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Summary Article: INHALANTS from Encyclopedia of Wellness

Inhalants are substances that have a chemical or volatile nature, leading to intoxication when inhaled into the lungs. These are readily available, and among the most common and insidious substances that we know to be abused. There are several general types of substances used as inhalants, whose chemical vapors can be inhaled for psychoactive (or mind-altering) effects. These include the categories of volatile substances—liquid solvents that vaporize at room temperature; cleaning fluids—industrial or household products; fuels—including propane and gasoline; aerosols—sprays containing propellants and solvents; gases—found in household or commercial products; nitrites—a special class of inhalants abused primarily as sexual enhancement; and medical anesthetics.

People often do not think of these kinds of products as drugs—these common products have other uses and were never intended to be misused in this way. According to a recent 2009 study, these everyday substances may include such ordinary household products as gasoline, various glues, paint thinner, nail polish, nail polish remover, and spray paint. Other products misused include rubber cement, airplane glue, aerosol whipping cream and hairspray, and correction fluid. This kind of substance use and abuse is a worldwide problem, since the substances are so readily available and relatively inexpensive. In 2008 some 2 million Americans, age 12 and older, had abused inhalants according to the National Institute on Drug Abuse (NIDA). Those statistics were part of the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health.

A minority of substances used as inhalants have medicinal purposes, such as nitrous oxide (a dental anesthetic) or amyl nitrite (which expands blood vessels, resulting in lowering of blood pressure). However, the majority of common substances mentioned above have no medicinal purpose. The abuse of these household products can be viewed as “recreational.”

As mentioned in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM–IV–TR; American Psychiatric Association, 2000), inhalant abuse is defined using the same listing of criteria identified for all other substance use disorders. In other words, abuse has one or more maladaptive patterns of use, resulting in clinically significant impairment or distress. This includes (1) recurrent failure to fulfill major role obligations; (2) recurrent use in physically hazardous situations; (3) recurrent substance-related legal problems; and (4) continued use despite persistent or recurrent social or interpersonal problems due to use. One marked exception is that a characteristic withdrawal symptom is not included in the DSM–IV–TR abuse criteria.

Inhalants are not regulated according to the Controlled Substances Act of 1970 (CSA), which serves as the foundation for the U.S. government's legal battle against drugs of abuse. Moreover, patterns of inhalant abuse are difficult to track, since there is lack of agreement of a national classification of inhalants. However, recent studies and trends in abuse and addiction have caused many state legislatures to place restrictions on the sale of many of these everyday household products to minors. As of 2000, according to the National Conference of State Legislatures, 38 states had “adopted laws preventing the sale, use, and/or distribution to minors of various products commonly abused as inhalants.” In addition, many states have fines, incarceration, or mandatory treatment in place for those selling, distributing, using, or possessing inhalants.

Inhalant intoxication and abuse comes in different formats. In certain cases, the abuser inhales vapors directly from containers or bottles originally packaged by the manufacturer (called “sniffing” or “snorting”). Other abusers pour a small portion into a plastic bag and inhale a concentrated amount (called “bagging”). Still others use rags or bandannas soaked in fluids and held over the mouth (called “huffing”). Abusers can be called “glueys” or “huffers.” Among the street names or slang for what can be “huffed” are glue, air gas, sniff, huff, boppers or poppers, discorama, hardware, snotballs, and laughing gas.

Short-term effects related to inhalant abuse include but are not limited to:

  • Loss of inhibitions;

  • Drowsiness;

  • Initial feelings of well-being and relaxation;

  • Flulike symptoms;

  • Reckless behavior;

  • Blurred vision;

  • Unpleasant breath;

  • Nosebleeds and sores around the mouth and nose.

Short-term effects of inhalants are felt immediately, since the chemical vapor enters the bloodstream directly from the lungs. Inhalants are depressants, so they slow down brain function and the activity of the central nervous system. This affects physical, mental, and emotional activity and responses. Common chemicals contained in these substances are fat-soluble, so the chemicals remain stored in the lungs, brain, heart, liver, and stomach lining for an extended period of time. This means that abuse often has long-term and lasting consequences. For example, the hippocampus—a region of the brain controlling memory—can be and often is affected by inhalant abuse. Abusers may lose the ability to learn new things, or even have a difficult time carrying on simple conversations. These short-term difficulties can be permanent.

Inhalants provide a sudden “high,” but can also lead to sudden oxygen deficiency, or hypoxia. This may lead to brain damage or even death. Inhalation of aerosol items can be especially dangerous: these devices can generate very high concentrations of inhaled chemicals. Any use of any type of inhalant can also cause Sudden Sniffing Death Syndrome, or SSDS. Even a single session of inhalant use can induce the potential of dying from SSDS. This condition involves serious cardiac arrhythmia, which happens during or immediately following repeated inhalation. Repeated and high concentrations of inhalants also can cause death from suffocation, since the user may lose consciousness and stop breathing.

