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Inhalants

Danger

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Inhalants can be fatal at any dosage and are impossible to use safely.

Our understanding of the literature is that there is no such thing as safe recreational use of volatile solvents, aerosols and other street inhalants : their psychoactive effects are inseparable from nerve and organ damage. It is strongly discouraged to take any amount of these substance.

Also known as

Whippets, volatile substances, tooting, solvents, petrol, inhalants, huffing, glues, glue sniffing, gases, gas, dusting, chroming, butane, aerosols, chroming, gasoline, glue, huff, poppers, sniff.

Classification

Inhalant, depressant

Overview

A wide range of glues, gases and aerosols contain volatile substances which, when breathed in or sniffed, get you high. Breathing in a volatile substance can make you feel uninhibited, euphoric and dizzy. But the effect they have on your heart can cause death, even if it's your first time (known as Sudden Sniffing Death).

Most glues, gases and aerosols have the same effects and the same risks, but there are a very small number - poppers and laughing gas - which have slightly different effects and/or levels of risk.

Abusing glues, gases and aerosols is sometimes called Volatile Substance Abuse (VSA) or Volatile Substance Misuse (VSM).

There are lots of glues, gases and aerosols which, when abused, can cause you harm. Many are normal household products - such as, gas lighter refills, aerosols containing hairspray, deodorants and air fresheners, tins or tubes of glue, some paints, thinners and correcting fluids, cleaning fluids, surgical spirit, dry-cleaning fluids and petrol.

Glues, gases and aerosols are breathed in or sniffed from something acting as a container or holder. There are several different ways to do this, but whatever method is used, it is difficult to control the dose and all methods are potentially fatal. The risk is greater if used in an enclosed space or if a plastic bag is used that covers both nose and mouth.

How long the hit lasts varies and some users tend to keep repeating the dose to keep the feeling going [1].

Domestic products such as spray deodorants, glue, lighter refills and spray air fresheners can be used as drugs.

Volatile substance use may be defined as the deliberate inhalation of volatile compounds to produce psychoactive effects. These compounds have few characteristics in common, other than their intoxication effects and the behavioural effects they produce. Such volatile substances are often referred to as inhalants, a term which encompasses a diverse group of psychoactive chemicals that are defined by the route of administration, rather than their mechanism of action on the central nervous system or psychoactive effects.

The use of volatile substances is unlike most other forms of drug use in that it involves various compounds contained in readily accessible domestic or commercial products. These compounds, that are safe when used for their intended purposes, may cause intoxication and in some cases death when their vapours are deliberately concentrated and inhaled [2].

Inhalants fall into the following four categories -

  • Volatile Solvents are liquids that vaporise when exposed to air at room temperature. They are found in numerous household cleaning products and industrial items.
  • Aerosols are sprays that contain solvents and propellants. They include spray-paint and various other types of sprays.
  • Gases include those used in household and commercial products as well as medical anesthetics. Medical anesthetic gases include ether, chloroform, and nitrous oxide ('laughing gas' or 'whippets'), the most abused of these gases.
  • Nitrites do not act directly on the central nervous system like most other inhalants; they primarily act to dilate blood vessels and relax the muscles. The two most commonly abused nitrites are amyl and butyl nitrite. 'Poppers' or 'snappers' are slang terms for small bottles of nitrites. See poppers for more information [3].

Chemicals in the product alter the user's mental state. Inhalants are cheap and readily available. Inhalant use usually starts at a young age and begins at home. In fact, with more than 1,000 products containing chemical vapours that can be found in the average household, inhalants are always available [4].

VSA stands for Volatile Substance Abuse, it has previously been called Glue Sniffing and Solvent Abuse. The VSA term is now used to include all the volatile substances including gases such as butane and aerosols which can be 'sniffed' for their effects [5].

What does it look like?

They vary greatly in appearance, most are normal household products that come in canister or bottles with a 'volatile substance' sign printed on it. They include the following; aerosols, hairspray, air fresheners, tins or tubes of glue, cleaning fluids, gas lighter refills, nail polish remover, surgical spirit, dry-cleaning fluid and thinners and correcting fluids. They can also include laughing gas which can be sold within balloons [6].

Source

Hairspray, deodorants, air freshners, thinners, petrol and fire extinguishers, gas lighter refills, tins or tubes of glue, some paints, thinners and correcting fluids, cleaning fluids, surgical spirit, dry-cleaning fluids and petroleum products. Found in the home or purchased from local shops [5].

Some common inhalants include -

  • aerosol spray,
  • chrome-based paint,
  • paint and paint thinner,
  • felt-tipped pens,
  • correction fluid (e.g. 'liquid paper'),
  • gas from lighters or barbecues (butane),
  • cleaning fluid,
  • glue,
  • petrol,
  • nitrous oxide [7].

Prevalence

Use of volatile substances is thought to be usually confined to short periods during early adolescence and may be superseded by use of other psychoactive substances (such as alcohol and cannabis) as age and disposable income increase access to alternatives. Long term or intensive use of volatile substances is generally confined to socially marginalised individuals or groups, often under-represented in general population household surveys and school surveys.

