Inhalants (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- How Is It Taken?
- Usage Trends
- Effects on the Body
- Chemicals in Everyday Items
- Ignorance Is Not Bliss
- For More Information
What Kind of Drug Is It?
Inhalants are legal household, industrial, medical, and office products that can be deadly when misused. They contain dangerous vaporsas or fumes that can be irritating or physically harmful when inhaled. Such vapors produce effects when breathed in through the mouth or nose.
There are three main characteristics of inhalants: 1) They are volatile. This means that they are unstable or easily converted to a vapor at room temperature. 2) They do not fall into the category of drugs that are usually inhaled, such as nicotine or cocaine. 3) They are deliberately inhaled by users in concentrated form so that the users can get high. Substances that fit into this category include gasoline, lighter fluid, glues, liquid cleaning agents, and spray paint, just to name a few. These products were never intended to be used as drugs.
More than 1,000 household and industrial productsncluding felt-tip markers, correction fluid, nail polish remover, shoe polish, cooking spray, and certain gluesre abused for the highs they produce. These items are referred to as inhalants because they produce an effect when inhaled through the mouth or nose. Inhalants are generally inexpensive and easy to buy. When purchased for their intended uses, they are perfectly legal. When abused, they can be deadly.
Abused products contain chemicals that are volatile. Inhalant abusers deliberately breathe in these toxic fumes to experience a quick high. The vapors affect both the brain and the body of users who inhale them in concentrated amounts. Most products used as inhalants carry warning labels that direct consumers to use them in "well-ventilated areas." These messages are ignored by abusers, as are further warnings regarding the damage such chemicals can do to their bodies. A standard warning label reads: "Do not inhale because the fumes can be dangerous to your health."
The U.S. Drug Enforcement Administration (DEA) reported in its "Get It Straight" publication on inhalants that "in just ten years
the number of youth who have used inhalants has nearly doubled." According to the 2003 National Survey on Drug Use and Health (NSDUH), the number of new inhalant users rose from about 625,000 in 1994 to 1 million in 2002. (New inhalant users are defined by the NSDUH as Americans who tried inhalants for the first time. Inhalants are defined as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good.")
Sniffing through History
The intoxicating effects of certain chemical vapors are believed to have been discovered by the ancient Greeks about 3,500 years ago. anestheticA substance used to deaden pain. gases were the first inhalants to become popular in more modern times. In the 1700s and the 1800s, chemists, doctors, and dentists in Europe and the United States experimented with three different anesthetic gases: nitrous oxide, ether, and chloroform. (A separate entry on nitrous oxide is available in this encyclopedia.)
Such compounds revolutionized surgical and dental procedures by allowing patients to "sleep" through the painful experiences. But the highs they produced soon led to their use and abuse as intoxicating drugs. In fact, in the 1800s, some people had "ether parties." Partygoers would gather together to inhale the substance and experience its effects. The ether mainly caused giddiness or silliness. Some of these parties were held by medical students who took the opportunity to learn more about how the substance affected people.
The anesthetic gas craze of the 1800s gave way to glue sniffing in the mid-1900s. In The Consumers Union Report on Licit and Illicit Drugs, Edward M. Brecher and his coauthors stated that "before 1959, glue sniffing was essentially unknown," and there were no "documented studies" of the practice. But in the summer of 1959, the Denver Post ran an article about a new trend occurring in Pueblo, Colorado. Youths were coating the palms of their hands with model airplane glue and then inhaling the fumes for their intoxicating effects. Brecher called the Denver Post article "the first full description [of glue sniffing] in the mass media." He also suggested that the warnings prompted by the article fueled "a further spread" of the inhalant problem. Instead of discouraging inhalant abuse, it seemed to increase interest among teens in this new method of getting high.
Inhaling gasoline gained popularity in the 1950s and 1960s. Gasoline remains a dangerous and widely abused inhalant around the world. At the end of the 1960s, the sniffing of other such as paint thinner, varnish remover, and lighter fluid was not yet common. aerosolGas used to propel, or shoot out, liquid substances from a pressurized can. sprays, however, became the inhalant of choice in the early 1970s.
Accessibility Adds to Problem
Preteens and teens often experiment with inhalants before any other drug. The main reason for this is the accessibility of inhalable products. Products that can be used as inhalants are available in just about every kitchen, bathroom, and home office. In addition, these products are inexpensive, legal, and easy to hide. Inhalants are also popular because they produce a high that, in general, hits fast and wears off quickly.
In "Sucking the Life from Your Child," an article that appeared on the Preteenagers Today Web site, Sue Marquette Poremba noted: "Oftentimes, kids don't consider it [inhalant use] drug use because they aren't using an illegal substance, like marijuana." The truth about inhalants is often shocking to individuals who have not been educated about their effects. Inhalants can kill, even if they are used just once. Inhalant use has been linked to the sudden deaths of otherwise healthy people. Even short-term use can cause damage to the brain, heart, liver, kidneys, and lungs. With prolonged use, inhalant abusers may also lose their sense of taste and develop problems with their hearing, vision, immune system, and muscle functions.
What Is It Made Of?
Inhalants come in many forms. According to the National Institute on Drug Abuse (NIDA), there are four general categories of inhalants: volatile solvents, aerosols, gases, and nitrites.
Volatile solvents are liquids that vaporize at room temperature. Products containing volatile solvents are widely available for household and industrial use. Some examples include paint thinner and remover, nail polish remover, gasoline, model airplane glue, correction fluid, and felt-tip marker fluid.
Aerosols are sprays that contain propellants and solvents. Bathroom cleaners, air fresheners, and bug-killing sprays found in any supermarket are just a few examples of easily obtainable aerosol spray products. Consumers can tell an aerosol spray from a pump spray in two main ways. First, aerosol cans are usually made of metal, while pump sprays are made of plastic. Second, an aerosol spray delivers its product in a fine and continuous mist. The mist is released from the can as long as the user presses down on the spray button. Pump sprays deliver short, premeasured bursts of a liquid. The button must be "pumped," or pushed down, for each spray. Spray paints, hair sprays, computer air dusters, body deodorants, and nonstick cooking sprays were among the most commonly used aerosol inhalants in early 2005.
