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Source: Richard Scatterday, M.D., Kaiser Permanente

Toluene, and toluene containing compounds

(representing the "aromatic hydrocarbons")

a. Found in: Gasoline; some glues; some paints, thinners and paint removers; some nail polishes; typewriter correction fluid.

b. Historically, the predominant euphorigenic substance utilized in inhalant abuse settings.

c. Toluene and toluene-containing compounds are ubiquitously encountered in home, school and work place settings.

d. As a low molecular weight, highly lipid-soluble substance, toluene is avidly absorbed by the lungs, brain, heart, liver, reproductive organs and other lipid-rich tissues. The capacity of these organs to concentrate and store toluene and similar compounds is illustrated by the fact that shortly after inhalation, brain concentrations may be ten times greater than blood levels.

e. Chronic abuse of toluene-containing products has been associated with serious brain toxicity, documented by loss of brain tissue mass on computerized tomographic (CT) scans, and by white matter degeneration on magnetic resonance imaging (NM) scans. Such brain damage results in impairment of cognition and other brain functions, gait disturbance and loss of coordination.

f. Toluene may cause effects upon the heart's rhythm regulating system that can cause fatality by the "Sudden Sniffing Death" mechanism.

g. Serious lung injury can result when toluene-containing paint preparations are inhaled.

h. Kidney problems, including renal tubular toxicity resulting in serious acid-base derangement, and kidney stone formation have been reported with chronic toluene abuse.

i. Significant losses of hearing and vision have been reported in association with toluene abuse.

j. Toluene can cause multifactorial adverse impact upon reproductive toxicity, including:

  • chromosomal alteration and breakage
  • germ cell injury
  • abnormalities in the physiology of pregnancy
  • fetal malformation or death
  • premature birth
  • perinatal complications including increased rates of infant withdrawal syndrome
  • maternal-child adjustment disorders including an increased prevalence of child abuse


Butane and Propane

(including the "aliphatic hydrocarbons")

a. Found in: paint sprays, hair sprays, air fresheners, fuel gas, lighter fluid.

b. Readily available to youth and abuseable when commercially packaged as "lighter fluid" (butane) or as fuels.

c. Marked propensity for causation of the "Sudden Sniffing Death Syndrome" via their cardiac effects.

d. Because of their flammability and explosives and a strong association with smoking of tobacco or illicit drugs, their abuse has been associated with serious burn injuries.



(a mixture of "aromatic" and "aliphatic" hydrocarbons)

a. The universal use and availability of gasoline in the U.S. and worldwide contributes to its abuse by inhalation.

b. Gasoline inhalation may be particularly prominent in relation to other forms of drug abuse in the late childhood and pre-adolescent years, in rural settings and among certain socioeconomic groups.

c. Gasoline contains aromatic (ring-structured) hydrocarbons, especially toluene and benzene, along with C6-C8 aliphatic (straight-chained) hydrocarbons are the primary euphorigenic components of gasoline.

d. Purposeful inhalation yields intoxication lasting up to 5-6 hours, but reaching a peak within 3-5 minutes.

e. Additives, historically including lead, and a variety of inorganic chemicals and impurities aggravate the toxicity of the major hydrocarbon components of gasoline.

f. Gasoline's explosiveness and combustibility are universally recognized. The stage is set for serious burn injuries when youth whose judgment is impaired by intoxication combine gasoline inhalation with the smoking of marijuana, tobacco or other drugs.

g. Gasoline components affect the rhythm-controlling tissues of the heart in a way that predisposes to dangerous, potentially fatal heart rhythms (the "Sudden Sniffing Death Syndrome").

h. Benzene, a gasoline component, may cause serious injury to the bone marrow, impairing immunologic functioning, and perhaps causing increased risk of leukemia. It can also cause reproductive system toxicity.

i. TCP, a gasoline additive, can cause degeneration of motor nerve cells. The lead in it can cause lead poisoning.


Trichlorethylene and trichlorethane-containing preparations

(representing the "chlorinated hydrocarbons")

a. Found in: Anitfreeze, some paints, some glues, adhesives, sealants, caulking compounds.

b. Historic use as general anesthetic agents.

c. Striking portraits of toxicity based upon past use as general anesthetic agents.

d. Trichlorethylene and trichlorethane-containing agents are also ubiquitously encountered in home, school and work place settings.

e. Trichlorethylene and trichlorethane-containing products have been associated with a significant risk of "Sudden Sniffing Death" due to the induction of fatal cardiac rhythm abnormalities.

f. In a Dallas postmortem study of three adolescent trichlorethylene inhalation fatalities, two of the three victims had hepatic cirrhotic changes. A closely related compound formerly used extensively in the dry cleaning industry is so toxic that the equivalent of one teaspoon is able to cause potential fatal liver necrosis.

g. While adequate studies are lacking of the dangers of trichlorethylene and trichlorethane when purposefully inhaled, chronic workplace exposure has been associated with:

  • cirrhosis of the liver
  • electrocardiographic changes and heart muscular injury
  • reproductive complications, especially miscarriage. Studies involving intrapartum exposure of rats to trichlorethylene have demonstrated growth retardation, and skeletal and soft tissue abnormalities.