Lifetime prevalence of 'inhalant' use among 15- to 16-year-old school students ranged from 3% to 28% in the 24 EU Member States and Norway with ESPAD surveys in 2011. The highest lifetime prevalence rates in the EU are reported in Croatia, Latvia and Slovenia (28%, 23% and 20% respectively). In five countries, reported misuse of 'inhalants' is higher than cannabis use among the students [2].

In any given area, a proportion of adolescents mainly aged between 12 and 16 would have tried inhaling solvents. It is difficult to quantify, but statistics suggest that around 7.6% of secondary school children would have tried solvents at least once. VSA is often sporadic and isolated to hot spots or areas where it is hardly done.

Solvent abuse is the only drug where girls not only match boys, but sometimes outnumber them in taking the drug (usually around the age of 13 years). Only a minority will go on to become regular users, often inhaling alone to escape from personal problems. The UK does not measure adult volatile substance abuse. However, the mortality statistics indicate that whilst VSA mortality has fallen amongst young people, the mortality for adults has remained roughly the same since the 1980's.

Around 45 people die from solvent abuse every year and some of these fatalities will be first time users. The mortality rates in Scotland, Northern Ireland and the north East of England is higher than in the rest of the UK [8].

Street price

Cheap or free; many products that are used are household items, and so available for nothing. Others, such as cigarette refills, cost under £2 [9].

Why take it?

Sought after effects

  • dreaminess,
  • relaxed,
  • fits of giggles (with laughing gas) [6],
  • intoxication,
  • disinhibition,
  • reduced anxiety [5].

Undesired effects

  • can experience vomiting and blackouts,
  • mood swings,
  • aggressive behaviour and hallucinations,
  • potential breathing problems with chronic use,
  • memory impairment,
  • solvents and glue often perceived as a 'losers habit' in many circles [6],
  • confusion,
  • drowsiness,
  • loss of coordination,
  • slurred speech,
  • nausea,
  • visual disturbance [5].

What are the different forms?

Solvents

A solvent is something that emits vapours that can be inhaled for their psychoactive effects. The liquid form of the solvent itself is not used [10].

Toluene

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

Toluene is a chemical solvent commonly used in industry. It can found in gasoline, acrylic paints, varnishes, lacquers, paint thinners, adhesives, glues, rubber cement, airplane glue, and shoe polish, among various other common everyday household items. Around 23 degrees Celcius or room temperature, toluene is a colourless liquid with sweet smelling properties. It is a volatile liquid and rapidly releases vapours that can be inhaled. It is a known carcinogen.

Toluene is a liquid solvent that is volatile at room temperatures. It's vapours can be inhaled from soaking a rag in toluene containing liquids or sniffing the vapours directly from glue emitting toluene vapours [10].

Acetone

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

Acetone is a liquid solvent that is volatile at room temperatures. Its vapours can be sniffed and are known to have damaging physical effects [10].

Petrol/Gasoline

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

Petrol, or gasoline, is a toxic liquid that is volatile at room temperatures. This makes it easy to inhale the vapours from sniffing a container full of liquid gasoline and achieving effects ranging from hallucinations to numbness and cognitive euphoria [10].

Gases or Propellants

Gasses or propellants are inhalants that are inhaled directly into the lungs in their gaseous form [10].

Freon

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

This class of chemical refrigerants can be abused as a psychoactive drug. Pure freon is a brand manufactured by DuPont, the most current brand of freon being phased out of production is R-22 and contains primarily Chlorodifluoromethane. There are many different variants of the brand name 'freon' and the chemical composition varies along with the "R-x" name given the refrigerant. Some people huff freon directly from AC units and this is a dangerous practice as one does not know the exact type of freon found in an AC unit, much less the potential chemical contaminants found in the gas from the AC unit [10].

Difluoroethane and Tetrafluoroethane

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

These chemicals are commonly found in "Dust Off" brand cans of electronics cleaner [10].

Butane

Use of this inhalant can cause spontaneous death upon inhalation and is not advisable from a harm reduction point of view.

This chemical is often found in a compressed form in a can and can be inhaled directly. Using butane as a drug is dangerous due to possible oxygen deprivation. The direct inhalation of the gas can also cause drowsiness, narcosis, asphyxia, and cardiac arrhythmia among other CNS depressant effects. Butane is the most commonly abused volatile organic solvent in the United Kingdom and caused 52% of solvent-related deaths in 2000. When butane is sprayed directly into the throat, the jet of fluid can cool rapidly to the dangerous temperature of −20 °C by adiabatic expansion, causing prolonged laryngospasm and other bodily harm [10].

Medical anaesthetics

Nitrous Oxide

While not a volatile organic chemical, nitrous is often inhaled or huffed and is therefore technically an inhalant. It is also worth noting that this is one of the very few inhalants which are not inherently dangerous to use assuming that appropriate precautions are taken.