Gases fall into two categories: 1) medical anesthetics such as ether, chloroform, and nitrous oxide (N2O), or "laughing gas"; and 2) fuel gases found in products such as butane lighters, propane tanks, and air conditioners.
Nitrous oxide, though usually associated with dentistry, was actually the most frequently abused gas in the early 2000s. It is purchased at dance clubs in balloons or ready-to-use canisters. Another well-known source of nitrous oxide is canned whipped cream. (Whipping cream cartridges, nicknamed "whippets," also contain nitrous oxide.) Whipped cream is usually dispensed from its container by turning the can upside down and depressing the lever. Nitrous oxide is the substance used to force the whipped cream out of the can. Abusers breathe in the nitrous oxide propellant without dispensing any cream.
A nitrite is a chemical compound that contains one nitrogen atom joined to two oxygen atoms. (A separate entry on nitrites, listed under the title "Amyl nitrite," is available in this encyclopedia.) Nitrites are , not depressantsSubstances that slow down the activity of an organism or one of its parts., and work differently on the body systems than other inhalants. Most abusers are drawn to inhalants for their psychoactive effects. Users of nitrites are the exception. Inhaled nitrites dilate, or open up, blood vessels, increase the heart rate, and create a brief but powerful sense of warmth and sexual excitement in the user.
Amyl nitrite was especially popular among gay men in the 1970s. The drug was intended for use by heart patients suffering from severe chest pain. Amyl nitrite ampules (small, sealed vials) earned the nickname "poppers" among drug users on the dance party circuit because they had to be crushed, or "popped," to release their chemical vapors. In 1979, amyl nitrite became available by prescription only in the United States. Two closely related chemical compoundsutyl nitrite and isobutyl nitriteuickly took its place. These substances also contain a single nitrogen atom attached to two oxygen atoms and are generally sold as room odorizers. They are packaged in small, dark-colored glass bottles and sniffed in concentrated form. Nitrite-based inhalants produce an almost instant high that lasts for two to five minutes.
How Is It Taken?
The vapors from inhalants are deliberately breathed in through the nose or the mouth of the user. Sometimes the substances need to be heated in order to release the intoxicating vapors.
NIDA and the Partnership for a Drug-Free America describe several methods by which inhalants are consumed. They include:
- sniffing or snorting fumes from the container in which the inhalant is sold, such as glue from a can or a tube
- inhaling fumes sprayed directly from an aerosol can through the nose or mouth
- bagging, which involves holding an inhalant-filled plastic or paper bag over the mouth and nose, and then breathing in the fumes; sometimes, the entire bag is placed over the head, increasing the risk of suffocation
- huffing, which involves soaking a cloth with an inhalant, placing it over the nose and mouth, and then breathing in the vapors
- inhaling substances from balloons (often the method used when sniffing nitrous oxide) or empty soft drink cans (often the method used when sniffing paint or paint thinner)
- painting the fingernails with an inhalant such as correction fluid and then sniffing the substance from the nails
- spreading the inside of a painter's face mask with a toxic substance and inhaling. The substance is usually glue because it is thick enough to stick to the mask.
"Bagging" is the riskiest of all inhalant methods because the concentration, or strength, of the fumes inside the bag increases to extremely high levels. "Sniffed" fumes are diluted somewhat by the air, delivering lower amounts of dangerous vapors. "Huffed" fumes are more concentrated than sniffed fumes but less concentrated than bagged fumes.
Once inhaled, the chemicals from inhalants move into the lungs. From the lungs, they easily enter the bloodstream. Then, the blood quickly carries the throughout the body.
Are There Any Medical Reasons for Taking This Substance?
Fumes from household and industrial products are not meant to be inhaled. Inhalants with accepted medical uses include nitrous oxide and amyl nitrite. Nitrous oxide is an anesthetic used frequently by dentists to minimize pain during routine procedures. It is also used in operating rooms to prepare patients for surgery.
Amyl nitrite is a clear, yellowish liquid. It was originally manufactured and prescribed by physicians to relieve severe chest pain in people with heart disease. This pain, called angina pectoris, occurs when the blood supply to the heart is restricted. Amyl nitrite helps relax the muscles around the blood vessels of the heart, making it easier for blood to flow through them. Newer medicines for angina pectoris have become available, so amyl nitrate is rarely used to control chest pain anymore. The most important medical use for amyl nitrite since the late 1980s has been as an antidote for cyanide poisoning.
Much inhalant use occurs during early adolescence, but experimentation may begin before that. In an article for the Washington Post, Shankar Vedantam reported that "children as young as fourth-graders [nine and ten year olds] are deliberately inhaling fumes of dangerous chemicals" to get a quick high. "Unlike the effect of alcohol," continued Vedantam, "these highs disappear within minutes, making it hard for parents to detect the abuse."
Rates of Use Rose in the Early Twenty-first Century
The "2003 National Survey on Drug Use and Health (NSDUH)," conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), revealed that 9.7 percent of Americans age twelve and over had used inhalants at some time in their lives. That is almost 23 million people. Approximately 718,000 of these people were between the ages of twelve and thirteen, and 2.6 million were seventeen or younger. From the mid-1990s to the early 2000s, the number of young females abusing inhalants increased. Long-term abusers, however, are usually male.
In 2004, the annual Monitoring the Future (MTF) study, conducted by the University of Michigan and funded by the National Institute on Drug Abuse, found that 17.3 percent of eighth graders had abused inhalants at least once. The rate in 2003 was lower, at roughly 15.8 percent. Results of the 2004 MTF study also revealed that eighth graders reported higher rates of current abuse than tenth and twelfth graders.
