BEAUVAIS, F., & SPENCE, R. (EDS.). (2000). Inhalant abuse (NIDA Research Monograph, NIH Pub. No. 00-3818). Washington, DC: U.S. Government Printing Office.

SHARP, C. W., & ROSENBERG, N. L. (1992). Volatile substances. In J. H. Lowinson et al. (Eds.). Substance abuse: A comprehensive textbook, 3rd ed. Baltimore: Lippincott, Williams & Wilkins.

SIEGEL, E., & WASON, S. (1990). Sudden death caused by inhalation of butane and propane. New England Journal of Medicine, 323(23), 1638.

NEIL SWAN

REVISED BY DONNA GRAFT