Nitrous oxide, commonly known as laughing gas, nitrous, nitro, NOS or hippy crack, is an inorganic molecule and chemical compound with the formula N2O. It is an oxide of nitrogen. At room temperature, it is a colourless and non-flammable gas with a slightly sweet odour and taste. It is used in surgery and dentistry for its anaesthetic and analgesic effects. It is known as "laughing gas" due to the euphoric effects of inhaling it, a property that has led to its recreational use as an atypical dissociative anaesthetic. The duration of these effects is approximately 2 - 5 minutes in length. It is also used as an oxidizer in rocketry and in motor racing to increase the power output of engines. At elevated temperatures, nitrous oxide is a powerful oxidizer similar to molecular oxygen [10].

See also Nitrous oxide.

Ether

Ether was commonly used in the 19th century for anaesthesia. It was also used as a psychoactive drug for its intoxicant effects. It can be drank in its liquid form but due to the volatility of the substance this practice is not advised. Pure ether is volatile at standard temperature and pressures, and the vapours of ether can be inhaled to experience its psychoactive effects [10].

Xenon

Xenon is an elemental gas that is reported to have psychoactive effects upon inhalation. This chemical is reported to have dissociative effects upon inhalation [10].

Pharmacology

The mode of action of these compounds is not well understood as is also the case for the volatile anaesthetics legitimately used in medical practice. It is the physical properties, such as volatility and fat solubility, of the compounds that determine their ability to be used as drugs. The chemical properties and consequently the degree to which they are metabolised may however be important in terms of morbidity because the metabolites may be toxic and cause lasting organ damage.

The intoxication induced by inhalation of volatile substances produces some behavioural effects similar to those due to alcohol. Minutes after inhalation, dizziness, disorientation and a short period of excitation with euphoria are observed, followed by a feeling of light-headedness and a longer period of depression of consciousness.

Marked changes in mental state are induced in people who misuse toluene and other solvents. Most users report elevation of mood and hallucinations. Potentially dangerous delusions can occur, thoughts are likely to be slowed, time appears to pass more quickly, and tactile hallucinations are common. These behavioural effects are accompanied by visual disturbances, nystagmus, incoordination and unsteady gait, slurred speech, abdominal pain and flushing of the skin.

The duration of action varies greatly, depending largely on the volatility of the compound. The effects of butane last only a few minutes - requiring frequent repeated doses - whereas toluene is much longer acting (more like alcohol) requiring less frequent doses. There are indications that toluene activates the brain's dopamine system that plays a role in the rewarding effects of many psychoactive drugs.

Most deaths are believed to occur from 'sudden sniffing death syndrome' (SSDS) an irregular and rapid heart rhythm brought on by the use of volatile substances and anoxia or hypercapnia and a sudden stimulus that produces an epinephrine (adrenaline) release. Unless a defibrillator is available, death can result within minutes from a single session in an otherwise healthy young person. Deaths also may result from asphyxiation, particularly if a plastic bag is used to inhale the compound (e.g. when inhaling glue). Deaths from trauma may occur, particularly with the longer acting compounds, e.g. toluene.

The chronic exposure to solvents such as toluene damages the protective sheath around certain nerve fibres in the brain and peripheral nervous system. This extensive destruction of nerve fibres may be similar to that seen with neurological diseases such as multiple sclerosis. Trichloroethylene may cause cirrhosis of the liver, reproductive complications, hearing and vision damage.

There is no evidence of chronic harm caused by butane, which is very volatile and largely excreted unchanged. However, in a young and otherwise healthy population, chronic organ toxicity arising from the use of volatile substances would probably have to be gross in order to become clinically apparent [2].

Most solvents used recreationally are central nervous system depressants: this means they slow down operation in certain areas of the brain. Volatile nitrites (amyl nitrite, butyl nitrite and isobutyl nitrite) dilate blood vessels and cause a brief drop in blood pressure. However, the 'high' experienced can also be as a direct result of the lack of oxygen reaching the brain, a form of asphyxia. When used excessively, this can result in unconsciousness and a risk of brain damage.

When inhaled, solvents enter the bloodstream directly from the lungs and rapidly reach the brain and other organs. Some are broken down and excreted through the kidneys, ultimately being passed out in urine; however others are exhaled unchanged through the lungs. As a result, it is sometimes possible to smell the original solvent on the breath of the user for several hours following use [6].

Lethal dosage

The lethal doses of inhalants vary depending on the substance used.

Sudden sniffing death syndrome, also known as SSDS, is when inhalants indirectly cause sudden death by cardiac arrest, in a syndrome known as 'sudden sniffing death'. In some cases, the anaesthetic gasses present in the inhalants themselves appear to sensitise the user to adrenaline treatment by emergency medical services and, in this state of intoxication, a sudden surge of adrenaline (possibly from a frightening hallucination or run-in with other persons), may cause fatal cardiac arrhythmia.

