Inhalant Abuse in the United States

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Inhalant Abuse in the United States

• Dr. Minda R. Lynch
• National Institute on Drug Abuse
• National Institutes of Health/DHHS
• Bethesda, Maryland

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Some Powerpoint Slides Courtesy of

• Robert L. Balster, Ph.D.
• Director, Institute for Drug and Alcohol Studies
• Butler Professor of Pharmacology
• Research Professor of Psychology and Psychiatry
• Virginia Commonwealth University

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Inhalant Abuse in ContextDrug Abuse Problems in
Alaska

• Slides courtesy of Dr. Kathy Etz,
• Division of Epidemiology, Services and Prevention
  Research
• National Institute on Drug Abuse
• Expert in Native American and Native Alaskan Drug
  Abuse and Addiction

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Past Year Marijuana Use, Cocaine Use, and Needing
but Not Receiving Treatment for Illicit Drug Use
among Persons Age 12 or Older, by Substate
Region Percentages, Annual Averages Based on
2002, 2003 and 2004 NSDUHs






Note Large, diverse areas combined as rural
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Past Month Marijuana Use, Any Illicit Drug Use,
and Any Illicit Drug Other than Marijuana among
Persons Aged 12 or Older, by Substate Region,
Percentages, Annual Averages Based on 2002, 2003,
and 2004 NSDUHs









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Past Month Cigarette Use, Any Tobacco Product
Use, Binge Alcohol Use among Persons Aged 12 or
Older, by Substate Region Percentages, Annual
Averages Based on 2002, 2003, and 2004 NSDUHs


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Leading Drug Abuse Issues

• Tobacco use
• Iqmik (smokeless tobacco fungal ash mixed with
  tobacco leaves)
• Used by Alaska Natives
• 22 continue use through pregnancy
• Given to infants for teething pain, etc.
• Western part of state (YK Delta) med chart review
  shows rates 25 at age 6, 80 age 16 then to
  cigarettes
• Inhalant Abuse
• Marijuana Abuse

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Alaska Natives

• Approximately 16 of population
• Health Disparitiesrepresent approximately 33 of
  disease (suicide, mental health disorders, etc.)
• Alaska Natives
• Age Adjusted Death Rate 40 Higher
• (from Alaska Dept of Vital Statistics)

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Suicide Alaska Non Native vs. US
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Suicide Among Youth
Alaska vs. US
Native vs. Non-Native
Data Source Alaska Bureau of Vital Statistics
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From the National Institute on Drug Abuse

• From the Director
• Although many parents are appropriately
  concerned about illict drugs such as marijuana,
  cocaine, and LSD, they often ignore the dangers
  posed to their children from common household
  projects that contain volatile solvents or
  aerosols.

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And

• Many young people inhale the vapors from these
  sources in search of quick intoxication without
  being aware of the serious health consequences
  that can result.

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Types of abused inhalants

• Volatile Solvents, liquids that vaporize at room
  temperature, present in certain industrial or
  household products, such as paint thinner, nail
  polish remover, degreaser, dry-cleaning fluid,
  gasoline, and contact cement
• Some art or office supplies, such as correction
  fluid, felt-tip marker fluid, and electronic
  contact cleaner
• Aerosols, sprays that contain propellants and
  solvents, including spray paint, hair spray,
  deodorant spray, vegetable oil sprays, and fabric
  protector spray
• Gases, that may be in household or commercial
  products, or used as medical anesthetics, such as
  in butane lighters, propane tanks, whipped cream
  dispensers, and refrigerant gases
• Anesthetics, including ether, chloroform,
  halothane, and nitrous oxide

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What Are the Common Street Names?

• Common slang for inhalants includes "laughing
  gas" (nitrous oxide), "snappers" (amyl nitrite),
  "poppers" (amyl nitrite and butyl nitrite),
  "whippets" (fluorinated hydrocarbons, found in
  whipped cream dispensers), "bold" (nitrites), and
  "rush" (nitrites).