A Global Problem
Solvent abuse has been a worldwide problem for decades. The rates of young abusers are particularly high in poor nations with large populations of homeless children. Glue sniffing is an enormous public health issue in the southeast Asian nations of Cambodia and Singapore; the eastern African nations of Kenya, Tanzania, and Uganda; and the city of Bombay in eastern India. Street children with no money, food, or shelter sniff glue to ease the feelings of hungernd sometimes the coldhey experience every day and night. In Singapore alone, the number of reported inhalant abuse cases rose from 24 in 1980 to 1,112 in 1987 before beginning a steep decline. And those are just the cases that were reported to the Central Narcotics Bureau of Singapore. Glue sniffing is widespread in parts of Mexico, Central America, and South America as well. It is not uncommon to see children high on inhalants lying in the streets. Many of them took up the habit when they were under the age of ten.
Inhalant use is also high in other regions. Sniffing gasoline is a serious problem among young Aborigines in Australia's rural desert communities and among the Native American population in Canada. The 1999 "European School Survey Project on Alcohol and Other Drugs" cited rates of lifetime inhalant use reported by graduating high school students throughout Europe. According to the survey, about one in every seven graduates in the United Kingdom reported using inhalants at some point in time. Rates in Ireland were slightly higher, with one in every five graduates reporting inhalant use.
Inhalant use tends to be highest among adolescents. Some young people who abuse inhalants, especially when they do it repeatedly over a span of several days, find they have a strong need to keep using them. Early abusers may move from experimentation into regular, long-term use. Some continue to abuse the substances into their fifties and sixties. These users have become on the
chemical vapors and need treatment to kick their habit. Teens who continue abusing inhalants at later ages develop more severe social and psychological problems than do those who discontinue use after adolescence.
Effects on the Body
In The Consumers Union Report on Licit and Illicit Drugs, Brecher pointed out that "drugs of many kinds reach the brain more rapidly and efficiently when they are sniffed rather than swallowed." Inhalants deliver their mind-altering effects very quickly, satisfying the desires of users looking for a near-instant high. The effects occur within seconds.
Similar to Alcohol Intoxication
Most toxic vapors (except nitrites) act as depressants on the people who inhale them. The action of these vapors is similar to that of alcohol, sedatives, and anesthetics. (Sedatives are drugs used to treat anxiety and calm people down.) Users may actually feel slightly stimulated at first. They report feeling happy, giddy, and excited. This effect often occurs with the first alcoholic beverage that a person consumes. In fact, the effects of inhalants closely resemble drunkenness. But, like alcohol, the depressant action of inhalants kicks in soon after the initial stimulation. Users then begin to feel more relaxed and less inhibited.
Continued inhalation makes the user feel light-headed and drowsy. Higher doses may bring on feelings of agitation and anger, impaired judgment, slurred speech, muscle weakness, slowing of the reflexes, and a lack of coordination. Dizziness, tiredness, headache, nausea, and vomiting may also occur.
The Effects Intensify
Heavy inhalant use often causes people to feel completely out of control. Among the most frightening symptoms of heavy use are and delusionsFalse, unshakable beliefs indicating severe mental difficulties; 'delusional' refers to the inability to distinguish between what is real and what seems to be real.. The authors of the NIDA Research Report titled "Inhalant Abuse" state: "If sufficient amounts are inhaled, nearly all solvents and gases produce anesthesia, a loss of sensation, and even unconsciousness."
With time, regular abusers experience personality and behavioral changes. They may show signs of memory loss and an inability to reason. Severe mood swings, violent behavior, depression, hyperactivity, physical and mental dependence, and tolerance are often seen among long-time abusers as well. Tolerance is a condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced.
The irritating effects of inhaled chemicals can cause abusers to sneeze repeatedly, cough heavily, and even drool. Other observable signs of inhalant use include pale skin, breath that smells like chemicals, weight loss, nosebleeds, bloodshot eyes, tremors, and even seizures. Inhalants are dangerous for pregnant women and their developing babies. Studies of animals indicate that inhalant use by mothers leads to low birth weights, skeletal abnormalities, and developmental delays in exposed offspring.
Organ and Nerve Damage
Depending on the chemicals involved, inhalants damage the heart, liver, kidneys, bone marrow, and lungs. They may also reduce the blood's ability to carry oxygen throughout the body.
Shrinking the Brain:
The use of inhalants can damage the brain and the network of nerves that connects the brain and spinal cord to other organs. As described in NIDA's article "Mind over Matter: Inhalants," the vapors from inhalants "don't go away when you exhale." Instead, they stay in your brain and nervous system "for a long time."
The effects of inhalants on the brain can be devastating. In 2002, NIDA conducted a study using brain imaging techniques and other tests to compare the effects of inhalants and cocaine on the brain. Robert Mathias explained in NIDA Notes that long-term inhalers of volatile solvents showed more extensive brain abnormalities than cocaine abusers. All of the participants in the NIDA study had abused either cocaine or inhalants regularly for at least ten years. was the most-abused product among the members of the inhalant-abusing group. Mathias noted that the inhalant abusers "did significantly worse than cocaine abusers on tests of working memory and the ability to focus attention, plan, and solve problems." They also had difficulty controlling their behaviors.
Inhalants are attracted to fatty tissue like a magnet is attracted to steel. Researchers suggest that this attraction is what causes nerve and brain damage in inhalant abusers. Nerve cell fibers in the brain and body are surrounded by white fatty wrappers called myelin (MY-uh-linn) sheaths. Since myelin sheaths are made of fat, inhalants are quickly drawn to them. The chemical vapors in inhalants can damage the myelin, slowing the ordinarily rapid flow of messages from one nerve to another. Mathias noted that these effects dull the part of the brain involved in intellectual activities such as language comprehension. The authors of "Mind over Matter" explained: "Someone who repeatedly uses inhalants may lose the ability to learn new things, may not recognize familiar things, or may have a hard time keeping track of simple conversations."