The direct inhalation of any gas or solvent that is capable of displacing oxygen in the lungs, especially gasses heavier than oxygen itself, carries the risk of hypoxia as a result of the very mechanism by which breathing is triggered. Since reflexive breathing is prompted by elevated carbon dioxide levels rather than diminished blood oxygen levels, breathing a concentrated and inert solvent or gas (such as tetrafluoroethane or nitrous oxide) that removes carbon dioxide from the blood without replacing it with oxygen will produce no outward signs of suffocation even when the brain is experiencing hypoxia. Once full symptoms of hypoxia appear, it may be too late to breathe without assistance, especially if the gas is heavy enough to sink down in and remain in the lungs for extended periods of time. Even completely inert gasses, such as argon, can have this effect if oxygen is largely excluded. This dangerous nature of heavy gasses makes many inhalants inherently unsafe [10].

Mode of use

The contents of a tin, aerosol or cannister may be emptied into a bag or sprayed onto a cloth or sleeve and the vapours inhaled. Some users spray the contents of an aerosol or butane canister directly into the mouth [5].

Products used as inhalants are sniffed, snorted, bagged, or huffed as a way of inhaling the fumes to produce the desired high [11].

Signs of usage

  • unusual breath odour or chemical odour on clothing,
  • slurred or slowed speech,
  • paint or other products commonly used as inhalants on face or fingers,
  • red or runny eyes or nose,
  • nausea and/or loss of appetite,
  • weight loss,
  • lack of interest in usual activities,
  • trouble at school or work,
  • difficulties in personal relationships,
  • legal troubles,
  • hanging out with a new crowd of people,
  • irritable, anxious and even aggressive [11].

Effects

Glues, gases and aerosols contain volatile substances which are depressants, which means they slow down your brain and body's responses and produce a similar effect to being drunk.

The effects can vary from person to person and depend on what specific glue, gas or aerosol has been used, but the common effects can include -

  • Mood swings, aggressive behaviour, hallucinations, vomiting and blackouts.
  • Feeling like being drunk with dizziness, dreaminess, fits of the giggles, and difficulty thinking straight.
  • In the case of some glues, gases and aerosols, you can develop a red rash around the mouth.
  • Getting a 'hangover' afterwards - such as a severe headache, feeling tired and/or feeling depressed [1].

On the mind

Inhalant abuse can cause damage to the parts of the brain that control thinking, moving, seeing, and hearing. Cognitive abnormalities can range from mild impairment to severe dementia [12].

On the body

Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream and quickly distributed to the brain and other organs. Nearly all inhalants produce effects similar to anaesthetics, which slow down the body's function. Depending on the degree of abuse, the user can experience slight stimulation, feeling of less inhibition or loss of consciousness.

Within minutes of inhalation, the user experiences intoxication along with other effects similar to those produced by alcohol. These effects may include slurred speech, an inability to coordinate movements, euphoria, and dizziness. After heavy use of inhalants, abusers may feel drowsy for several hours and experience a lingering headache [12].

Short-term effects

In addition to the above, inhalants can kill a person by heart attack or suffocation as the inhaled fumes take the place of oxygen in the lungs and central nervous system. Someone on inhalants may also suddenly react with extreme violence [13].

Long-term effects

Can lead to muscle wasting and reduced muscle tone and strength. Can permanently damage the body and brain [13].

Additional symptoms exhibited by long-term inhalant abusers include -

  • weight loss,
  • muscle weakness,
  • disorientation,
  • inattentiveness,
  • lack of coordination,
  • irritability,
  • depression,
  • damage to the nervous system and other organs [12],
  • memory loss,
  • reduced attention span and ability to think clearly,
  • pimples around the mouth and lips,
  • pale appearance,
  • tremors,
  • tiredness,
  • excessive thirst,
  • loss of sense of smell and hearing,
  • problems with blood production, which may result in anaemia, irregular heartbeat, heart muscle damage,
  • chest pain and angina,
  • indigestion and stomach ulcers,
  • liver and kidney damage,
  • needing to use more to get the same effect,
  • dependence on inhalants,
  • financial, work and social problems [7].

Some of the damaging effects to the body may be at least partially reversible when inhalant abuse is stopped; however, many of the effects from prolonged abuse are irreversible.

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. There is a common link between inhalant use and problems in school - failing grades, chronic absences, and general apathy [12].

Coming down

In the days after inhalant use, you may experience -

  • headache,
  • nausea,
  • dizziness,
  • drowsiness,
  • mental numbness [7].

Overdose

  • nausea,
  • vomiting,
  • diarrhoea,
  • irregular heartbeat,
  • chest pain,
  • hallucinations,
  • blackout,
  • seizures,
  • coma [7].

Because intoxication lasts only a few minutes, abusers try to prolong the high by continuing to inhale repeatedly over the course of several hours, which is a very dangerous practice. With successive inhalations, abusers may suffer loss of consciousness and/or death.

