Drug Information - Inhalants Addiction
What are inhalants?
Inhalants are volatile substances that produce chemical vapors that can be
inhaled to induce a psychoactive, or mind-altering, effect. Although other
abused substances can be inhaled, the term "inhalants" is used to describe a
variety of substances whose main common characteristic is that they are rarely,
if ever, taken by any route other than inhalation. This definition encompasses
a broad range of chemicals found in hundreds of different products that may
have different pharmacological effects. As a result, precise categorization of
inhalants is difficult. One classification system lists four general categories
of inhalants - volatile solvents, aerosols, gases, and nitrites - based on the
form in which they are often found in household, industrial, and medical
products.
Inhalants fall into the following categories:
Solvents
Volatile solvents are liquids that vaporize at room temperatures. They are
found in a multitude of inexpensive, easily available products used for common
household and industrial purposes. These include paint thinners and removers,
dry-cleaning fluids, degreasers, gasoline, glues, correction fluids, and
felt-tip marker fluids.
Aerosols are sprays that contain propellants and solvents. They include spray
paints, deodorant and hair sprays, vegetable oil sprays for cooking, and fabric
protector sprays.
-
Industrial or household solvents or solvent-containing products, including
paint thinners or removers, degreasers, dry-cleaning fluids, gasoline, and glue
-
Art or office supply solvents, including correction fluids, felt-tip-marker
fluid, and electronic contact cleaners
Gases
Gases include medical anesthetics as well as gases used in household or
commercial products. Medical anesthetic gases include ether, chloroform,
halothane, and nitrous oxide, commonly called "laughing gas." Nitrous oxide is
the most abused of these gases and can be found in whipped cream dispensers and
products that boost octane levels in racing cars. Household or commercial
products containing gases include butane lighters, propane tanks, whipped cream
dispensers, and refrigerants.
-
Gases used in household or commercial products, including butane lighters and
propane tanks, whipped cream aerosols or dispensers (whippets), and refrigerant
gases
-
Household aerosol propellants and associated solvents in items such as spray
paints, hair or deodorant sprays, fabric protector sprays, and aerosol computer
cleaning products
-
Medical anesthetic gases, such as ether, chloroform, halothane, and nitrous
oxide ("laughing gas")
Nitrites
Nitrites often are considered a special class of inhalants. Unlike most other
inhalants, which act directly on the central nervous system (CNS), nitrites act
primarily to dilate blood vessels and relax the muscles. While other inhalants
are used to alter mood, nitrites are used primarily as sexual enhancers.
Nitrites include cyclohexyl nitrite, isoamyl (amyl) nitrite, and isobutyl
(butyl) nitrite, and are commonly known as "poppers" or "snappers." Amyl
nitrite is used in certain diagnostic procedures and was prescribed in the past
to treat some patients for heart pain. Nitrites are now prohibited by the
Consumer Product Safety Commission, but can still be found, sold in small
bottles, often labeled as "video head cleaner," "room odorizer," "leather
cleaner," or "liquid aroma."
-
Organic nitrites are volatiles that include cyclohexyl, butyl, and amyl
nitrites, and are commonly known as "poppers." Amyl nitrite is still used for
medical purposes. Volatile nitrites are often sold in small brown bottles and
labeled as "video head cleaner," "room odorizer," "leather cleaner," or "liquid
aroma."
Health Hazards
Although they differ in makeup, nearly all abused inhalants produce short-term
effects similar to anesthetics, which act to slow down the body's functions.
When inhaled in sufficient concentrations, inhalants can cause intoxication,
usually lasting only a few minutes.
However, sometimes users extend this effect for several hours by breathing in
inhalants repeatedly. Initially, users may feel slightly stimulated. Repeated
inhalations make them feel less inhibited and less in control. If use
continues, users can lose consciousness.