One special use of inhalants is seen as a “party drug,” common to the nightclub scene. Amyl nitrite is typical of this sort of inhalant, and is made available in ampules (“poppers”). These are held to the nostrils for quick inhalation, specifically to enhance sexual arousal or stimulation. This type of drug—nitrites—are chemicals that cause vasodilation, and so have some legitimate health use, and are still used in certain medical procedures today. However, some variations of these nitrites have been banned from prescription use since the 1990s. They remain popular—in an illegal or nonprescribed form—among a certain segment of teens and young adults. The potential of SSDS remains with this form of inhalants, as well.

Heavy or frequent inhalant abuse often causes serious physical and psychological health problems. As described by the New Zealand Drug Foundation (“Inhalants and Solvents”), long-term effects may include but are not limited to:

  • Weight loss;

  • Muscle spasms or tremors;

  • Constant thirst;

  • Facial sores;

  • Memory loss;

  • Personality changes;

  • Irritability;

  • Seizures;

  • Constant irregular heartbeat;

  • Problems with breathing;

  • Brain and nerve damage;

  • Stupor or coma.

If the abuser continues to use, some of the above damage becomes irreversible. In fact, chronic inhalant abuse has come to be associated with neurological damage. Cognitive changes and abnormalities can be permanent, and can range from mild cognitive impairment to severe dementia.

Inhalants are one of the most easily obtained substances, so children and adolescents are among those most likely to abuse them. According to the NIDA, adolescents can abuse different products at different ages. For example, users ages 12–15 are likely to abuse glue, shoe polish, spray paints, gasoline, and lighter fluid. Inhalant abusers can be identified by such markers as organic solvent odors on their breath or clothes. In addition, concerned loved ones may possibly find spray paint canisters or solvent containers stashed nearby, along with the “huffing” materials such as stained rags or plastic bags.

Different classes of users (e.g., street children, school-aged children from certain geographic regions, or indigenous people-groups) are particularly prone to initial inhalant abuse. Young people involved with the juvenile system and those with exposure to the criminal justice system have been noted to be disproportionately affected by this kind of product abuse. Generally speaking, living in unhappy situations, with family-of-origin and/or school problems, poverty, child abuse and other forms of abusive behavior all are highly associated with inhalant abuse, according to a number of NIDA and other research studies (National Institute on Drug Abuse, “Inhalants”).

Nitrous oxide—one of the few medically relevant inhalants, commonly used for minor dental or outpatient procedures—has long been known to be abused widely among health professionals or their staff members. Similar to nitrous oxide are other anesthetics: ether, chloroform, and halothane. This is one kind of inhalant that is not as readily available to the general public, although if someone has connections or enough money, it can be obtained without a prescription by mail order, Internet, or fraudulent or illegal means.

There are specific laws on record in states across the country prohibiting the use or sale of inhalants, citing the particular chemical compounds that induce intoxication. For example, the state of Illinois has drug statutes that have been active since January 1997, stipulating that use of such chemicals (“in any manner changing, distorting or disturbing the auditory, visual or mental processes”) is legally deemed “an intoxicated condition.” These drug statutes are particularly stringent when it comes to the sale or delivery of such inhalants to young people under the age of 18.

If users do decide to suddenly stop inhalant use, withdrawal symptoms can appear. These often include anxiety, depression, loss of appetite, irritation, aggressive behavior, dizziness, nausea, and a high level of craving. These withdrawal symptoms sometimes resemble alcohol withdrawal. Inpatient drug and alcohol detoxification units have some familiarity with inhalants, more so than the typical hospital emergency department (ED). The point can be made that certain hospital EDs would have more understanding about inhalants, given their proximity to vulnerable subpopulations. However, the better option would be to provide an abuser who wanted to stop his use with knowledgeable medical and clinical help.

See also Addiction; Drugs, Recreational.

References
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. American Psychiatric Association Washington, DC, 2000.
  • Balster, R. L.; S. L. Cruz; M. O. Howard; C. A. Dell; L. B. Cottler.Classification of Abused Inhalants.” Addiction 104, no. 6 (2009): 878-82.
  • Hanson, G. R.; P. J. Venturelli; A. E. Fleckenstein.Inhalants.” Drugs and Society. 9th ed. Ch. 14, 418-29; “Appendix B, Drugs of Use and Abuse,” 570-75. Jones and Bartlett Burlington MA, 2006.
  • Illinois Drug Statutes, Criminal Offenses (720 ILCS 690/1-2) Use of Intoxicating Compounds Act. Enacted January 1997.
  • National Conference of State Legislatures. Unpublished information on inhalant legislation through June 2000.
  • National Institute on Drug Abuse. NIDA InfoFacts. “Inhalants.” Updated March 2010, http://drugabuse.gov/infofacts.
  • New Zealand Drug Foundation. “Inhalants and Solvents.” www.nzdf.org.nz/inhalants-solvents.
  • Perron, B. E.; M. O. Howard; M. G. Vaughn; C. S. Jarman.Inhalant Withdrawal as a Clinically Significant Feature of Inhalant Dependence Disorder.” Medical Hypotheses 73 (2009): 935-37.
  • Van Dusen, V.; A. R. Spies.An Overview and Update of the Controlled Substances Act of 1970.” Pharmacy Times, February 1, 2007. www.pharmacytimes.com/print.php?url=2007-02-6309.
  • Elizabeth Jones
    Copyright 2012 by Sharon Zoumbaris

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