'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 can also cause death by asphyxiation from repeated inhalations, which lead to high concentrations of inhaled fumes displacing the available oxygen in the lungs, suffocation by blocking air from entering the lungs when inhaling fumes from a plastic bag placed over the head, and choking from swallowing vomit after inhaling substances [12].

Risks

Because glues, gases and aerosols are available as household products, some people think they are safe to use, but they're not. Between 2000 and 2008, abusing glues, gases and aerosols killed more 10 - 15 year olds than illegal drugs combined. They can kill the first time they are used [1].

Here's what else they could do to you -

  • Inhaling glues, gases and/or aerosols can cause mood swings, aggressive behaviour, hallucinations, vomiting and blackouts.
  • They can seriously affect your judgment and when you're high there's a real danger you'll try something dangerous.
  • Squirting gas products down the throat is a particularly dangerous way of taking the drug. It can make your throat swell up so you can't breathe and it can slow down your heart and can cause a heart attack.
  • Some users die from passing out and choking on their own vomit.
  • You risk suffocation if you inhale from a plastic bag over your head.
  • Long-term abuse can damage the muscles, liver and kidneys. While very long term use, such as ten years or more, can cause a lasting impairment of brain function (especially affecting how the brain controls body movement).
  • It can be hard to get the dose right. Just enough will give the desired 'high' - a little too much can result in a coma or even death.
  • Unsteadiness, disorientation/confusion and fainting can all contribute to the risk of accidents which are implicated in a number of the deaths.
  • Many products are flammable and there is a risk of burns and explosions, especially if someone is smoking nearby or if in an enclosed space [1].

Long-term

There is very little research into the long term risks from VSA. However the inhaling of some solvents can cause -

  • hearing loss,
  • limb spasms, and
  • damage to the central nervous system,
  • damage to brain [5].

Serious but potentially reversible effects include -

  • liver and kidney damage,
  • blood oxygen depletion [5].

Death from Inhalants is generally caused by a large concentration of fumes. Inhaling solvents from a paper or plastic bag or in a closed area increases the chances of suffocation. Brain damage is typically seen with chronic long term use as opposed to short term exposure. Industrial studies have demonstrated damage to brain, liver, kidneys, lungs and airways from long term exposure to some of the above substances [5].

Purity

The products that contain the volatile compounds may also contain other components. For example, aerosols, where the propellant 'butane' (a blend of butane, iso-butane and propane) is used, may contain active ingredients such as aluminium hydroxychloride in the case of antiperspirants or they may be essentially 'pure' e.g. cigarette lighter refills. The aerosols that are used are those that contain a high proportion of propellant (deodorants/antiperspirants, hair spray, air freshener or paint).

The purity of the volatile compound itself may also vary depending on its intended legitimate use, for example, butane used as a propellant in aerosols is likely to be deodorised (low in sulphur compounds) whereas butane used as a fuel may not be deodorised and may have odorants (sulphur compounds) added. Limits (<0.1%) are imposed on the carcinogen 1,3-butadiene in butane used in aerosols, but may not be when used for fuel [3].

Addiction

Can you get addicted

Tolerance can build up within a few weeks in regular users, so you might need to use more to achieve the same effects. This reverts back to normal within a few days of stopping.

It may be possible to become psychologically dependent on volatile substances, meaning the users develop an increased desire to keep using despite any harms they experience, but the evidence on this is limited.

Withdrawal symptoms have been reported in regular users. When they stop their use they experience irritability and headaches [1].

Indicators of inhalant abuse may include -

  • paint or stains on the body or clothing,
  • hidden rags, cloths, or empty containers,
  • spots or sores around the mouth or nose,
  • red or runny eyes and nose,
  • a chemical odour on the breath,
  • a dazed or dizzy appearance,
  • loss of appetite,
  • excitability,
  • irritability,
  • problems in school (failing grades, learning problems, absences),
  • memory loss,
  • general apathy [3].

Sustained inhalant use can cause tolerance; in addition, withdrawal symptoms develop after use is stopped [3]. These symptoms can include -

  • sweating,
  • rapid pulse,
  • hand tremors,
  • insomnia,
  • nausea,
  • vomiting,
  • physical agitation,
  • anxiety,
  • hallucinations,
  • seizures [3].

Withdrawal

Inhalant withdrawal typically will begin within as little as a few hours from its last use, often reaching a peak within 3 days and subsiding within one week. The symptoms of withdrawal and duration vary with the individual person, factors such as length of time abusing inhalants, how often and what type of inhalant is abused will determine this [11]. Commonly symptoms of inhalant withdrawal are -

- hand tremors, - nervousness, - excessive sweating, - hallucinations, - headaches, - muscle pains, - psychosis, - irritability, - insomnia, - aggression [11].

Drug testing

Inhalant presence can be detected in some blood work. In order to verify use, a complete blood count with measures for electrolyte, phosphorous and calcium levels must be done. Along with this, an acid-base assessment, liver and kidney screens, and heart muscle/enzyme testing must be performed.