Sniffing highly concentrated amounts of the chemicals in solvents or aerosol
sprays can directly induce heart failure and death within minutes of a session
of repeated inhalations. This syndrome, known as "sudden sniffing death," can
result from a single session of inhalant use by an otherwise healthy young
person. Sudden sniffing death is particularly associated with the abuse of
butane, propane, and chemicals in aerosols.
High concentrations of inhalants also can cause death from suffocation by
displacing oxygen in the lungs and then in the central nervous system so that
breathing ceases. Deliberately inhaling from a paper or plastic bag or in a
closed area greatly increases the chances of suffocation. Even when using
aerosols or volatile products for their legitimate purposes (i.e., painting,
cleaning), it is wise to do so in a well-ventilated room or outdoors.
Chronic abuse of solvents can cause severe, long-term damage to the brain, the
liver, and the kidneys.
Harmful irreversible effects that may be caused by abuse of
specific solvents include:
-
Hearing loss-toluene (spray paints, glues, dewaxers) and trichloroethylene (dry
cleaning chemicals, correction fluids)
-
Peripheral neuropathies, or limb spasms-hexane (glues, gasoline) and nitrous
oxide (whipped cream dispensers, gas cylinders)
-
Central nervous system or brain damage-toluene (spray paints, glues, dewaxers)
-
Bone marrow damage-benzene (gasoline)
Serious but potentially reversible effects include:
-
Liver and kidney damage-toluene-containing substances and chlorinated
hydrocarbons (correction fluids, dry cleaning fluids)
-
Blood oxygen depletion-aliphatic nitrites (known on the street as poppers,
bold, and rush) and methylene chloride (varnish removers, paint thinners)
Extent of Use
Initial use of inhalants often starts early. Some young people may use
inhalants as an easily accessible substitute for alcohol. Research suggests
that chronic or long-term inhalant abusers are among the most difficult drug
abuse patients to treat. Many suffer from cognitive impairment and other
neurological dysfunction and may experience multiple psychological and social
problems.
Brief Description:
Breathable chemical vapors that users intentionally inhale because of the
chemicals' mind-altering effects. The substances inhaled are often common
household products that contain volatile solvents or aerosols.
Street Names:
Whippets, poppers, snappers.
Effects:
Most inhalants produce a rapid high that resembles alcohol intoxication. If
sufficient amounts are inhaled, nearly all solvents and gases produce
anesthesia, a loss of sensation, and even unconsciousness.
Statistics and Trends:
Inhalants are often among the first drugs that young kids use. In NIDA's 2005
Monitoring the Future study, 17.1% of 8th graders, 13.1% of 10th graders, and
11.4% of 12th graders said they had abused inhalants at least once.
How can inhalant abuse be recognized
Early identification and intervention are the best ways to stop inhlants abuse
before it causes serious health consequences. Parents educators, family
physicians and other health care pratitioners should be alert to the following
signs of a serious inhalant abuse problems:
-
Chemical odors on breath or clothing
-
Pait on other
-
Hidden empty spray paintor solvent containers and chemical- soaked rags or
clothing
-
Drink or disoriented apperance
-
sturred speech
-
Nausea or loss of appetite
-
Inattentiveness, lack of coordination irritability and depression
What are the patterns of inhalant abuse?
Inhalants - particularly volatile solvents, gases, and aerosols - are often
among the first drugs that young children use. One national survey indicates
that about 3.0 percent of U.S. children have tried inhalants by the time they
reach fourth grade. Inhalant abuse can become chronic and extend into
adulthood.
Generally, inhalant abusers will abuse any available substance. However,
effects produced by individual inhalants vary, and some individuals will go out
of their way to obtain their favorite inhalant. For example, in certain parts
of the country, "Texas shoe-shine," a shoe-shining spray containing the
chemical toluene, is a local favorite. Silver and gold spray paints, which
contain more toluene than other spray colors, also are popular inhalants.
Data from national and State surveys suggest inhalant abuse reaches its peak at
some point during the seventh through ninth grades. In the Monitoring the
Future (MTF) study, an annual NIDA-supported survey of the Nation's secondary
school students, 8th-graders also regularly report the highest rate of current,
past year, and lifetime inhalant abuse; 10th- and 12th-graders report less
abuse.