The toxic chemicals in inhalants are stored in fatty tissue in the body for weeks. Thus, when long-term abusers attempt to quit, they may develop withdrawal symptoms several hours to a few days after
stopping the abuse. Withdrawal symptoms are the physiological effects one experiences as the body adjusts to not having the drug anymore. Common withdrawal symptoms for inhalants include hand tremors, excessive sweating, constant headache, rapid pulse, sleeping difficulties, nausea, vomiting, anxiety, and possibly hallucinations and seizures.
Toluene: An Example of a Brain-Damaging Solvent:
Damage to nerve fibers in the brain is particularly associated with toluene abuse. Toluene is a liquid hydrocarbonA compound containing only two elements: carbon and hydrogen; hydrocarbons are found in petroleum and natural gas. that is used as a solvent and a gasoline additive. Its chemical formula is C7H8. Toluene is clear, strong-smelling, and highly flammable. According to Francha Roffe Menhard in The Facts about Inhalants, "shortly after inhalation, concentrations of toluene may be ten times greater in the brain than in the blood."
Users inhale toluene because it seems to activate a called dopamine (pronounced DOPE-uh-meen), which controls movement, emotion, motivation, and pleasure. The authors of NIDA's "Inhalant Abuse" report note that "the dopamine system has been shown to play a role in the rewarding effects of many drugs of abuse." Because it activates the "feel-good" centers of the brain, this dangerous solvent can cause dependence in users.
Volatile solvents such as toluene dissolve fats. That is what makes them so useful as degreasers and industrial-strength cleaners. When breathed in through the mouth or nose, however, toluene goes straight to the brain, where it begins its "dissolving" action. Indeed, brain scans of long-term heavy toluene abusers show visible shrinkage of brain tissue. Toluene tends to affect areas of the brain that control physical movement. Abusers of this type of inhalant often have trouble coordinating their movements. The way they walk may seem stiff or spastic. Toluene can also produce giddiness, headaches, and even deliriumA mental disturbance marked by confusion, hallucinations, and difficulty focusing attention and communicating. in users.
Sudden Sniffing Death (SSD)
In the January 24, 2005, issue of the Washington Post, Shankar Vedantam pointed out that it is hard to estimate the actual number of fatalities caused by inhalants because so "many deaths linked to abuse go unreported or are listed as accidents." The National Inhalation Prevention Coalition (NIPC), a nonprofit organization based in Austin, Texas, issued guidelines to assist medical examiners and coroners in recognizing and reporting inhalant deaths. The most common cause of inhalant abuse death is . SSD occurs when the heart loses its regular rhythm and begins to beat in a fast and irregular manner. The NIPC guidelines describe a "typical scenario" of SSD: The victim experiences a sudden threat while under the influence of an inhalant. He or she may fear discovery by a teacher, a parent, or a police officer or be frightened by an extremely realistic hallucination. Then, "the individual begins to flee and suddenly collapses and dies at the scene."
When an otherwise healthy individual, especially a young person, dies for no apparent reason, inhalant abuse is considered as a possible cause. According to the NIPC guidelines, postmortem examinationsExamining the body after death; also called an autopsy. of an inhalant overdose victim may reveal:
- paint stains on the face, hands, or clothing
- correction fluid stains on the fingernails
- skin eruptions known as "huffer's rash" on the face and mouth
- chemical burns on the face or hands
- burns on the mucus membranes of the mouth and airway
- eye irritation
- cyanosisluish or purplish skin caused by a lack of oxygen in the blood
- the presence of vomit in the mouth and lungs
Sometimes, clues to the inhaler's death can be found near the body. The presence of the following items all point to the possibility of an inhalant-related death: 1) plastic bags; 2) balloons; 3) chemical-soaked rags; 4) open or crushed felt-tip pens; 5) empty glue tubes or aerosol cans; or 6) open bottles of nail polish, nail polish remover, or correction fluid.
Nitrites and AIDS
Nitrites carry special risks, even with occasional use. Nitrites significantly decrease the of people who use them, making them more likely to engage in risky activities, such as having unprotected sex. In addition, drug researchers suspect that nitrite abuse reduces the efficiency of the immune system. This may hinder the body's efforts to fight infections and resist the growth of tumors. According to NIDA, users of nitrites put themselves at a high risk for contracting HIV (the human immunodeficiency virus), which can lead to AIDS (acquired immunodeficiency syndrome).
The Death Toll
Inhalant abusers can die, even the first time they sniff, huff, or bag. Death can be caused by the physical effects of the chemicals or by the dangerous behavior related to the user's impaired state of mind. The noxiousPhysically harmful. vapors in inhalants take the place of oxygen in the lungs. Other inhalant-related causes of death include: 1) ; 2) suffocationn inability to breathe due to a blockage of air to the lungs; 3) choking on vomit; and 4) accidentsuch as car crashes, drownings, falls, and burnsaused by the mental and physical effects of inhalants.
As of July of 2005, the NIPC reported approximately 100 to 150 inhalant deaths per year based on news reports and contacts with victims' families. However, according to the NIPC Web site, the actual number is probably much higher. "Inhalant abuse related fatalities are underreported," state NIPC authors, "because they may not be recognized or because of a perceived stigma [shame or disgrace]." Although inhalant abusers come from a variety of social backgrounds, inhalant use is often associated with poverty, low academic achievement, and unemployment.
Reactions with Other Drugs or Substances
When users combine inhalants with other drugs, the risks to their health are increased. For instance, alcohol slows the breakdown of toluene in the blood, thus raising the concentration of the solvent in the user's body. Cocaine can boost the chance of fatal irregular heart rhythms. Huffing correction fluid while taking Ritalin can kill. The stimulating effects of Ritalin dramatically increase the risk of SSD in users who combine these substances. Nitrites used in combination with the sexual-performance-boosting drug Viagra can also be deadly. Plus, because of the flammability of most inhalable substances, fires may result when they are used near an open flame or a lit cigarette.