Other tests that give indication of damage done and for presence of evidence is performing specific tests on blood samples sealed with heparin and processed by gas chromaphotography, which can detect the presence of solvents.

Testing for use of other drugs is performed to rule out their presence in the user. If there is no evidence of other drugs and the user is experiencing distress, it is wise to test for heart arrhythmias and possible brain damage if the user is experiencing trauma or hallucinations/delusions.

Therapists or physicians may screen for use of inhalants with a written test prepared to measure history of use and current use. This test is called the Volatile Solvent Screening Inventory (VSSI) and Comprehensive Solvent Assessment Interview (CSAI). These tests can be completed in 30 - 90 minutes and can provide a framework of mental conditions, physical conditions, suicidal thoughts (found higher in inhalant users), and behavioural problems, along with amount and frequency of use. This test is free online and could become a valuable tool for those working with a fragile population [14].

Limitations of drug tests for inhalants

Results for tests can be inconclusive, due to the wide range of products used for inhalation. There is no specific set of tests that will give proof of use [14].

Legality

Glues, gases and aerosols aren't illegal, but this doesn't mean that they are safe to use. It's illegal in England and Wales for anyone to sell glues, gases and aerosols to people under-18, if they think they're likely to be inhaling them to get 'high'.

Under Scottish law you can be prosecuted for 'recklessly' selling substances to any age group if you suspect they're going to inhale them.

It is illegal to sell petrol to anyone under the age of 16 or to supply gas lighter refills to anyone under the age of 18. This applies to the whole of the UK [1].

There are two laws covering the sale of volatile substances. The Intoxicating Substances Supply Act 1985, applying to England and Wales (Northern Ireland has similar legislation), makes it an offence for a person to supply or offer to supply to someone under the age of 18 a substance (other than a controlled drug) 'if he knows or has reasonable cause to believe that the substance or its fumes are likely to be inhaled for the purpose of causing intoxication'.

This Act is primarily aimed at irresponsible retailers, but it is difficult to prove that a shopkeeper knew the substances would be inhaled (unless a 'sniffing kit' - a small quantity of glue plus plastic bag as one item - is sold). Thus, only relatively few prosecutions, 116 resulting in 64 convictions as of 2011, have been brought under this Act.

Scottish common law provides for a similar offence of 'recklessly' selling solvents to children knowing they are going to inhale them.

The Cigarette Lighter Refill (Safety) Regulations 1999 made it an offence to 'supply any cigarette lighter refill canister containing butane or a substance with butane as a constituent part to any person under the age of eighteen years'.

This means that shopkeepers must not sell butane gas lighter refills to an under-18-year-old, even if they claim they want it to refill their cigarette lighter. This law covers the whole of the UK.

Some young people who have used solvents in public have offended against a variety of laws and local by-laws concerned with unruly, offensive, alarming or intoxicating behaviour or breach of the peace [8].

Did you know?

Like drinking and driving, driving while under the influence of drugs is illegal - with some drugs you can still be unfit to drive the day after using. You can get a heavy fine, be disqualified from driving or even go to prison [1].

Mixing with other drugs

Gases, glues and aerosols produce a similar effect to alcohol, so mixing them together can have serious consequences. The effects are increased and can lead to unconsciousness and death.

Because glues, gases and aerosols are easily available as household products, purity is not normally an issue. However, different glues, gases and aerosols will contain different ingredients and chemicals, some of which may also be harmful.

Household products come with a strong printed warning that humans should not take them in any way [1].

  • Inhalants + alcohol, benzodiazepines or opiates - enormous strain on the body, and can affect breathing rate and may increase the risk of passing out and suffocating or choking on vomit [7].

When using inhalants, which are extremely toxic products to begin with, using alcohol or other drugs can be a very deadly combination. Due to the highly flammable nature of some of the gases and sprays, even smoking cigarettes can cause an explosion likely to be fatal to the user and anyone else within range.

Because huffing chemicals varies as to which products are used, those under the influence have little or no executive function during the time of use. The effects of most inhalants are similar to alcohol and cause intoxication that is debilitating, especially given the age range (12 - 17) for most users. Cognitive functioning may be determined more by peer and social pressures to 'dare' themselves and each other to do things that do not make sense when not in the heat of the moment. This age group is not known for their common sense and good decision making abilities. This is an 'at risk' population, at best. Under the influence and in the midst of peers, choices may be made that do permanent damage [14].

