Developed
by Richard Scatterday, M.D.
Irving, Texas
Inhalant
use ... What is it?... Is it really a serious problem?...
Can it affect my children?... My community?
Physicians
can expect to face questions such as these with increasing
frequency. Why? Because inhalant use has emerged over the
past several years as the drug use problem most likely to
inflict serious damage upon youth, even with transient involvement.
Inhalant
use has also been the problem most resistant to drug use prevention
efforts. From 1980 to 1990, it was the only drug abuse problem
monitored by the National Institute on Drug and Alcohol Abuse
that demonstrated an overall increase in prevalence. It has
also been particularly elusive to early diagnosis and resistant
to intervention and treatment efforts. Yet, parents, physicians,
educators, and law enforcement officers tend to have limited
awareness of the problem.
With
continued occurrence of inhalant-abuse related complications,
physicians will be called upon ever more frequently to provide
information and services for inhalant-abuse related problems.
The following are concise answers to eleven representative
questions frequently directed to physicians regarding inhalant
abuse. Equipped with basic information such as this, physicians
can become valuable resources in preventive, intervention,
and treatment efforts directed at our inhalant use problem:
1)
What is inhalant use?
Inhalant
use refers to the purposeful utilization of any of a very
large and diverse group of volatile compounds to produce euphoria.
2)
What volatile substances are most frequently abused by youth?
Historically,
environmentally accessible household or commercial products,
especially those containing toluene, have been utilized most
frequently. Beginning with paint products, glues, and gasoline
the number of abused compounds has expanded exponentially
such that today literally hundreds of familiar volatile products
have been abused.
3)
How significant a problem is inhalant use?
Inhalant
use appears to be a very significant form of youth drug use.
Self-report surveys in Texas suggest that at least one-in-five
junior and senior high school students have used inhalants,
thus surpassing the frequency of use of such highly publicized
drugs as cocaine, methamphetamine, LSD, and in some cases,
marijuana.
4)
What trends have been observed in the use of inhalants by
youth?
Disturbing
trends have been noted, including
a)
relative increases in the use of substances with greater sudden
death potential
b)
increased incidence of inhalant use among females, and
c)
increased utilization in settings associated with youth violence.
5)
Why are inhalants, taken as a group, considered to be so toxic?
Various
factors operate here. Most inhalants are commercial products
composed of a variety of chemicals. Each of these chemicals
caries it's own potential for toxic damage to vital organ
systems. When the multiple toxic ingredients act together,
a multiplied, synergistic in-vivo toxicity can be projected.
This toxic impact is then augmented by the typical developmental
immaturity of the user, the massive concentrations of these
substances achieved in abuse settings, the efficiency of the
lungs at delivering these toxic chemicals to vital tissues
at high concentrations, and the tendency for lipid-rich vital
organs to avidly retain these lipid-like organic toxins. The
summation of these and yet other factors confers upon inhalants
as a class a more formidable toxic profile than any other
type of drug of abuse.
6)
What is the developmental impact of inhalant use upon youth?
Typical
onset of experimentation with inhalants occurs earlier than
with most other drugs of abuse, in the preteen years, coinciding
with the time of initiation of crucial steps of physical,
cognitive, and emotional development. Because inhalants bring
to bear at this crucial developmental interval chemicals of
unsurpassed toxicity the projected developmental impact would
be expected to be great, probably exceeding that of other
drugs of abuse.
7)
How serious is the risk that sudden death could occur related
to inhalant use?
It
appears that the risk of sudden death with any given episode
of inhalant use exceeds that presented with any other drug
of abuse. Death has been noted to occur via a variety of cardiovascular,
pulmonary, accidental, and violence-related mechanisms. Of
particular importance is death via the induction of refractory
cardiac rhythm disturbances, referred to as the "sudden sniffing
death syndrome". Sudden death risk appears to be prominent,
even with initial experimentation. In British studies of sudden
death related to inhalant use, of every ten persons who died
from inhalants, up to three of these victims died during their
initial inhalant use experience.
8)
What evidence exists that inhalant abuse causes neuropsychological
damage to the user?
Clinical
studies investigating this question are few and have been
criticized on methodological grounds. Nevertheless, the aggregate
weight of these studies suggests that chronic long-term use
of inhalants is likely to result in neurologic deficits and
cognitive impairment.
9)
What reproductive complications can occur related to inhalant
use?
Much
of what is known relates to toluene exposure in occupational
and abuse settings. There is evidence to suggest that chronic
toluene abuse may incur chromosome damage in the user, and
that extensive exposure during pregnancy is capable of producing
many serious intrapartum derangements. These include disruptions
of the physiology of pregnancy and birth, as well as a variety
of fetal toxic effects, ranging from fetal growth retardation
and fetal death to a syndrome of fetal teratogenic effects
analogous to the fetal alcohol syndrome.
10)
How effective are treatment efforts directed at inhalant abuse?
Youth
with a history of chronic inhalant use appear to be particularly
resistant to outpatient and inpatient treatment efforts. Compared
with other forms of drug abuse, they exhibit strikingly high
rates of relapse and treatment failure. In particular, longer
term treatment efforts appear to be necessary to produce reasonably
successful results. While many professionals believe that
specific programs and approaches are needed to address inhalant
abuse effectively, very few programs are available. In fact,
because of the difficult problems associated with inhalant
abuse treatment, these youth are specifically excluded from
some drug abuse treatment programs. Treatment resource availability
for the large number of youth with significant inhalant use
problems is at best problematic, and often nonexistent.
11)
What are some common misconceptions that impede the prevention
of inhalant abuse?
The
first problematic concept is to have "no concept," to have
no awareness that a problem exists. Another is that inhalant
abuse is a "harmless and passing phase" typical of normal
adolescent development, and as such is not worthy of much
concern since it will spontaneously resolve without difficulty.
The frequency of sudden death among initial users exposes
the inappropriateness of this view. A third is that the problem
mainly affects minority and socio-economically disadvantaged
youth. While certainly such youth are affected, a careful
examination of Texas statistics indicates that inhalant use
affects youth of all racial socio-economic groups, and that
among them, Caucasians tend to be most affected.
Inhalant
use tends to be under recognized as a serious threat to youth:
it affects substantial numbers, and because of inherent toxicity
and sudden death risk, it presents hazard of serious injury,
long and short-term interference with quality of life, and
death even to those who experiment briefly. For the physician
desiring to contribute to the health of our youth, some basic
information and a watchful eye can be sufficient resources
to allow earlier diagnosis and intervention, and to convey
desperately needed preventive information to youth, their
parents, and others who care for them, including school personnel
and community agencies. A worthy challenge is to take this
information, build on it, apply it in your practice, and convey
it to others with a view to addressing this relatively untouched
serious youth drug use concern. Why not be a physician who
helps to clear the air regarding inhalant abuse?