Treatment for Habitual Users
In 2004, the Partnership for a Drug-Free America (PDFA) conducted a study of parents' attitudes toward inhalant abuse. According to the results, parents are indeed aware that inhalants are more available to their children than are other drugs. However, parents are actually less likely to discuss inhalants with their children than they are to discuss cigarettes, marijuana, alcohol, or other drugs. PDFA researchers noted that adults "mistakenly believe their children see as much risk in inhalant abuse as they do. Believing their children know the risks of inhalants removes the perceived need to educate them." In addition, the study found that "only four percent of parents of sixth to eighth graders believe their child has tried inhalants." In reality, young people are five times more likely to have tried inhalants than their parents are willing to believe.
Getting the Word Out about Inhalants
Compounding the problem, according to the MTF survey, is the number of young teens who fail to see the risk of using inhalants. The 2004 MTF results indicate that with each year since 2001, fewer and fewer teens have viewed inhalants as potentially deadly substances. As of 2005, the NIPC, with the support of the Mental Health Services Administration Center for Substance Abuse Treatment, was trying to change this trend by educating the public about the dangers of inhalants. Each year during the third week in March, the coalition sponsors National Inhalants and Poison Awareness Week (NIPAW).
Jail Time vs. Rehab
In the 1960s, inhalant-abusing youths were arrested rather than treated for their dependency. Relapse and treatment failure rates remain high among inhalant abusers. Some professionals believe that programs specific to inhalant abuse, perhaps led by recovering abusers, are critical to improving treatment success. But programs like this are scarce.
Even in 2005, there were few treatment centers for inhalant abusers in the United States. When asked for recommendations, Harvey Weiss, the executive director of the NIPC, could report on only four centers in the entire country specializing in rehabilitation for inhalers. The facilities he mentioned were Fairbanks Hospital in Indianapolis, Indiana; Pathway Family Center, also in Indianapolis; Four Winds Hospitals in Ketonah, New York; and the Tundra Swan McCann Treatment Center in Bethel, Arkansas.
According to SAMHSA, nearly 200,000 Americans are in need of treatment for inhalant dependency or abuse. The majority of inhalant users seeking treatment are white males under twenty. More than half of the individuals admitted to treatment centers began using inhalants before the age of fourteen.
Long-term treatment, as long as two years, has yielded the best results for inhalant abusers. This treatment includes identifying the underlying causes of drug use among addicts, teaching them better coping skills, and helping them to sever ties with their drug-abusing peers.
Many questions have been raised about the lasting effects of inhalant damage to the brain and other organs. New research shows reasons for optimism about recovery. In the NIDA Notes report, Robert Mathias quoted Dr. Neil Rosenberg of the University of Colorado Health Sciences Center in Denver as saying, "Every day we learn more about the ability of the central nervous system to regenerate If you can stop the inhalant abuse, there's a good chance you can get significant recovery of function in chronic abusers." According to Dr. Rosenberg, the best method of treatment for inhalant abusers combines neurological rehabilitation with drug abuse treatment.
SAMHSA researchers tracked the drug use patterns of Americans age eighteen through forty-nine in 2002 and 2003. They found that more than a third of the individuals who had started using inhalants at age thirteen or younger were hooked on alcohol or some other drug by the time they reached adulthood.
Inhalants affect the judgment of people who use them, so abusers may make poor choices and engage in high-risk behaviors. The side effects of inhalants increase the risks involved in activities such as driving a vehicle or operating machinery. Fire-related injuries may occur among users because inhalants are combustible, meaning they are capable of burning. In addition, inhalant abusers are likely to have trouble learning new information at school or holding onto a job. Their relationships with family and friends may also suffer because of the mood swings associated with inhalant use.
Inhalant Use and Social Problems
Researchers are studying possible links between inhalant abuse and social problems such as violent behavior and run-ins with the authorities. The authors of NIDA's "Inhalant Abuse" report state that "adverse socioeconomic conditions, a history of childhood abuse, poor grades, and dropping out of school all are associated with inhalant abuse."
Data from the 2003 NSDUH report showed that twelve- and thirteen-year-old inhalant users "were more than twice as likely to have been in a serious fight at school" in the last year than youths their age who did not use inhalants. They were also "six times as likely to have stolen or tried to steal anything worth more than $50." Furthermore, the tendency to abuse illegal drugs was much higher among twelve- and thirteen-year-old inhalant users than it was for nonusers in the same age group.
By 1968, according to Brecher in The Consumers Union Report on Licit and Illicit Drugs, thirteen states had issued laws prohibiting glue sniffing. The city of Anaheim, California, was one of the first places to pass such a law. In 1962, it became illegal in Anaheim to "inhale, breathe, or drink any compound, liquid, chemical, or any substance known as glue with the intention of becoming intoxicated." In the mid-1960s, the Federal Bureau of Investigation (FBI) proposed that the sale of certain glues to people under age twenty-one be prohibited.
The more than 1,000 household and industrial substances that can be used as inhalants are legal products. They are not regulated under the U.S. Controlled Substances Act (CSA) of 1970. At the start of the twenty-first century, thirty-eight states had enacted laws to address the issues of inhalant use among minors. In various ways, the laws attempt to prevent the sale, use, and distribution of abusable inhalants to consumers under the age of eighteen. In roughly half of the United States, it is illegal to inhale certain compounds for intoxication. Consequences vary from state to state but usually involve fines of several hundred dollars and up to six months in jail.
As of 2005, two inhalant bills were awaiting approval by the Tennessee and Wisconsin legislatures. Ricky and Johnson's Law, named for two Tennessee youths who died from huffing, would provide resources for inhalant education, prevention, and treatment. Aaron's Law, named for a Wisconsin teen, would make it illegal to sell abusable products to youths under eighteen.
The United Kingdom also controls the access of inhalants to its minors. The Intoxicating Substances Act of 1985 made it an offense to supply teens with inhalable products that will be abused. The Cigarette Lighter Refill Regulations of 1999 govern the sale of purified liquefied petroleum gas, mainly butane. This is the substance most often involved in inhalant fatalities in the United Kingdom. The 1999 law made it illegal to sell this type of cigarette lighter refill to anyone under the age of eighteen.