  • anti-psychotics - When combined with inhalant use/abuse, these drugs can produce symptoms similar to those the medications are designed to combat. Because inhalants often produce hallucinations/delusions for users, combined use of anti-psychotics and inhalants may intensify this experience and create intense paranoia or could depress their mood to the extent of suicidal thoughts and behaviours.
  • alcohol - Drinking causes several increased risks for inhalant users. The combined effects of alcohol and inhalants, two powerful nervous system depressants, create a strong risk for cardiac arrest and loss of consciousness. While passing out may not be a danger in some instances, the risk of choking on vomit is doubled when inhalants and alcohol are present, due to the nausea creating effects of both substances. Another high risk is that of dangerous or life-threatening behaviours, such as driving or suicide attempts.
  • benzodiazepines - These drugs depress the central nervous system of the user. Along with the depressant properties of inhalants, benzodiazepine mixing is a deadly combination. Cardiac arrest and respiratory distress/failure can occur with either drug. Adding them together increases the risks substantially.
  • marijuana - Taking marijuana while under the influence of inhalants is another double whammy depressant to the central nervous system. Because they become too high to function, signs of nausea and heart/lung distress may not be recognised. Dangers for cardiac arrest and aspirating their vomit are present, along with respiratory failure due to oxygen depletion. Another risk is that smoking pot may entail dangerous lighter and inhalant fume interactions.
  • antidepressants - Antidepressants and their effects on the brain of the inhalant user/abuser can be varied. Depending on the chemicals being used, they may increase likelihood of suicidal ideation in this young population. Because many antidepressant medications can create this risk, along with the high risk for suicidal ideation recognized in users of inhalants, there is a dangerously high probability for suicide with this combination.
  • heroin - As with alcohol, heroin presents a high risk situation, due to the severe depression of the central nervous system. Because the mental abilities of the inhalant user may be so severely compromised, the risk for overdose is very high [14].

Harm reduction

Side-effects vary according to the user and the substance and quantity used. It may include headaches, nausea and soreness of the throat. Extended use may cause unconsciousness.

Some other warning signs will include weight loss/gain, memory problems, respiratory problems, depression, displays of aggression and paranoia, anxiety and frustration. This cluster of psychiatric difficulties can lead to self harming and suicidal ideation. This is clearly a situation that requires professional help. Contact your local GP, specialist service or Release.

Solvent use represents a significant cause of death or injury among young people. In 1999, 73 people died as a result of volatile substances use [6]. Causes of death or injury include -

  • Heart failure - solvent use may stop the heart instantly or cause it to beat irregularly. Sudden exercise after inhaling solvents increases the risk of heart failure.
  • Suffocation and asphyxiation - spraying aerosols or butane gas down the throat can cause swelling of the windpipe, leading to asphyxiation. When volatile substances are used in an enclosed space, there is a risk of suffocation due to lack of oxygen, especially if the user becomes unconscious. When users place their whole head in a bag containing a volatile substance, they incur a high risk of suffocation. Choking on vomit, especially when unconscious, is another significant risk.
  • Accidental injuries - users may become confused and disorientated. This creates a risk of accidents such as falling or drowning. Young people may use volatile substances in dangerous environments such as car parks, construction sites, railway embankments or river sides. Such places are hazardous and may be inaccessible to emergency services.
  • Burns - solvents can usually be highly flammable and therefore carry a high risk of serious burn injuries, especially when used near cigarettes or candles [6].
  • squirting gas or aerosol products down the throat is a particularly dangerous way of taking the drug. It can make your throat swell so you can't breathe and slows down your heart. It is safer to use a cloth as a barrier between your mouth and the container,
  • don't use plastic bags to inhale the fumes as this can increase the risk of suffocation,
  • avoid sniffing in isolated or dangerous places and avoid physical activity or being frightened after sniffing,
  • it is best to avoid mixing solvents with other downer drugs such as alcohol and benzos as this increases the risk of overdose [15].

Health implications

Volatile substances represent a bigger health threat, especially to young people, than most other drugs. While the mortality rate has decreased in recent years, on average in this country one or two young people a week die through solvent-related causes. A significant number of deaths are believed to be amongst first time users [9]. Mechanisms of death are as follows -

  • Toxic reactions - some people experience a fatal toxic reaction to the chemicals that they take, and die for no other apparent reasons;
  • Heart failure - volatile substance use can cause irregular heart-beats (arrhythmia) which can lead to heart failure. This risk is exacerbated if a user attempts sudden exercise such as running after using volatile substances;
  • Suffocation and asphyxiation - some users place glue in larger plastic bags such as bin-liners; these may be placed over the entire head, and there is a high risk of suffocation, especially if the user becomes unconscious.
  • Nausea and unconsciousness are high risks when using volatile substances so there is a high risk that users will choke on their vomit while unconscious.
  • An especially high risk is the direct introduction of butane gas from lighter refills directly down the throat. This can cause swelling of the trachea which can lead to asphyxiation; if the freezing jet of gas hits the area surrounding the vagal nerve, it can cause respiratory and heart failure through vagal inhibition [9].

Other causes of death and injury relate to trauma accidents through falling while intoxicated, drowning accidents and accidents relating to burns, as volatile substance are by and large very flammable.

Volatile substances can cause lung, liver and kidney problems, and there is some evidence that they can impair brain function, especially in terms of memory and concentration [9].

Paraphernalia

Some paraphernalia that can indicate abuse of inhalants include nitrous canisters, canister 'crackers', large balloons, small bottles or vials containing liquid, empty bottles, whipped cream containers, rags, or suspicious collections of household products [3].

