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Inhalant Use in the Adolescent Population

Inhalant Use in the Adolescent Population. Angela L. Godejohn LCDR, MC, USN. Background Incidence Pathophysiology Clinical syndrome Acute intoxication syndrome Chronic inhalant use Treatment Prevention resources. Inhalant Abuse. Terminology. Sniffing

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Inhalant Use in the Adolescent Population

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  1. Inhalant Use in the Adolescent Population Angela L. Godejohn LCDR, MC, USN

  2. Background Incidence Pathophysiology Clinical syndrome Acute intoxication syndrome Chronic inhalant use Treatment Prevention resources Inhalant Abuse

  3. Terminology • Sniffing • Inhaling vapors from an open container or off a heated pan • Huffing • Inhaling vapors from a volatile-soaked cloth held against the face • Bagging • Application of the volatile into a paper or plastic bag, which is then held over the face

  4. Common Household Inhalants • Glue, shoe polish, tolune (30%) • Gasoline or lighter fluid (25%) • Nitrous oxide or “whippets” (25%) • Spray paints (23%) • Other aerosols (18%) • Correction fluid, degreaser, or cleaning fluid (18%) • Amyl nitrate, “poppers”, locker room deodorizers or “rush” (15%) • Lighter gases, butane, propane (9%) National Survey on Drug Use and Health: Characteristics of Recent Adolescent Inhalant Initiates; Issue 11, 2006

  5. Trends in inhalant use National Drug Intelligence Center; National Drug Threat Assessment 2005

  6. ER related visits from inhalant abuse National Drug Intelligence Center; National Drug Threat Assessment 2005

  7. Percentage of teens that agree that sniffing or huffing to get high can cause brain damage National Drug Intelligence Center; National Drug Threat Assessment 2005

  8. Pathophysiology • Highly lipid soluble • Easily cross both alveolar membranes and blood-brain barrier • Avoids first pass hepatic metabolism • Accumulates in brain tissue • Exact mechanism of action is unknown • Potentiates the effects of GABA and dopamine

  9. Pathophysiology • Inhaled concentrations depend on route of administration • Bagging > Huffing > Sniffing • Elimination occurs primarily through the lungs • Alkyl nitrites, aromatics, methylene chloride undergo hepatic metabolism leading to toxic by-products of free nitrites and carbon monoxide

  10. Clinical Syndromes • Acute intoxication • Sense of intoxication similar to alcohol or marijuana

  11. Clinical Syndromes • Chronic inhalant abuse • Withdrawal syndrome • Can develop symptoms similar to delerium tremens

  12. Cardiovascular Effects • “Sudden Sniffing Death” • Sensitize heart to effects of catecholamine • Fatal arrhythmias, especially if user is startled while inhaling • Can happen on first use

  13. Pulmonary Effects • Hypoxia • Chemical pneumonitis • Bronchospasm • Pulmonary edema • Hemorrhagic • Non cardiogenic • Pneumothorax • Cyanosis of extremities • Methemoglobinemia

  14. Signs of Inhalant Use • Recurrent epistaxis • Rhinorrhea • Watery eyes, conjunctival injection • Oral or peri-oral lesions • Facial rash “Glue sniffers” rash • Unusual chemical odor of breath • Burns • Paint stains on clothing • Change in personality or behavior

  15. Evaluation • Cardiopulmonary monitoring • 12 lead EKG • Chest radiograph • Laboratory evaluation • Complete blood count • Complete metabolic panel • Urinalysis, • Urine drug screen

  16. Treatment • Removal from the source of volatile inhalant • Supportive care • Supplemental oxygen • Management of arrhythmias as per ACLS protocols • Epinephrine and other catecholamines can induce or worsen arrhythmias due to sensitization of myocardium

  17. Death and Disability • Toxic Exposure Surveillance System (TESS) Database of the American Association of Poison Control centers • 1996 to 2001 • 11,670 cases reported of intentional volatile substance abuse • 15% age 6 to 12 • 54% age 13 to 19

  18. Death and Disability • Clinical effects • 20% of cases (2330) had serious outcome • Moderate effect- systemic signs or symptoms requiring treatment but not life threatening (2000; 85%) • Major effect- life threatening symptoms or significant residual disability (267; 11%) • Death (63; 3%)

  19. Death and Disability • Gasoline, air fresheners, butane, and propane responsible for most deaths • Death rate probably underestimated • Virginia recorded 39 deaths between 1987 and 1996 due to volatile inhalants • (Drug Alcohol Depend 1999 Feb; 53(3): 239-45) • Gasoline responsible for 46% of deaths • Extrapolated data using TESS • 200 deaths per year • Similar to death rates reported in the UK

  20. Prevention and Resources • National Inhalant Prevention Coalition (www.inhalants.com) • National Institute on Drug Abuse (www.nida.nih.gov) • The Partnership for a Drug Free America (www.drugfreeamerica.org) • Alliance for Consumer Education (www.inhalant.org)

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