Inhalants

Inhalants are a broad category of volatile substances that produce chemical vapours, which can be inhaled to induce a psychoactive or mind-altering effect. The allure of these substances often lies in their easy accessibility and legal status, as many are found in everyday household items like cleaning fluids, paint, and aerosol sprays. Unlike many other substances of abuse that enter the body through ingestion, injection, or skin absorption, inhalants are unique in that they are only administered through inhalation.

One significant concern with inhalants is their widespread availability, often right under our noses, so to speak, in homes, schools, or workplaces. Their prevalence poses a particular risk to younger populations who may not have access to other types of substances but can easily obtain a can of aerosol or a bottle of glue. Because these substances are often not considered drugs or are legal to purchase, there is a common misperception that they are safer than other psychoactive substances—a dangerously incorrect assumption.

Furthermore, “inhalants” encompass a wide range of substances, which can be categorised based on their forms and uses. They include volatile solvents, aerosols, gases, and nitrites. Each category contains products easily bought over the counter for legitimate uses, making them challenging to regulate despite their potential for abuse.

Their effects are generally short-lived, lasting only a few minutes, but the implications of use—especially chronic use—can be devastating, resulting in severe physical and psychological harm. The impact of inhalants on the central nervous system is profound and immediate, often compared to the effects of alcohol, including impairment of judgement, motor coordination, and reaction time.

Using inhalants raises complex issues that intersect public health, law, and social norms. While there are clear and present dangers related to their abuse, the fact that they are ubiquitous and often legal makes tackling the issue a multifaceted challenge.

Definition and Classification

Inhalants are a diverse range of volatile substances that are commonly abused for their psychoactive effects, which are achieved through inhalation. Unlike other drugs, the route of administration for inhalants is exclusively through inhalation, typically through the mouth or nose. They are easily accessible and commonly found in household products, and their effects target the central nervous system, leading to altered states of consciousness.

The following are examples of substances commonly used as inhalants:

• Glue: Certain glues are frequently used in arts and crafts and contain toxic solvents.
• Paint Thinners: Widely available in hardware stores, these contain volatile organic compounds (VOCs).
• Aerosol Sprays: When inhaled, products such as deodorants and air fresheners may contain psychoactive propellants.
• Nitrites: Known as ‘poppers,’ they are used for enhancing sexual experience but are also abused as inhalants.

Physical Effects

Inhalants act rapidly, delivering an almost immediate high that is often described as similar to alcohol intoxication, complete with dizziness, slurred speech, and lack of coordination. The substances can also lead to more dire physical consequences, such as heart failure, suffocation, and even sudden death due to heart arrhythmia or asphyxiation. Long-term use can result in liver and kidney damage, as well as chronic respiratory issues.

Psychological Effects

Inhalants can induce a variety of psychological effects ranging from euphoria and relaxation to disorientation and hallucinations. The substances can also impair judgement, leading to risky behaviours. Extended or frequent use can result in significant cognitive deficits, including attention and memory loss, and can exacerbate or trigger psychiatric disorders like depression or anxiety.

Short-term and Long-term Effects

• Short-term Effects: The immediate consequences of inhalant use often include euphoria, dizziness, and auditory or visual hallucinations. Physical symptoms may range from headaches and nausea to more serious outcomes like unconsciousness or seizures. Additionally, some individuals may experience violent behaviours or mood swings.
• Long-term Effects: Long-term use of inhalants poses severe risks. Prolonged exposure can lead to detrimental neurological effects, such as cognitive impairment and memory loss. Chronic use also risks organ damage, particularly to the liver and kidneys. Moreover, long-term use may result in addiction, with withdrawal symptoms including nausea, tremors, and delirium. Psychologically, extended use can exacerbate mental health disorders, including depression and anxiety, and may even result in permanent psychological impairment.

Treatment of Asthma

Inhalants are pivotal in managing asthma by serving as bronchodilators that facilitate the relaxation of muscles surrounding the airways. This allows for improved airflow and reduced respiratory distress. Common medications in this category include albuterol and salmeterol.

Treatment of Chronic Obstructive Pulmonary Disease (COPD)

Inhalants are also employed in the treatment of COPD. The objective is to reduce inflammation and facilitate better mucus clearance. Anticholinergics and corticosteroids are the primary classes of medications used for this purpose.

Other Medical Conditions

Inhalants like nitrous oxide find utility in dental procedures, primarily as anaesthetics or analgesics. It’s crucial to note that such usages are medically regulated.

Prescription Inhalants

Prescription inhalants include many medications, such as albuterol, which falls under brand names like Ventolin and ProAir, and salmeterol, marketed as Serevent. Additional examples include corticosteroids like fluticasone, sold as Flovent, and anticholinergics such as tiotropium, known by Spiriva.