The Freons

("halogenated hydrocarbons" characterized by mutually
potentiating chemical and physical hazards in the abuse setting)

a. The freons are a major cause of "Sudden Sniffing Death" via the induction of fatal cardiac arrhythmias.

b. Respiratory obstruction and death due to sudden cooling/cold injury to the respiratory tract may occur.

c. When inhaled from a high pressure source, pulmonary injury with rupture of alveoli ("air sacs") and/or of the fine tissue layer covering the lung can occur, resulting in life-threatening collapse of a segment, lobe or the entire lung.

d. Freon also appears to decrease the ability of certain special cells that line the pulmonary alveoli to produce a special phospholipid chemical (surfactant) that functions to maintain the air sacs in a non-collapsed state. Chronic freon inhalation could hypothetically predispose to air sac collapse by inhibiting surfactant production.

e. Serious freeze injuries to the skin can occur when individuals inhaling freon lose consciousness, leaving the cold container in juxtaposition to unprotected skin.

f. With other chlorinated hydrocarbons, chronic high-dose exposure to freons may cause hepatic injury.

g. Studies in animal models suggest that repeated exposure to high doses of fluorocarbons during pregnancy may present serious teratogenic (induction of birth) hazard.


Butyl Nitrite and Isobutyl Nitrite

("Rush," "Locker Room;" representing the "alkyl nitrites")

a. The nitrite compounds have been associated with the causation of fatal cardiac rhythm disturbance (Sudden Sniffing Death Syndrome).

b. Chronic abuse of butyl nitrite and similar compounds appears to suppress immunologic functioning. A relationship has been proposed between the use of butyl nitrite by homosexual males for sexual enhancement, and the development of AIDS. If this relationship exists, the immunosuppresive effects of these compounds may be contributory.

c. Clinical studies also suggest an association between abuse of butyl and other nitrites for sexual enhancement by homosexual males and the development of Kaposi's Sarcoma.

d. Butyl nitrite is capable of causing serious injury to the red blood cells due to potent "oxidizing" effects of these compounds. The oxygen-carrying molecule of red blood cells, hemoglobin, is permanently converted by these effects to a nonfunctional form (methemoglobin), thus interfering with oxygen supply to vital tissues. These oxidizing effects can be so severe that in susceptible persons (glucose-6-dehydrogenase deficiency and other hereditary disorders that limit the ability to withstand oxidant challenge) massive red blood cell breakdown has occurred.


Nitrous Oxide

a. Found in whipped cream canisters, whippets.

b. Characterized by distinctive modes of access and settings of abuse.

c. The most serious abuse complication is death via brain anoxia when the pure gas is extensively inhaled.

d. Altered perception and motor coordination caused by nitrous oxide intoxication have been a significant cause of motor vehicle and other accidents.

e. Prominent venous dilatory effects of nitrous oxide inhalation can cause sudden position-related blood pressure changes sufficient to induce syncopal ("blackout") episodes, with potential for serious injury.

f. Chronic abuse, though unusual, can occur. Such abuse may interfere with vitamin B-12 metabolism resulting in neurologic and hematologic complications.

g. Chronic abuse may result in both depression of heart muscular functioning and in cardiac rhythm disturbances.

i. Chronic abuse has also been linked with risk of miscarriage, birth defects, kidney and liver defects.


Hazards presented by the inhalation of aerosol
preparations or other pressurized gases.

a. The inhalation of aerosol preparations involves, almost by definition, a multi-toxic hazard.

b. Aerosol preparations are capable of generating particularly high concentrations of the inhaled chemicals. Upon their release from aerosol containers, butane and other propellants become available for inhalation at concentrations much higher than those involved with the inhalation of vapors released much more slowly from liquid products, or viscous materials such as glues and adhesives. Aerosol preparations releasing these propellants are capable of producing nearly a 100 % concentration of the desired substance.

c. Aerosol preparations can cause respiratory tract injury through exposure to surprisingly cold temperatures. The aerosol contents expand suddenly upon release, resulting in cooling to temperatures as low as 20 degrees Celsius.

d. Gases inhaled from tanks or air conditioning systems may expose the respiratory system to sufficient pressures to cause rupture and life-threatening pulmonary collapse.

e. Abuse of aerosol preparations was identified in the United Kingdom as a major factor in an increased incidence of inhalant related sudden death.

Methylene Chloride

a. Found in: Degreasers, waxes, paints, paint removers, some paint and varnish thinners, pesticide sprays, lubricants.

b. The body converts methylene chloride to carbon monoxide and chloride. This solvent affects the heart muscle and heartbeat.

c. Long-term exposure to fumes causes cancer in laboratory animals.