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Sources

• In 1988 and 1990 Congress prohibited sale of
  alkyl nitrites, such as isobutyl nitrite, under
  the Consumer Product Safety Act
• Manufacturers switched to cyclohexyl nitrite,
  which is not an alkyl nitrite
• Many online sites sell as aromas
• http//www.poppersonline.com/
• http//www.realpoppers.com/
• Estimates place annual sales in the tens of
  million dollars

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Nitrous Oxide

• How is it obtained?
• cylinders for anesthesia
• racing fuels (after filtering)
• dairy industry foaming agent
• whipped creme chargers
• How is it used?
• balloons

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Commonly Abused Solvents in Household Products

• Toluene
• Xylene
• Trichloroethane
• Methylene chloride
• Butane
• Many others, many combinations

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Where are they found?

• Paint thinners and removers
• Stains and Varnishes
• Adhesives
• Nail polish and removers
• Inks
• Spot removers, cleaning agents
• Gasoline
• Lighter Fuels
• Dry Erase Markers
• Dusters

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How are solvents used?

• "sniffing" or "snorting" fumes from containers
• spraying aerosols directly into the nose or mouth
  
• sniffing or inhaling fumes from substances
  sprayed or placed into a plastic or paper bag
  ("bagging")
• "huffing" from an inhalant-soaked rag stuffed in
  the mouth
• inhaling from balloons filled with nitrous oxide

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Patterns of use

• Because intoxication lasts only a few minutes,
  abusers frequently try to make the high last
  longer by inhaling repeatedly over several hours.

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Health Effects

• Breaks down myelin
• Induces hypoxia loss of oxygen to the brain
• Regular abuse of inhalants can cause serious harm
  to vital organs besides the brain, including the
  heart, kidneys, and liver.
• Certain inhalants can also cause the body to
  produce fewer blood cells, which may result in a
  condition known as aplastic anemia (in which the
  bone marrow is unable to produce blood cells).

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Examples of Effects by Type of Inhalant
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Lethal Effects

• Prolonged sniffing of the highly concentrated
  chemicals in solvents or aerosol sprays can
  induce irregular or rapid heart rhythms and can
  lead to heart failure and death within minutes of
  a session of prolonged sniffing.
• This "sudden sniffing death" is particularly
  associated with the abuse of butane, propane, and
  chemicals in aerosols.

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Scope of Use National Data

• According to the Monitoring the Future survey,
  more 8th graders (15.7) have tried inhalants in
  their lifetime than any other illicit drug,
  including marijuana.
• Lifetime use (at least once during a respondents
  lifetime) of inhalants was reported by 15.7 of
  8th graders, 12.8 of 10th graders and 9.9 of
  12th graders in 2008.

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Data from Monitoring the Future 2008 Data from
In-School Surveys
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Table 2. Trends in Past Year Use of Specific
Types of Inhalants among Past Year Inhalant
Initiates Aged 12 to 17 in 2007
Source 2002 to 2007 SAMHSA National Surveys on
Drug Use and Health (NSDUHs).
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Future Trends?

• The perception of harm associated with trying
  inhalants once or twice is at its lowest level
  among 8th graders in 2008, 34 of 8th graders
  perceived harm, compared to 46 in 2001.

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Signs of Inhalant Abuse

• A person who is using inhalants might have
  chemical odors on their breath or clothing paint
  or other stains on their face, hands, or
  clothing nausea or loss of appetite weight
  loss muscle weakness disorientation or
  inattentiveness, uncoordinated movement,
  irritability, and depression.

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How do Inhalants Produce their Effects?

• Almost all inhalants induce pleasurable effects
  via action on the central nervous system.
• Animal studies reveal that a number of commonly
  abused volatile solvents and anesthetic gases
  induce effects on brain and behavior resembling
  those produced by depressants, which include
  alcohol,sedatives and anesthetics.

