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Inhalants |
InhalantsIntroduction
- What are inhalants? 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. 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. 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. And 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. Cyclohexyl nitrite is found in room odorizers. Amyl nitrite is used in certain diagnostic procedures and is prescribed to some patients for heart pain. Illegally diverted ampules of amyl nitrite are called "poppers" or "snappers" on the street. Butyl nitrite is an illegal substance that is often packaged and sold in small bottles also referred to as "poppers." What
are the patterns of inhalant abuse? 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. For example, the American Drug and Alcohol Survey of children in the 4th through 12th grades indicate that the percentage of children who have ever used inhalants peaks in the 8th grade. 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. Gender differences in inhalant abuse have been identified at different points in childhood. One study indicates inhalant abuse is higher for boys than girls in grades 4 through 6, occurs at similar rates in grades 7 through 9-when overall use is highest-and becomes more prevalent again among boys in grades 10 through 12. The National Household Survey on Drug Abuse (NHSDA), 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 1998. However, the percentage of 18- to 25-year-old males who abused inhalants 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, rather than racial or cultural factors per se, may account for most reported racial and ethnic differences in rates of inhalant abuse. Poverty, a history of childhood abuse, poor grades, and dropping out of school all are associated with inhalant abuse. Native American youths who live on reservations, where socioeconomic distress and school dropout rates are high, typically have higher rates of inhalant abuse than both the general population of young people and those Native American youths who do not live on reservations. What
is the scope of inhalant abuse? The percentage of high school seniors who abused any inhalants declined to 5.6 percent in 1999 from a peak of 8 percent in 1995. Abuse of nitrites, specifically, also declined to less than 1 percent (0.9) among seniors in 1999. Abuse of all inhalants by 10th-graders declined to 7.2 percent in 1999, from 9.6 percent in 1995. Among eighth-graders, abuse declined to 10.3 percent in 1999 from 12.8 percent in 1995. Despite the declines in abuse among schoolchildren in recent years, inhalants are still being abused at higher rates than they were a decade ago, according to the NHSDA. The 1998 survey indicates that the rate of first use among 12- to 17-year-olds rose significantly from 8.4 to 18.8 per 1,000 potential new users from 1989 to 1995 and remained at those levels through 1997. The rate of first use of inhalants for young adults aged 18 to 25 also rose, from 3.7 to 10.7 per 1,000 potential new users between 1989 and 1996, before leveling off in 1997. MTF's lifetime prevalence figures also indicate that the percentages of students who have tried inhalants remain at high levels. In 1999, 19.7 percent of 8th-graders, 17.0 percent of 10th-graders, and 15. 4 percent of 12th-graders said they had abused inhalants at least once in their lives. 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. The latter explanation is supported by research that shows higher rates of inhalant abuse among children who have poor grades or have dropped out of school than among their classmates who remain in good standing in school. How
are inhalants used?
Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream and quickly distributed to the brain and other organs. Within minutes 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, such as thinking they can fly. 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? A recent study indicates that toluene, a solvent found in many commonly abused inhalants including 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? 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?
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, spasticity, 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. What
are the special risks for nitrite abusers? Recent 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. Where
can I get further scientific information about inhalant
abuse? Fact sheets on the health effects of inhalants and other abused drugs and other drug abuse topics can be ordered free of charge, in English and Spanish, from NIDA Infofax at 1-888-NIH-NIDA (1-888-644-6432) or, for deaf persons, 1-888-TTY-NIDA (1-888-889-6432). Information is available also on the NIDA Web site (www.drugabuse.gov) or the NCADI Web site (www.health.org). Glossary Central nervous system: The brain and spinal cord. Dementia: A condition of deteriorated mentality. Dopamine: A neurotransmitter present in regions of the brain that regulate movement, emotion, motivation, and feeling of pleasure. Epidemiology: The sum of the factors controlling the presence or absence of a disease or condition. Toxic: Causing temporary or permanent effects that are detrimental to the functioning of a body organ or group of organs. Withdrawal: A variety of symptoms that occur after use of an addictive drug is reduced or stopped. References Bowen, S.E.; Wiley, J.L.; Evans, E.B.; Tokarz, M.E.; and Balster, R.L. Functional observational battery comparingeffects of ethanol, 1,1,1-trichlorethane, ether, and flurothyl. Neurotoxicology and Teratology 18(5):577-585, 1996. Edwards, R.W., and Oetting, E.R. Inhalant use in the United States. In: Kozel, N.; Sloboda, Z.; and De La Rosa, M. (eds.), Epidemiology of Inhalant Abuse: An International Perspective. National Institute on Drug Abuse Research Monograph 148. DHHS Publication No. NIH 95-3831. Washington, DC: U.S. Government Printing Office, 8-28, 1995. Fendrich, M.; Mackesy-Amiti, M.E.; Wislar, J.S.; and Goldstein, P.J. Childhood abuse and the use of inhalants: Differences by degree of use. American Journal of Public Health 87(5):765-769, 1997. Jones, H.E., and Balster, R.L. Inhalant abuse in pregnancy. Obstetrics and Gynecology Clinics of North America 25(1):153-167, 1997. National Institute on Drug Abuse. National Survey Results on Drug Use From the Monitoring the Future Study, 1999 (www.monitoringthefuture.org). National Institute on Drug Abuse. NIDA Infofax, Inhalants, 1999. Riegel, A.C., and French, E.D. Acute toluene induces biphasic changes in rat spontaneous locomotor activity which are blocked by remoxipride. Pharmacology, Biochemistry and Behavior 62(3):399-402, 1999. Sharp, C.W., and Rosenberg, N.L. Inhalants. In: Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and Langrod, J.G. (eds.), Substance Abuse: A Comprehensive Textbook, 3d. ed. Baltimore: Williams and Wilkins, 246-264, 1996. Sharp, C.W., and Rosenberg, N. Inhalant-related disorders. In: Tasman, A.; Kay, J.; and Lieberman, J.A. (eds.), Psychiatry, Vol. 1. Philadelphia: W.B. Saunders, 835-852, 1997. Substance Abuse and Mental Health Services Administration. Population Estimates From the 1998 National Household Survey on Drug Abuse. SAMHSA, 1999. Substance Abuse and Mental Health Services Administration. Summary Findings From the 1998 National Household Survey on Drug Abuse. SAMHSA, 1999. Soderberg, L.S. Immunomodulation by nitrite inhalants may predispose abusers to AIDS and Kaposi's sarcoma. Journal of Neuroimmunology 83(1-2):157-161, 1998. Soderberg, L.S. Increased tumor growth in mice exposed to inhaled isobutyl nitrite. Toxicology Letters 101(1-2):35-41, 1999. Woody, G.E.; Donnell, D,; Seage, G.R.; et al. Non-injection substance use correlates with risky sex among men having sex with men: Data from HIV/NET. Drug and Alcohol Dependence 53(3):197-205, 1999.279(6): 22-26, 1998. This information is available courtesy of the NIDA. It is in the public domain and can be downloaded, reproduced, or copied without permission. For more information go to http://www.nimh.nih.gov/practitioners/patinfo.cfm |