Inhalant abuse

Question 1

What is inhalant abuse?

Answer 1

Deliberate inhalation of a volatile substance to achieve an altered mental state

Question 2

What percentage of Canadians 15yo reported lifetime use of inhalants in 2004?

Answer 2

1.3 +/- 0.3%

Question 3

Which groups are more at risk for inhalant abuse?

Answer 3

1. School dropouts
2. Physical or Sexual abuse victims
3. Neglect
4. Incarcerated
5. Homeless
6. Aboriginal
7. Rural
8. Reduced family support
9. Deviant family environments
10. Poor school performance
11. Poor self-esteem
12. Suicidality
13. Psychiatric conditions
14. Other substance abuse

Question 4

What are the most commonly abused inhalant substances?

Answer 4

Gasoline 41%
Paint 13%
Propane/butane 6%
Air fresheners 6%
Formalin 5%

Question 5

What are the majority of inhalant-related deaths from?

Answer 5

Gasoline 45%
Air fresheners 26%
Propane/butane 11%

Question 6

What are examples of aliphatic, aromatic, and halogenated hydrocarbons?

Answer 6

Examples: Hair spray, air fresheners, deodorants

Fuels including cigarette lighters

Paint/polish removers, paint thinners, felt-tip markers, correction fluids, glues and rubber cements

Varnishes, lacquers,resins, lacquer thinners

Dry cleaning fluids, spot removers, degreasers

Computer/electronics cleaning sprays

Vegetable oil cooking sprays

Medical anesthetics

Chemicals: Butane, propane, fluorocarbons

Gasoline, propane, benzene, butane

Trichloroethane, trichloroethylene, toluene, hexane, acetone, methylene chloride, ethyl acetate

Benzene, xylene

Trichloroethane, tetrachloroethylene, xylene

Dimethyl ether, hydrofluorocarbons, hydrocarbons

Hydrocarbons

Diethyl ether, halothane, enflurane, ethyl chloride

Other terms: Medusa, moon gas, poor man’s pot,
air blast, discorama, hippie crack,
chroming, gladding, whiteout

Question 7

What are examples of nitrous oxide?

Answer 7

Whipping cream aerosols, balloon tanks, anesthetics

Other terms: Lauging gas, shoot the breeze, whippets,
buzz bomb

Question 8

What are examples of volatile alkyl nitrites?

Answer 8

Examples: Angina medications, ‘room odourizers’, videocassette recorder head cleaners, synthesized products

Chemicals: Amyl nitrities, butyl nitrites, cyclohexyl nitrite, isopropyl nitrite, other nitrites

Other terms: Medusa, moon gas, pearls, boppers,
snappers, poppers, amys, bolt, quicksilver, rush, climax, aroma of men, hardware, locker room, thrust

Question 9

What is sniffing or snorting?

Answer 9

Direct inhalation of fumes

Question 10

What is bagging?

Answer 10

Direct inhalation of fumes from a plastic or paper bag

Question 11

What is huffing?

Answer 11

Direct inhalation of fumes from a rag or cloth soaked in the substance held over the mouth or nose

Question 12

What is glading?

Answer 12

Direct inhalation of fumes from air freshener aerosols

Question 13

What is dusting?

Answer 13

Direct spraying of aerosol cleaners into the mouth or nose

Question 14

What are the immediate effects?

Answer 14

1. Stimulation
2. Disinhibition
3. Euphoria
4. Hallucinations
5. General depression including slurred speech, disturbed gait, dizziness, disorientation, drowsiness, sleep
6. Headache
7. Freezing and burning of face and upper aerodigestive tract
8. Respiratory arrest due to CNS depression
9. Fatal vagal depression from cooling of the larynx
10. “Sudden sniffing death syndrome” likely due primarily cardiac arrhythmia
11. Dangerous behavior
12. Aspiration and suffocation
13. Volatile alkyl nitrites vasodilatory effects i.e. hypotension, syncope, sensations of warmth and flushing
14. “Poppers” sphincter relaxation effect and penile engorgement in young men for anal sex with links to increased HIV transmission

Question 15

What are the long term effects of inhalant abuse?

Answer 15

1. Irreversible damage of myelin and neuronal membranes by lipophilic chemicals
2. Brainstem dysfunction and a variety of motor, cognitive and sensory deficits –> irritability, tremor, ataxia, nystagmus, slurred speech, decreased visual acuity, deafness
3. Cardiomyopathy with distinct ECG changes
4. Dyspnea
5. Emphysema-like abnormalities
6. Other pulmonary debilitations
7. Distal renal tubular acidosis
8. Hepatitis
9. Bone marrow toxicity (i.e. aplastic anemia, leukemia) from hydrocarbons
10. Volatile nitrites –> immune impairment, replication of HIV and Kaposi’s sarcoma, carcinogenic nitrosamine and methemoglobin as metabolites
11. Menstrual disorders
12. Pre-eclampsia
13. Spontaneous abortions
14. Teratogenic effects “fetal solvent syndrome”
15. Neonatal withdrawal: high-pitched cry, disturbed feeding and sleep
16. Poor school performance
17. Criminal behaviors
18. Abuse of other substances
19. Social maladjustment
20. Low self esteem
21. Suicidality

Question 16

What signs of inhalation abuse are seen on presentation?

Answer 16

1. Odour on the breath
2. Stains, paint, glitter and/or odour on skin or clothing
3. Perioral dryness or pyodermas
4. “Huffer’s rash”
5. Facial, oral/nasal or esophagopharyngeal freezing or burning w/ secondary edema of lips, oropharynx, trachea
6. Confusion, moodiness, irritability
7. Wheezing, emphysema, dyspnea
8. Poor hygiene
9. Weight loss
10. Fatigue
11. Epistaxis
12. Conjunctivitis
13. Muscle weakness
14. Nausea
15. Apathy
16. Poor appetite

Question 17

What is the CRAFFT Screening Tool?

Answer 17

C –> Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

R –> Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?

A –> Do you ever use alcohol or drugs while you are by yourself or, Alone?

F –> Do you ever Forget things you did while using alcohol or drugs?

F –> Do your Family members or Friends ever tell you that you should cut down on your drinking or drug use?

T –> Have you ever gotten into Trouble while you were using alcohol or drugs?

Question 18

HCP should make themselves aware of the following key points regarding inhalant abuse:

Answer 18

1. epidemiology and trends;
2. its signs and symptoms, effects and dangers, and the treatment of acute cases;
3. screening techniques; and
4. the availability of local resources for prevention, intervention and treatment.

Question 19

What should HCP educate children, youth, schools, teachers, media and policy-makers about regarding inhalant abuse?

Answer 19

1. types and examples of abused chemicals;
2. signs and dangers of inhalant abuse;
3. intervention and treatment: what to do if someone suspects another is abusing;
4. combating misconception: advise that even casual substance abuse is dangerous.

Question 20

What are recommendations regarding HCP?

Answer 20

1. play a guiding role in creating a network of health and community care for inhalant abusers;
2. guide policy regarding inhalant abuse prevention education and treatment;
3. ensure that the social determinants of health affecting inhalant abuse are understood and considered in policy;
4. advocate for the replacement of dangerous and psychoactive substances in common products with less harmful alternatives;
5. advocate for and contribute to research that increases our understanding of inhalant abuse – including epidemiology, and effective prevention and treatment strategies that address the social determinants of health – particularly in Aboriginal peoples, with research that is specific to First Nations, Métis and Inuit populations.

Question 21

What are the recommendations regarding treatment?

Answer 21

Health services and authorities should ensure access to effective family-based treatment programs, including long-term residential treatment when required.