For More Information
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See also: Amyl Nitrite; Nitrous Oxide
Inhalants (Encyclopedia of Drugs, Alcohol, and Addictive Behavior)
Inhalants are solvents or volatile anesthetics that are subject to abuse by inhalation. Most are central nervous system (CNS) depressants, but some are convulsants. As a class they are characterized by high vapor pressure and significant solubility in fat at room temperature. Vapors and gases have been inhaled since ancient times for religious or other purposes, as at the oracle at Delphi. Experimentation with inhalants did not occur to any significant extent until after the discovery of nitrous oxide and the search for volatile anesthetics commenced in earnest. Arguably the most toxic of abused substances, inhalants can produce a wide range of injuries, depending on the chemical constituents of what is inhaled. Many are very complex mixtures formulated for a specific purpose, or are used because they are the least expensive alternative, or both. Thus their purity and safety are in no way comparable with those achieved by pharmaceutical companies manufacturing medications for human consumption.
Inhalants are typically abused by achieving a high airborne concentration of a substance and deliberately inhaling it. With solvents, this typically involves putting the solvent in a closed container, or saturating a piece of cloth and inhaling through it. Compressed gases are sometimes released into balloons and inhaled; directly releasing these substances into the mouth may freeze the larynx, causing laryngospasm and death by asphyxiation. Once the chemical is inhaled, its uptake and duration of action are determined by its solubility in blood and brain, and by the respiratory rate and cardiac output.
The mechanism of action of this class of agents is less well understood than those of other drugs and medications. As CNS depressants, they have been thought to exert their actions by dissolving in membranes and altering their function in a nonspecific way; the potency of these compounds is frequently related to their solubility in membranes. Many consider this relationship to better predict the access of the agent to the site of action, and to be unrelated to the mechanism by which the solvents exert their effects. Solvents impair conduction in isolated nerves, and affect nerves with smaller diameters first. This suggests that parts of the nervous system such as the cortex would be affected before systems consisting of large fibers. There is significant interest in the GABA receptor complex as the site of action of many of these compounds. There is not yet evidence for specific interactions with a receptor, in the sense of a "lock and key" mechanism. However, these agents may "lubricate" or "obstruct" such mechanisms.
Although inhalant abuse has been implicated in a variety of organic diseases, its effects on the nervous system have been of the greatest concern. Such injuries range from paralysis and loss of bowel and bladder control, to permanent impairment of the higher cognitive functions and fine motor control. Those who become involved in inhalant abuse vary across culture and, as in many
Alkanes are hydrocarbons of the general formula CnH2n+2;. The potency of this family of straight-chain chemicals increases with the number of carbons. The smaller molecules (methane, ethane, butane, propane) are gases at room temperature; their deliberate inhalation produces cardiac arrhythmias and sudden death. Pentane, hexane, and longer alkanes are liquids that become progressively less volatile. Hexane produces a devastating neurotoxicity. Alkanes are paraffins; cycloparaffins are rings without alternating double bonds; and alkylcycloparaffins have a short substituent on the ring. Alkylcycloparaffins such as methylcyclopentane and methylcyclohexane (hexahydrotoluene) are convulsants.
Amyl nitrite is a volatile, oily liquid with a sweet, banana-like odor. It is sold by prescription in glass ampules for the treatment of angina pectoris, chest pain caused by the narrowing of vessels in the heart. When the glass ampules are broken, they "pop"; hence they are sometimes called "poppers." Amyl nitrite relaxes the vessels of the heart by relaxing the muscles of the veins as well as all other smooth muscles in the body. When the veins throughout the body dilate, blood pressure falls. Because a minimum blood pressure is required to maintain blood supply to vital organs such as the brain, a reflex protects the brain by increasing heart rate and blood flow. This produces a "rush" as the heart pounds, and there is a throbbing sensation in the head. Users also experience a warm flush as the blood accumulates near the skin because of the dilation of veins. Vision also may "redden" as the retinal vessels dilate. The user may faint if the heart cannot maintain blood flow to the brain. If this occurs, the user falls to the floor, and blood flows to the brain, restoring consciousness. Use in a situation where it is impossible to become horizontal may result in brain damage.
The duration of action of the drug is very brief, and as the effect wears off, the user may experience headache, nausea, vomiting, and a chill. The drop in body temperature occurs because of the loss of heat when the veins dilate and the skin flushes. Use of the drug for prolonged periods, or swallowing the liquid, may produce fatal methemoglobinemia, a "chocolate" blood condition in which the blood is brown and cannot carry oxygen to the brain. The drug produces a thick, crusty brown rash if it is spilled on the skin, and is irritating to the lungs. It is flammable and explosive. Volatile nitrites are converted to nitrosamines in the body, and most nitrosamines are very potent cancer-causing chemicals. There is an association of the use of volatile nitrites with Kaposi's sarcoma, an AIDS-related skin cancer. Volatile nitrites impair the function of the immune system. The physiology of sexual intercourse involves smooth muscle; the nitrites relax those muscles as well and so will affect sexual function.
The prescription requirement for amyl nitrite was eliminated in 1960, and its use became popular; in 1964 prescription requirements were reestablished. "Designer" nitrites, such as butyl and isobutyl nitrites, were then bottled and sold as "room deodorizers" with such names as RUSH, Locker Room, and Aroma of Men, so named because it smelled like a locker room. Since these products were not controlled substances or sold as medicines, they were once legal products.
Anesthetics are used in medicine to permit surgical procedures without pain or consciousness. They are of two types: local and general. A local anesthetic is usually injected near nerves to prevent pain in a limited area, such as a Novocaine injection to anesthetize a tooth. General anesthetics are administered to the whole body and depress the CNS to such an extent that major surgery can be performed without killing the patient from the shock resulting from procedures that otherwise would be unendurable. General anesthetics were developed in the mid-nineteenth century by doctors experimenting, usually on themselves, with the organic solvents available at the time. These experiments were sometimes done by groups of people who inhaled the vapors and described the effects, or passed out. Later, careful experimental work identified volatile chemicals that are used to save lives by permitting surgery that would otherwise be impossible to perform, and that are safe to use and have relatively low toxicity.