Percent of 8th-Graders Reporting Lifetime Use of Inhalants
Increased
Gender differences in inhalant abuse have been identified at different points
in childhood. The 2004 MTF indicates that 10.5 percent of 8th grade females
reported using inhalants in the past year, compared with 8.8 percent of 8th
grade males. Among 12th- graders, 3.4 percent of females and 4.8 percent of
males reported using inhalants in the past year. The National Survey on Drug
Use and Health (NSDUH), an annual survey of drug use among the Nation's
noninstitutionalized civilians, reports that similar percentages of 12- to
17-year-old boys and girls abused inhalants in 2003. However, the percentage of
18- to 25-year-old males who abused inhalants within the past month was more
than twice that of females in that age group, suggesting that sustained abuse
of inhalants is more common among males.
People who abuse inhalants are found in both urban and rural settings. Research
on factors contributing to inhalant abuse suggests that adverse socioeconomic
conditions, a history of childhood abuse, poor grades, and dropping out of
school all are associated with inhalant abuse.
What is the scope of inhalant abuse?
Inhalant abuse was up significantly for the second year in a row among
8th-graders, according to the latest MTF data, while use among 10th- and
12th-graders continued to decline.
The rate of high school seniors who abused inhalants in the past year was 4.2
percent in 2004, down from the peak of 8.0 percent in 1995.
Annual abuse of inhalants among 10th-graders was 5.9 percent in 2004, also down
from a high in 1995 (9.6 percent). Among 8th-graders, 2004 abuse figures, at
9.6 percent, were down overall from the 1995 peak of 12.8 percent, but were up
from the 2002 rate of 7.7 percent.
According to the 2003 NSDUH, lifetime, past year, and past month inhalant use
among persons aged 12 to 17 were 10.7 percent, 4.5 percent, and 1.3 percent,
respectively. The number of new inhalant users increased from 627,000 new users
in 1994 to 1 million in 2002. Inhalant initiates were predominantly under age
18 (78 percent in 2002).
MTF's lifetime prevalence figures indicate that the percentages of students who
have tried inhalants continue to decrease steadily for 10th- and 12th-graders.
In 2004, 12.4 percent of 10th-graders and 11.9 percent of 12th-graders said
they have abused inhalants at least once in their lives. Although lifetime
prevalence peaked for 8th-graders in 1995 (21.6 percent), rates of inhalant use
among this group are still high. In fact, 8th-graders reported a significant
increase in lifetime use from 15.8 percent in 2003 to 17.3 percent in 2004. For
10th-graders, the peak was 19.3 percent in 1996. For seniors, rates were
highest in 1994 at 17.7 percent. These data raise a question: How can fewer
12th-graders than 8th-graders consistently report they have ever abused
inhalants? Possibly, many 12th-graders fail to recall their much earlier use of
inhalants or, more troubling, many 8th-grade inhalant abusers may have dropped
out of school by the 12th grade and are no longer included in the survey
population.
How are inhalants used?
Inhalants can be breathed in through the nose or the mouth
in a variety of ways, such as:
-
"Sniffing" or "snorting" fumes from containers;
-
Spraying aerosols directly into the nose or mouth;
-
"Bagging"-sniffing or inhaling fumes from substances sprayed or deposited
inside a plastic or paper bag;
-
"Huffing" from an inhalant-soaked rag stuffed in the mouth; and
-
Inhaling from balloons filled with nitrous oxide.
Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream
and quickly distributed to the brain and other organs. Within seconds of
inhalation, the user experiences intoxication along with other effects similar
to those produced by alcohol. Alcohol-like effects may include slurred speech,
an inability to coordinate movements, euphoria, and dizziness. In addition,
users may experience lightheadedness, hallucinations, and delusions.