Bags containing volatile substances, empty aerosols or gas canisters [5].

History

Solvents have been known and used as fuel, medicines, and cosmetics as well as for many other purposes since ancient times. The burning of herbs and spices to produce vapours is arguably one of the earliest uses of substances as inhalants. The Industrial Revolution made both their usefulness and reproduction much more widespread; 'inhalant parties' were popular in the 19th century, and the use of 'laughing gas' (nitrous oxide) was even famously promoted as an 'entertainment' to massed audiences. Soldiers fighting in the First World War are known to have used petrol as an inhalant to distract them from the horrors of the conflict.

Modern use of commercially produced solvents (sometimes referred to in the media as 'glue sniffing', even though it can in fact involve a number of substances) dates back to at least the 1950's, but there are few records of it in the UK before the 1960's. Perhaps the most famous period/subculture to have embraced them was the punk movement; in fact, one of the most influential fanzines was called 'Sniffin' Glue' (1976 - 77), the title coming from a Ramones song.

Today, largely due to the widespread availability of the substances involved, recreational solvent use is mostly associated with teenagers who are too young to purchase legal forms of intoxication (such as alcohol) and find it difficult to access other substances. Various laws have been introduced since the mid-1980's to raise the age at which it is legal to purchase many solvent-containing products in an attempt to cut off this route of access for young people [6].

Use of solvent type products to achieve intoxication is not new. In the late 19th century America and England there were crazes for nitrous oxide (laughing gas) and ether sniffing, especially at parties for the upper classes and medical students. Inhaling anaesthetic gases by the medical profession and of petrol among soldiers has also been reported in the past.

A Grand Exhibition of the effects produced by inhaling Nitrous Oxide Exhilarating or Laughing Gas! Will be given in the Union Hall this (Tuesday) Evening, December 10th 1884.

Forty gallons of Gas will be prepared and administered to all in the audience who desire to inhale it. Twelve Young Men are engaged to occupy the front seats to protect those under the influence of/ /the Gas from injuring themselves or others.

The effect of the Gas is to make those who inhale it either to Laugh, Sing, Dance, Speak or Fight, and so forth, according to the leading trait of their character. They seem to retain consciousness/ /enough not to say or do that which they would have occasion to regret.

N.B. The Gas will be administered only to gentlemen of the first respectability. The object is to make the entertainment in every respect a genteel affair'.

Quoted in Brecher Licit and illicit drugs, Little Brown 1972.

The modern day phenomenon of VSA among young people was first reported in America in the 1950's. The first case of solvent abuse in the UK was reported in 1962, but only in late seventies did the incidence of VSA increase substantially.

In the 1970's and 80's the concern focused on the sniffing of glue but more recently inhaling aerosols, butane cigarette lighter refills and other products has become much more common. Some commentators have suggested that this trend from glue to gas has been one of the effects of the 1985 Intoxicating Substances (Supply) Act, designed to prevent shopkeepers selling glue to young people - and that this led to people inhaling more dangerous products [8].


References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Inhalants, 2016, http://www.talktofrank.com/drug/glues-gases-and-aerosols#aka=inhalants+
  2. 2.0 2.1 2.2 Volatile substances, 2015, http://www.emcdda.europa.eu/publications/drug-profiles/volatile
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Inhalants, 2013, http://www.cesar.umd.edu/cesar/drugs/inhalants.asp
  4. Inhalants, 2015, https://www.addiction.com/a-z/inhalants/
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 Solvents, 2014, http://www.dan247.org.uk/Drug_Solvents.asp
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Solvents, 2017, http://www.release.org.uk/drugs/solvents-laughing-gas-glue
  7. 7.0 7.1 7.2 7.3 7.4 Inhalants, 2016, http://adf.org.au/drug-facts/inhalants/
  8. 8.0 8.1 8.2 Solvents, 2017, http://www.drugwise.org.uk/solvents/
  9. 9.0 9.1 9.2 9.3 Volatile Substances (solvents), 2016, http://www.kfx.org.uk/drug_facts/drug_facts_volatile_substances.php
  10. 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 10.11 Inhalants, 2017, https://psychonautwiki.org/wiki/Inhalants
  11. 11.0 11.1 11.2 11.3 Inhalants: Uses, Symptoms, Signs and Addiction Treatment, 2016, http://addictionlibrary.org/prescription/inhalants.html
  12. 12.0 12.1 12.2 12.3 12.4 Drugs of Abuse, 2015, Drug Enforcement Administration, https://www.dea.gov/pr/multimedia-library/publications/drug_of_abuse.pdf
  13. 13.0 13.1 Inhalants, 2016, http://www.drugfreeworld.org/drugfacts/drugs/inhalants.html
  14. 14.0 14.1 14.2 14.3 Inhalants, 2017, http://www.thegooddrugsguide.com/inhalants/index.htm
  15. Solvents, 2017, http://www.mycrew.org.uk/drugs-information/solvents