Some anesthetics can be given by injection. Short-acting anesthetics are used for brief procedures in medicine and dentistry where inhalation anesthesia is inappropriate or difficult, or for starting anesthesia before longer-acting agents are given to the patient. Drugs used for this purpose include barbiturates such as sodium methohexital and sodium thiopental, and benzodiazepines such as midazolam. Fentanyl and related compounds are used for a longer duration of action. A dissociative anesthetic, ketamine, is used for treating burn patients and small children. These agents affect the brain in a more selective way than other anesthetics, so that there is more muscle tone and better circulation in the head and neck. A related veterinary drug, phencyclidine (PCP), has a longer duration of action; when given to humans, however, it has produced terrifying hallucinations upon recovery. It is subject to abuse.
Volatile anesthetics induce unconsciousness and loss of reflexes for surgical procedures. This CNS depression can be induced by a wide variety of different chemicals; those used in clinical medicine are selected for reasons that include low toxicity, ease of maintaining and adjusting a given depth of anesthesia, and freedom from adverse effects upon recovery. Many compounds were examined in the search for modern anesthetic agents.
The depth of anesthesia depends on how much of the medication is present in the CNS. This in turn depends on how much is in the air, to what extent the anesthetic passes between air and blood, and how much passes from blood to brain (or fat, since the brain is largely fat). An agent that is highly insoluble in blood achieves a plateau, or saturation, concentration very rapidly; an example is nitrous oxide. More soluble agents take a longer time to come to plateau, and take a longer time to be exhaled as well, so recovery from them takes longer. Nitrous oxide and cyclopropane have the same solubility in blood, and take the same amount of time to come to a steady concentration in blood; cyclopropane is more soluble in brain and fat, however, so it takes a much lower concentration to achieve the same effect. (Cycloproane is explosive, and therefore is not used in the operating room.) The way an anesthetic functions in a given individual depends on a number of variables, including the amount of fat in the individual's body, the volume of air inspired per minute, the amount of blood pumped through the lungs per minute, and various preexisting medical conditions.
AROMATIC HYDROCARBON SOLVENTS
Aromatic hydrocarbon solvents have a structure that includes a benzene ring. The simplest form is benzene, a six-membered ring with double bonds and six hydrogen atoms. All other aromatic hydro-carbons have alkyl substituents around the ring; for example, toluene has one methyl group and xylene has two methyl groups.
Benzene is a volatile aromatic hydrocarbon (see above). Its presence in consumer products and in the workplace has been reduced because it causes a form of leukemia. Its chemical formula is C6H6; it is a six-membered ring with alternating double bonds and a hydrogen on each carbon. The ring opens when metabolized, causing the formation of reactive and toxic chemicals. Benzine, a name applied to automotive fuel in Europe, is a solvent mixture.
This is a trade name for several inhalant products that contain either volatile nitrites or ethyl chloride.
These substances comprise a large class of industrial chemicals. Those which are highly volatile are sometimes subject to abuse. Chlorinated hydro-carbons undergo significant metabolism in the body, and these changes in chemical structure usually result in an increase of the solvent's toxicity. Because many of these metabolic products are reactive chemicals, they can produce injuries to the kidneys, the liver, and the blood-forming organs. Chlorinated hydrocarbon inhalation is also associated with lethal disorders of heart rhythm, ventricular arrhythmias.
Halogenated hydrocarbons are relatively nonreactive chemicals with very high vapor pressure that have been used to blow products out of containers through a tiny hole. Their widespread use in the early 1960s was followed by an epidemic of aerosol sniffing that led to cardiac arrhythmias and death among young people. The halogenshlorine, fluorine, and brominere used to make various chemicals for purposes ranging from propellants and refrigerants to fire extinguishers. Their use has been severely limited since the recognition that their release into the atmosphere depletes the upper layers of ozone, exposing the earth to excessive amounts of ultraviolet radiation. Freon is a brand name for a family of commercial products.
Chloroform, CHCl3, was one of the earliest solvents put to use as an anesthetic agent. It has been replaced with agents that are much less toxic. Its use in cough and cold medications is obsolete. Chloroform was widely abused in the nineteenth century.
This is a local anesthetic, CNS depressant, and refrigerant that has been subject to abuse by inhalation. Ethyl chloride has a very high vapor pressure, and spraying it directly into the mouth may freeze the tissues of the throat and cause fatal laryngospasm (contraction of the muscles of the throat and larynx), and the shutoff of air to the lungs. Ethyl chloride has been sold in canisters and spray cans (e.g., Black Jack). A related chemical, methyl chloride, has similar effects and was used in refrigerators until it was recognized as highly poisonous in closed spaces.
A volatile anesthetic agent subject to abuse by inhalation, ethyl ether was used as an inhalation anesthetic for many years. It has been supplanted by other agents with fewer recovery side effects, such as headache, nausea, and vomiting. It is explosive. Ethyl ether was drunk during the Whiskey Rebellion of the eighteenth century, when heavy taxes were imposed on whiskey. Consumed by this route, ether "tanned" (hardened dramatically) the soft palate. When swallowed, profound intoxication follows, but recovery is faster than from alcohol. Alcohol is metabolized at a fixed number of grams per hour, except under extreme conditions; ethyl ether is eliminated by exhalation.
Freon is a brand name applied to a class of aerosol propellants. See Chlorofluorocarbon Propellants, above.
Gasoline, a fuel that powers internal combustion engines, is a complex petroleum product that is subject to abuse by inhalation. The toxicity produced from gasoline exposure depends on the constituents of the mixture and the route of administration. Oral ingestion of gasoline is usually followed by vomiting; subsequent aspiration of gasoline liquid into the lungs is followed by a frequently fatal chemical pneumonia. Deliberate inhalation of leaded gasoline fumes can lead to brain injury related to absorption of tetraethyl lead, a very toxic chemical.