Because intoxication lasts only a few minutes, abusers frequently seek to
prolong the high by continuing to inhale repeatedly over the course of several
hours, a very dangerous practice. With successive inhalations, abusers can
suffer loss of consciousness and death. At the least, they will feel less
inhibited and less in control. After heavy use of inhalants, abusers may feel
drowsy for several hours and experience a lingering headache.
How do inhalants produce their effects?
Many brain systems may be involved in the anesthetic, intoxicating, and
reinforcing effects of different inhalants. Nearly all abused inhalants (other
than nitrites) produce a pleasurable effect by depressing the CNS. Evidence
from animal studies suggests that a number of commonly abused volatile solvents
and anesthetic gases have neurobehavioral effects and mechanisms of action
similar to those produced by CNS depressants, which include alcohol and
medications such as sedatives and anesthetics.
A recent study indicates that toluene, a solvent found in many commonly abused
inhalants, including model airplane glue, paint sprays, and paint and nail
polish removers, activates the brain's dopamine system. The dopamine system has
been shown to play a role in the rewarding effects of many drugs of abuse.
Nitrites, in contrast, dilate and relax blood vessels rather than acting as
anesthetic agents.
What are the short- and long-term effects of inhalant use?
Although the chemical substances found in inhalants may produce various
pharmacological effects, most inhalants produce a rapid high that resembles
alcohol intoxication with initial excitation, then drowsiness, disinhibition,
lightheadedness, and agitation. If sufficient amounts are inhaled, nearly all
solvents and gases produce anesthesia, a loss of sensation, and even
unconsciousness.
The chemicals found in solvents, aerosol sprays, and gases can produce a
variety of additional effects during or shortly after use. These effects are
related to inhalant intoxication and may include belligerence, apathy, impaired
judgment, and impaired functioning in work or social situations. Dizziness,
drowsiness, slurred speech, lethargy, depressed reflexes, general muscle
weakness, and stupor are other possible effects. For example, research shows
that toluene can produce headache, euphoria, giddy feelings, and inability to
coordinate movements. Exposure to high doses can cause confusion and delirium.
Nausea and vomiting are other common side effects.
Inhaled nitrites dilate blood vessels, increase heart rate, and produce a
sensation of heat and excitement that can last for several minutes. Other
effects can include flush, dizziness, and headache. Unlike other inhalants,
which are abused mainly for their intoxicating effects, nitrites are abused
primarily because they are believed to enhance sexual pleasure and performance.
A strong need to continue using inhalants has been reported among many
individuals, particularly those who abuse inhalants for prolonged periods over
many days. Compulsive use and a mild withdrawal syndrome can occur with
long-term inhalant abuse. Additional symptoms exhibited by long-term inhalant
abusers include weight loss, muscle weakness, disorientation, inattentiveness,
lack of coordination, irritability, and depression.
What are the medical consequences of inhalant abuse?
Inhalant abusers risk an array of devastating medical consequences. Prolonged
sniffing of the highly concentrated chemicals in solvents or aerosol sprays can
induce irregular and rapid heart rhythms and lead to heart failure and death
within minutes of a session of prolonged sniffing. This syndrome, known as
"sudden sniffing death," can result from a single session of inhalant use by an
otherwise healthy young person. Sudden sniffing death is particularly
associated with the abuse of butane, propane, and chemicals in aerosols.
Inhalant abuse also can cause death by:
-
Asphyxiation - from repeated inhalations, which lead to high concentrations of
inhaled fumes displacing the available oxygen in the lungs;
-
Suffocation - from blocking air from entering the lungs when inhaling fumes
from a plastic bag placed over the head;
-
Convulsions or seizures - caused by abnormal electrical discharges in the
brain;
-
Coma - the brain shuts down all but the most vital functions;
-
Choking - from inhalation of vomit after inhalant use; or
-
Fatal injury - from accidents, including motor vehicle fatalities, suffered
while intoxicated.
Animal and human research shows that most inhalants are extremely toxic.
