84: Inhalants

HISTORY AND EPIDEMIOLOGY

Inhalant abuse is defined as the deliberate inhalation of vapors for the purpose of changing consciousness or becoming “high.” It is also referred to as volatile substance abuse and was first described in medical literature in 1951.³⁷ Inhalants are appealing to adolescents because they are inexpensive, readily available, and sold legally. Initially, inhalant abuse was viewed as physically harmless, but reports of “sudden sniffing death” began to appear in the 1960s.¹¹ Shortly thereafter, evidence surfaced of other significant morbidities, including organic brain syndromes, peripheral neuropathy, and withdrawal.

The demographics of inhalant abuse differ markedly from those of other traditional substances of abuse. According to the 2011 National Survey on Drug Use and Health, inhalants continued to be the most frequently reported illicit xenobiotics used by 12 and 13 year-olds. The age at initiation of illicit drug use is youngest for those choosing inhalants, and the reported usage of inhalants peaked at age 14.¹⁴⁰ A worrisome trend reported by the 2011 Monitoring the Future study is that although the perceived risk of even one-time use of an inhalant has fallen steadily since 2001, and a study of 279 youths who were lifetime inhalant users found 37% perceived experimental inhalant use of slight or no risk.^100,116

In the United States, the problem is greatest among children of lower socioeconomic groups. Non-Hispanic white adolescents are the most likely and black adolescents the least likely to use inhalants.^14,96 Although inhalant use is a problem in both urban and rural communities, it is more prevalent in rural settings.^96,134 This may relate to the easier access that teens in urban areas have to other drugs of abuse.

Inhalant abuse includes the practices of sniffing, huffing, and bagging. Sniffing entails the inhalation of a volatile substance directly from a container, as occurs with modeling glue or rubber cement. Huffing involves pouring a volatile liquid onto fabric, such as a rag or sock, and placing it over the mouth, nose, or both while inhaling and is the method used by more than 60% of volatile-substance abusers.⁹⁶ Bagging refers to instilling a solvent into a plastic or paper bag and rebreathing from the bag several times; spray paint is among the xenobiotics commonly used with this method.

XENOBIOTICS COMMONLY USED

There are myriad xenobiotics abused as inhalants (Table 84–1), most of which are volatile hydrocarbons. Hydrocarbons are organic compounds comprised of carbon and hydrogen atoms and are divided into two basic categories: aliphatic (straight, branched, or cyclic chains) and aromatic. Most of the commercially available hydrocarbon products are mixtures of hydrocarbons; for example, gasoline is a mixture of aliphatic and aromatic hydrocarbons that may consist of more than 1500 compounds. Substituted hydrocarbons contain halogens or other functional groups such as hydroxyl or nitrite that are substituted for hydrogen ...