Glues are made by dissolving a sticky or adhesive material in a solvent. When the solvent evaporates, the adhesive material remains attached to the surfaces to which it is applied, sticking them together. Glues are complex mixtures formulated for specific purposes. They are not designed for human consumption. When inhaled, they may produce severe injury or death. Most of the solvents used in glues are flammable, and fires have resulted from their inappropriate use. The solvent mixtures in glues and glue thinners are designed to dissolve the solid glue material and to evaporate evenly at a rate appropriate for the product. Solvents of relatively low industrial purity are used in these products; they are usually complex mixtures whose formulation changes with market price. Their toxicity can be great when concentrated and inhaled. Some manufacturers label their products or add irritants in an attempt to dissuade youths from deliberately inhaling these products.
Hexane is a volatile solvent that contains six carbons in a straight chain and has the chemical formula C6H14. It can cause severe damage to the peripheral nervous system, producing death of the long myelinated nerves (distal axonopathy). This condition results in an inability to walk, loss of muscle mass in all limbs, and sometimes loss of bowel and bladder control. This injury occurs because hexane is metabolized to a gamma-diketone. Another solvent subject to abuse that undergoes the same change in the body is methylbutylketone.
Nitrous oxide is a volatile analgesic and anesthetic agent. It was discovered at the beginning of the nineteenth century by Sir Humphry Davy, who was looking for gases and vapors that might have some therapeutic use. Nitrous oxide quickly produces an inebriation that many found pleasurable, and it rapidly became the subject of much experimentation and merrymaking. Nitrous oxide parties became very fashionable, but could not long be limited to the upper classes. Popular demonstrations were conducted, and at one such demonstration Horace Wells noticed that a participant had injured his leg, yet seemed oblivious to the pain. Although Davy had noted that nitrous oxide deadened the pain of his toothaches, it was Wells who underwent the first tooth extraction using nitrous oxide for pain relief. The first widespread use of nitrous oxide for clinically significant pain relief was its use in childbirth by S. Klikovich. Nitrous oxide inhalation is about as effective as 30 mg of morphine for pain relief.
Nitrous oxide is not very soluble in either blood or brain tissue, and consequently it has a short duration of action and requires very high levels to produce effects, on the order of 15 to 30 percent by volume. Because the use of gases at this high a concentration might result in asphyxiation, special equipment is used to guard against this possibility in medical settings. Because it displaces oxygen, nitrous oxide frequently kills those who inhale it for pleasure in closed rooms or automobiles.
Nitrous oxide was long thought to be a relatively innocuous anesthetic, almost as safe as inert gases. Recent work has demonstrated, however, that its inhalation irreversibly inactivates methionine synthetase, and this enzyme inhibition produces a vita-min deficiency that can injure the peripheral nervous system. This was first observed in dentists and others with access to nitrous oxide and who inhaled it habitually. This nervous system injury is associated with numbness and clumsiness of the hands, and with Lhermitte's sign, a lightning-like shooting sensation that occurs when the patient bends the neck.
Nitrous oxide is used in dentistry because it has both analgesic and anxiety-relieving properties. It is used as a carrier gas and inducing agent in major surgery, facilitating induction of anesthesia maintained by other agents. Because it is not very soluble in blood, oxygen must be provided to patients at the end of the surgery, because the nitrous oxide can displace oxygen as it rushes out of the patient's body (diffusion hypoxia).
This chlorinated hydrocarbon solvent, used in the dry-cleaning industry, is also known as PERC (see Chlorinated Hydrocarbons, above).
Toluene (methyl benzene, toluol) is an aromatic hydrocarbon solvent widely used in industrial processes, fuels, and consumer products. It is among the least irritating of the aromatic hydrocarbon solvents. When inhaled, it can produce CNS depression, like alcohol and other solvents. Its pharmacologic effects resemble those of other CNS depressant drugs, displaying actions like those of medications used for the treatment of epilepsy or for the clinical management of anxiety.
Toluene is removed from the body by exhalation and by metabolism. It is metabolized to methylhippuric acid, and is excreted by the kidneys. Overexposure to toluene can produce distal tubular acidosis of the kidney, an injury attributable to excess acidity that is reversible upon termination of exposure. Toluene has been demonstrated to produce loss of high-frequency hearing in laboratory animals following repeated high exposure, such as occurs during solvent abuse. Toluene also has been implicated in severe injuries to the nervous system in a large number of patients who deliberately inhaled toluene-containing solvents. These injuries are characterized by injury and loss of brain tissue. Patients display flattened emotional responses, impaired cognitive abilities, and a wide, shuffling gait associated with injury to the cerebellum. Animal studies have not yet conclusively demonstrated that toluene alone is responsible for this severe brain injury syndrome; nonetheless, solvent abusers who inhale toluene-containing mixtures run a very high risk of irreversible brain injury.
1, 1, 1 TRICHLOROETHANE (TCE)
This is a chlorinated hydrocarbon solvent with very high vapor pressure. It is useful in products that need to dry quickly, such as liquid paper products used to cover errors. The deliberate inhalation of these products has been associated with sudden death from ventricular arrhythmias (see Chlorinated Hydrocarbons, above).
A chlorinated hydrocarbon solvent used as a degreaser and dry-cleaning agent, it is subject to abuse by inhalation. When alcohol is consumed after exposure to trichloroethylene, profound blushing of the face occurs, the "degreaser's flush." One of the metabolites of trichloroethylene is chloral hydrate, an anesthetic agent used in "Mickey Finns," drinks used criminally to anesthetize robbery victims.
Whippets are small canisters of nitrous oxide used at soda fountains to make whipped cream. They have been incorporated into various products, such as balloon inflators, "carburetor pipes," and other drug paraphernalia (see Nitrous Oxide, above).
(SEE ALSO: Complications; Ethnicity and Drugs; High School Senior Survey; Inhalants: Extent of Use and Complications)
RONALD W. WOOD