Perhaps the most significant toxic effect of chronic exposure to inhalants is
widespread and long-lasting damage to the brain and other parts of the nervous
system. For example, both animal research and human pathological studies
indicate that chronic abuse of volatile solvents such as toluene damages the
protective sheath around certain nerve fibers in the brain and peripheral
nervous system. This extensive destruction of nerve fibers is clinically
similar to that seen with neurological diseases such as multiple sclerosis.
The neurotoxic effects of prolonged inhalant abuse include neurological
syndromes that reflect damage to parts of the brain involved in controlling
cognition, movement, vision, and hearing. Cognitive abnormalities can range
from mild impairment to severe dementia. Other effects can include difficulty
coordinating movement, limb spasms, and loss of feeling, hearing, and vision.
Inhalants also are highly toxic to other organs. Chronic exposure can produce
significant damage to the heart, lungs, liver, and kidneys. Although some
inhalant-induced damage to the nervous and other organ systems may be at least
partially reversible when inhalant abuse is stopped, many syndromes caused by
repeated or prolonged abuse are irreversible.
Abuse of inhalants during pregnancy also may place infants and children at
increased risk of developmental harm. Animal studies designed to simulate human
patterns of inhalant abuse suggest that prenatal exposure to toluene or
trichlorethylene (TCE) can result in reduced birth weights, occasional skeletal
abnormalities, and delayed neurobehavioral development. A number of case
reports note abnormalities in newborns of mothers who chronically abuse
solvents, and there is evidence of subsequent developmental impairment in some
of these children. However, no well- controlled, prospective study of the
effects of prenatal exposure to inhalants in humans has been conducted, and it
is not possible to link prenatal exposure to a specific chemical to a specific
birth defect or developmental problem.
Arnyl nitrite, butyl nitrite
Sudden sniffing death syndrome, suppressed immunologic function, injury to red
blood cells ( interfering with oxygen supply to vital tissues)
Benzene ( found in gasoline)
Bone marrow injury, impaired immunologic function, increased risk of leukemia,
reproductive system toxicity.
Butane, Propane ( found in lighter fluid, Hair and paint
sprays)
Sudden sniffing death syndrome via cardiac effects, serious burn injuries (
because of flammability)
Freon (used as a refrigerant and aerosol propelant)
Sudden sniffing death syndrome, respiratory obsstruction and death ( from
sudden cooling / cold injury to always), liver damage.
Methylene Chloride (found in paint thinners and removers,
degreasers)
Reduction of oxygen-carrying capacity of blood, changes to the heart muscle and
heartbeat.
Nitrous Oxide ("Laughing gas"), Hexane
Death from lack of oxygen to the brain, altered perception and motor
coordination, loss of sensation, limb spasms, blackouts caused by blood
pressure changes, depression of heart muscle functioning.
Toluene (found in gasoline, paint tinners and removers,
correction fluid)
Brain damage (loss of brain tissue mass, impaired cognition, gait disturbance,
loss of coordination, loss of equilibrium, limb spasms, hearing and vision
loss), liver and kidney damage.
Trichlorethylene (found in spot removers, degreasers)
Sudden sniffing death syndrome, cirrhosis of the liver, reproductive
complications, hearing and vision damage.
What are the special risks for nitrite abusers?
Nitrites are abused mainly by older adolescents and adults. Typically,
individuals who abuse nitrites are seeking to enhance sexual function and
pleasure. Research shows that abuse of these drugs in this context is
associated with unsafe sexual practices that greatly increase the risk of
contracting and spreading such infectious diseases as HIV/AIDS and hepatitis.
Animal research raises the possibility that there may be a link between abuse
of nitrite inhalants and the development and progression of infectious diseases
and tumors. The research indicates that inhaling nitrites depletes many cells
in the immune system and impairs immune system mechanisms that fight infectious
diseases. A recent study found that even a relatively small number of exposures
to butyl nitrite can produce dramatic increases in tumor incidence and growth
rates in animals.
|