Chapter 81: Inhalants

HISTORY AND EPIDEMIOLOGY

Inhalant use is defined as the deliberate inhalation of vapors for the purpose of changing one’s consciousness or becoming “high.” It is also referred to as volatile substance use, which was first described in medical literature in 1951.⁴³ Inhalants are appealing to adolescents because they are inexpensive, readily available, and sold legally. Initially, inhalant use was viewed as physically harmless, but reports of “sudden sniffing death” began to appear in the 1960s.¹³ Shortly thereafter, evidence surfaced of other significant morbidities, including organic brain syndromes, peripheral neuropathy, and withdrawal.

The demographics of inhalant use differ markedly from those of other traditional substances of use.¹⁶⁰ Age at initiation of illicit drug use is youngest for those choosing inhalants, and among students, the reported use of inhalants peaked among eighth graders.^117,159 For the first time since conducting its drug use survey, the Substance Abuse and Mental Health Services Administration (SAMSHA) reported a second peak in use among 18- to 25-year-old individuals; this may be because of inclusion of a new question specifically asking about inhalation of computer dusters (see later).

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. Use among girls equals or surpasses boys.¹⁶⁰ Although inhalant use is a problem in both urban and rural communities, it is more prevalent in rural settings.^113,154 This may relate to the easier access that teens in urban areas have to other drugs of use. Disturbingly, a study of 279 youths who were lifetime inhalant users found 37% perceived experimental inhalant use of slight or no risk.¹³⁴

Inhalant use 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 users.¹¹³ Bagging refers to instilling a solvent into a plastic or paper bag and rebreathing from the bag several times; spray paint is among the inhalants commonly used with this method.

COMMON INHALANTS

There are myriad xenobiotics used as inhalants (Table 81–1). Hydrocarbons are organic compounds composed of carbon and hydrogen atoms and are divided into 2 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 consists of more than 1,500 compounds. Substituted hydrocarbons contain halogens or other functional groups such as hydroxyl or nitrite that are substituted for hydrogen atoms in the parent structure. ...