1. INHALANTS

2. HISTORY OF INHALANTS:
800 BC AD Oracle at Delphi inhales Ethylene vapors from fissures in the rock beneath the temple. The oracle would answer questions or make prophesies after entering a “trance” or being in a state of “frenzy.”
1275 Ether was named “sweet vitriol” when it was discovered by Spanish chemist Raymundus Lullius
1772 Nitrous Oxide gas was first discovered by English scientist Joseph Priestley.   

3. 1831 – 1832 Chloroform was discovered independently by 3 scientists: Samuel Guthrie, Justus von Liebig, and Eugene Soubeiran. Originally used as treatment for asthma.
1840 Ether used as a social lubricant for parties called “Ether Frolics.”
Late 1940s First known outbreak of gasoline sniffing in Warren, Pennsylvania.
1950s Reports of many cases of deliberate inhalation of gasoline fumes by young people in the US, Australia, India, and Great Britain.
1959 Earliest known references to glue-sniffing in either medical or popular literature.
1960s An increasing number of newspaper articles report adolescents sniffing airplane glue.
1961 – 1965 Glue sniffing epidemic in Denver. The epidemic may have been caused by hyperbolic media reports about the activity. Reports of glue sniffing soon spread to other U.S. cities like New York and Salt Lake City.   

4. 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

5. The Users, The Culture

6. Indiana Prevention Resource Center
Why Inhalants?
Inhalants don’t get a lot of attention.
But…
In the 1990s, they were the second most commonly-used illicit drug among year olds.
(Brouette & Anton, 2001).
Indiana Prevention Resource Center

9. Types of Inhalants
All different psychoactive substances are together grouped as Inhalants
3 groups of Inhalants:
Solvents
Anesthetics
Nitrites

10. Solvents (common household products)
Adhesives
model airplane glue, rubber cement, household glue
Aerosols
spray paint, hairspray, air freshener, deodorant, fabric protector
Solvents and gases
nail polish remover, paint thinner, type correction fluid and thinner, toxic markers, pure toluene, cigar lighter fluid, gasoline, carburetor cleaner, octane booster
Cleaning agents
dry cleaning fluid, spot remover, degreaser
Food products
vegetable cooking spray, dessert topping spray (whipped cream), whippets

11. Anesthetics nitrous oxide, ether, chloroform Anesthetic
Isofluorane, desflurane…

12. Nitrites Sodium nitrite Curing meat Amyl
Vasodilator; treatment for angina
Butyl
“Poppers”, "Rush," "Locker room," "Bolt," "Climax," also marketed in head shops as "video head cleaner"

13. Why are Inhalants so Popular?
Easy to obtain
The high is achieved instantly and lasts 5-15 minutes. (Pandina and Hendren 1999).
Easy to conceal (e.g., permanent markers, correction fluid)
Since inhalants are common, youths have misperception of safety (Johnston et al. 2002).

14. Pharmacokinetics
and
Pharmacodynamics

15. Inhalants: Pharmokinetics
Route of Ingestion:
Inhaled, either directly or by pouring/spraying into a bag or onto a cloth
Metabolism:
Liver
Distribution:
Some leave the body quickly others are absorbed by fatty tissues in the brain and nervous system.
Half life:
Short half-life: Varies among Inhalants, typically 1-5 mins

16. Inhalants: Pharmacodynamics
Lipid Soluble- causes a disruption of cell membrane and membrane components
Disruption of electrical Impulses within the system
Effects GABA neurotransmitters and its effect on GABA-A receptors
Ultimately it inhibits neuronal activity in the CNS

17. Inhalants: Effects
Chemicals become absorbed into fatty tissues in the brain and the nervous system
Typically affecting the myelin surrounding the bodies nerve cells
with long term use myelin is broken down and ultimately nerve cells can not transmit messages to one another.

18. Nitrous Oxide EFFECTS:
Immediate effects, usually lasts less than a min. Repeated use extends and intensifies the experience.
Results in temporary loss of motor control and a "dissociative" psychological effect, where sensations and perceptions become disconnected.
Effects include a dreamy mental state, and mild audio and visual hallucinations.

19. Solvents Immediate effects.
Effects include euphoria, delirium and hallucinations.
Solvents are highly addictive and will cause damage to the liver and CNS.

20. Poppers
EFFECTS:
Immediate effects: typically within a few seconds and lasts for 1-2 mins.
Causes muscles to relax; therefore, the heart rate increases as well as cardiac output. As a result oxygen-rich blood will quickly reach the brain to produce a “rush”.