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The Chemical Toluene
Human research reveals that toluene, a solvent
found in many commonly abused inhalants,
including model airplane glue, paint sprays, and
paint and nail polish removers, induces a marked
brain atrophy (shrinkage). In this figure,
the top image is from a normal control, and the
bottom, from a toluene abuser.
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Why are inhalants abused?

• Easy to obtain
• To produce intoxication
• But what kind of intoxication?

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Inhalant Intoxication

• Inhalants produce very strong effects similar to
  those of subanesthetic doses of general
  anesthetics
• Users feel "high." The effects are similar to
  those produced by alcohol and may include slurred
  speech, lack of coordination, euphoria, and
  dizziness. Inhalant users may also experience
  lightheadedness, hallucinations, and delusions.
  The high usually lasts only a few minutes.
• Effects occur very rapidly and dissipate rapidly
  as well
• With repeated inhalations, many users feel less
  inhibited and less in control.
• Some may feel drowsy for several hours and
  experience a lingering headache.

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What are the health consequences of inhalant
abuse?

• Short-term effects
• Accidents and injuries
• Overdose producing anesthesia and respiratory
  depression
• Sudden sniffing death
• Heart stoppage

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What are the health consequences of inhalant
abuse?

• Long-term Effects
• Depends on specific solvent
• Some more toxic than others (e.g. aerosols)
• Nose and mouth lesions, runny nose
• Brain damage
• Liver and kidney damage
• Fetal solvent syndrome
• No solid epidemiological evidence on actual
  prevalence of organic damage associated with
  inhalants, but widely encountered clinically

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Treatment Issues

• There are no controlled trials supporting an
  evidence based treatment for inhalant abuse
• Treatment should probably be focused on adding
  skills to typical adolescent care
• Canada has some models for inhalant specific
  treatment programs
• http//www.members.shaw.ca/ysac/default.htm

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Overview of NIDA Sponsored Research in Alaska

• Presenter
• Knowlton Johnson, , MS, MSW, PhD

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(No Transcript)
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What is the Level of Use of Harmful Legal
Products in the Targeted Communities
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The Alaska Drug Use and Attitude SurveyIndex of
30-day and Lifetime Use
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What is the difference between parent
self-reported use of harmful legal products and
their childs actual reported use?
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Inhalant Prevention NIDA Research

• Study Period 2005-2008
• Randomized Clinical Trials with 16 Frontier
  Alaska Communities
• Implementation Quality Study Sample Eight
  intervention communities

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Community Prevention Model

• we implemented a three-component CPM consisting
  of (1) Mobilization of communities (2)
  Environmental strategies (retailers, parents,
  schools) and (3) Schoolbased prevention
  curriculum (Think Smart) targeting drug use and
  related behaviors.
• We demonstrated that this model could effectively
  engage and interest communities in community
  prevention approaches.
• Further, we successfully implemented the model in
  frontier Alaska.
• Most importantly, we were able to produce
  evidence that the community mobilization and
  environmental strategies could produce change in
  the targeted proximal outcomes (mediators) in a
  positive direction.

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Contact Information

• Knowlton Johnson
• kwjohnson_at_pire.org

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Inhalant Treatments

• The Canadian YSAC Group is a Network of 9 First
  Nation Youth Residential Treatment Centres spread
  throughout various regions of Canada.  The
  centres were established between 1995 and 2005.  
• Health Canada, through the Brighter Futures/
  Solvent Abuse Initiative, began the development
  phase for several First Nations Treatment Centres
  geared toward adolescent Solvent Abuse.
• http//www.members.shaw.ca/ysac/default.htm

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Some Sources For More Information

• National Inhalant Prevention Coalition
• www.inhalants.org
• National Clearinghouse for Alcohol and Drug
  Information
• www.health.org
• National Institute on Drug Abuse
• www.nida.nih.gov
• SAMHSA (Inhalant Trends 2002-2007)
• http//oas.samhsa.gov/2k9/inhalantTrends/inhalantT
  rends.cfm
• Partnership for a Drug Free America
• www.drugfree.org

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The end!