21. Sensations Users may experience: Euphoria Light-headedness Sleepiness
Distorted Space Perception
Nausea
Spinning
Drunkenness
Altered shapes and colors
Dizziness
Numbness

22. Undesirable Effects Slowed breathing Slowed heart rate Disorientation
Loss of body control

23. Undesirable Effects Death Suffocation Asphyxiation
Choking on one’s vomit while unconscious
Asphyxiation
Decrease in oxygen and increase in carbon dioxide.
Occurs after losing consciousness with plastic bag over the head.
“Sudden Sniffing Death”

24. Undesirable Effects
“Sudden Sniffing Death”
Prolonged session of inhalation leading to the failure of the heart.
Can happen any given time someone abuses inhalants.

25. Effects, Treatment, Prevention

26. Inhalants: Effects on the Body
A. Blood- inhalant chemicals will block the oxygen carrying capacity of blood
B. Lungs- repeated use causes damage
C. Heart- results in “Sudden Sniffing Death Syndrome”
D. Liver- components of aerosol and paints will damage the liver
E. Kidney- Toluene (inhalant substance) will damage the kidney’s ability to control the amount of acid in the blood, may result in kidney stones

27. Inhalants: Effects on the Brain
A. Brain- causes sensory and psychological disorders. Since myelin sheaths are affected cell death is predominant.
B. Cerebral Cortex- Cell death causes permanent personality changes, memory impairment, hallucinations and learning disabilities
C. Cerebellum- damage results in a loss of coordination and slurred speech. Chronic users experience tremors and uncontrollable shaking
The scan shows diffuse, severe changes in cerebral white matter (center).
MRI Scan of 25-Year-Old Chronic Solvent Abuser
- Rosenberg et al.

28. Possible Long Term Effects of Prolonged Inhalant Abuse
- Depressed CNS Function
- Impaired Motor Coordination
- Loss/Impaired Vision
- Reduced Lung Function
- Hearing Loss
- Liver Damage
- Reduced Kidney Function
- Decreased Sensory Capacity
- Heart Damage
Neuronal Myelin Sheath Damage
Muscle Tremor
Numbness in extremities
Slurred Speech
Memory Loss
Decreased Sensory Capacity
Note: Neurological Deficits appear to be reversible with time and appropriate medical/rehabilitative services.

29. Tolerance and Withdrawal Symptoms
Tremors
Irritability
Insomnia
Delirium
Tingling Sensations
Seizures
Muscle Cramps
Anxiety
Physical withdrawal may arise a few hours to a few days after inhalant use.

30. Treatment Difficult to treat Cognitive impairment may last for months
Abuse coincides with social, family, financial, or behavior problems
Few go voluntarily
Cognitive impairment may last for months
Length of treatment may go up to two years

31. Treatment Step 1- Detoxification, may last up to a month.
Step 2- Extended Therapy, may last up to two years.
Initial therapy sessions are between minutes. Inhalant abusers have short attention spans and exhibit difficulty with complex thinking.

32. Prevention
Most successful prevention program involves comprehensive school Health Education.
Multiple years of programming
Interactive Methods
Development of skills (assertiveness)
Peer-to-peer activities
Providing information on risks.

33. Jun 6, 1962 First known law against glue sniffing is passed in Anaheim, California.
Early 1980s Nitrites were targeted as a cause for AIDS.
1992 NIPC, the National Inhalant Prevention Coalition, was founded.
August, 1996 after sniffing gasoline two 11-year-old boys in Canada poured gas over a six-year-old boy and lit him on fire.
July, 1998 a pregnant 33-year-old woman was arrested for sniffing a solvent-soaked bag, and gave birth the next day.

34. User Experience of Inhaling Freon
“For about 2 seconds I had a small buzz. Then my vision became very very distorted. My depth perception went wild. A wall about 5 feet from me seemed like it moved from 2 inches from me to 100 miles from me every second. Then my heart started beating like wild. As I collapsed to the floor I managed to gasp out- 'get an ambulance...' This all lasted about as long as a nitrous balloon would- say seconds.”

35. Percent of Students Reporting Inhalant Use, 2002

36. Who are the users? A typical Inhalant abuser is 14-16 years old
of any race or ethnic origin, or gender
Social drug: probably abuses inhalant substances with one or two friends
Lack of knowledge: doesn't understand what he or she is “getting into”

37. Age of Onset
Often first substance used before marijuana and cocaine. In fact, inhalant use often appears before onset of tobacco or alcohol use.
Experimental use onset in late childhood & early adolescence, use patterns are short lived, with cessation in late adolescence
Chronic use appears in early & late adolescence