Illicit Inhalants

The illicit category involves substances like glue, paint thinners, and nitrous oxide canisters commonly used for whipping cream.

Over-the-Counter Inhalants

These refer to readily available substances like menthol and camphor, typically found in vapour rubs and nasal sprays.

Prescription Inhalants

 Bronchodilators

• Types of Bronchodilators: These can be either short-acting, like albuterol, or long-acting, such as salmeterol.
• Brand Names: Examples include Ventolin for albuterol and Serevent for salmeterol.
• Street Names: These medications rarely have street names due to their specific medical usage.
• Methods of Use: Typically inhaled via metred-dose inhalers or dry powder inhalers.
• Short-term Effects: These may include rapid breathing, elevated heart rate, and mild tremors.
• Long-term Effects: Prolonged misuse can lead to conditions like chronic bronchitis, potential addiction, and cardiovascular issues.

Anticholinergics

• Types of Anticholinergics: These include ipratropium and tiotropium.
• Brand Names: Marketed as Atrovent and Spiriva, respectively.
• Street Names: Similar to bronchodilators, these have no common street names.
• Methods of Use: These are also inhaled, usually through metred-dose inhalers.
• Short-term Effects: Dry mouth, constipation, and occasionally blurred vision.
• Long-term Effects: Worsened lung function and a potential risk of glaucoma.

Illicit Inhalants

Nitrous Oxide

Street Names: Whippets, NOS, or Laughing Gas, among others.

Methods of Use: Usually inhaled from a balloon or whipped cream canisters.

Short-term Effects: Euphoria, dizziness, and loss of coordination are common.

 Long-term Effects: Risks include nerve damage, potential addiction, and, in severe cases, death.

Paint Thinner

• Street Names: Sometimes referred to as Air Blast or Highball.
• Methods of Use: Inhaled from a rag soaked in the substance or directly from the container.
• Short-term Effects: Drowsiness, slurred speech, and headaches are typical.
• Long-term Effects: The misuse of paint thinners can lead to severe brain damage, liver failure, and death.

Metred-Dose Inhalers (MDIs)

Metred-dose inhalers are the standard tool for administering medications such as bronchodilators and corticosteroids, especially in asthma and COPD. They are designed to deliver a specific amount of medication through the user’s spray mechanism. The particle size and velocity of the spray are calibrated to ensure optimal deposition of the medication in the lungs. A significant advantage of MDIs is their portability and convenience, enabling quick treatment on the go. However, the effectiveness of this method is critically dependent on the user’s inhaler technique. Incorrect technique can lead to the deposition of medication in the oral cavity instead of the lungs, reducing efficacy. Medical practitioners often recommend spacer devices to enhance medication delivery. MDIs also contain propellants, and there has been ongoing scrutiny about their environmental impact.

Dry Powder Inhalers (DPIs)

Dry Powder Inhalers contain medication in a powdered form and do not require propellants. The user must generate sufficient airflow through the device to disperse the powder, making the inhalation technique crucial for effective medication delivery. DPIs are sensitive to moisture, and improper storage can compromise the medication. These inhalers are often dose-specific, limiting the ability to adjust doses as required. DPIs are typically more compact than nebulisers and easier to use than MDIs for some people. The technique required can, however, be challenging for individuals with compromised lung function or for young children who may find generating the required airflow difficult. Despite this, DPIs offer an effective and environmentally friendly alternative to MDIs.

Nebulisers

Nebulisers are electronic devices that convert liquid medication into a fine mist for inhalation, making them particularly useful for individuals with difficulty using inhalers. They are often used in acute settings or for those who require higher medication doses. While highly effective, inhalers are more portable and usually require an electrical source, limiting their use to primarily indoor settings. Nebulisers also take longer to deliver medication, often requiring up to 15 minutes for a single dose. Despite their limitations in convenience, they are indispensable for certain populations, including infants and those with severe respiratory conditions.

 Intranasal Sprays

Intranasal sprays deliver medication directly to the mucous membrane of the nasal passage. This method is most commonly employed for medications that treat allergic rhinitis, sinus infections, or nasal congestion. Intranasal sprays provide a localised effect, reducing systemic absorption and potential side effects. However, overuse can lead to complications such as mucosal dryness and irritation. It’s also critical to employ proper technique, as incorrect angling of the spray can result in poor medication distribution. The swift onset of action is an advantage, but overuse can lead to “rebound congestion,” a condition where nasal passages become more congested once the medication wears off.

Recreational Inhaling (Huffing)

Huffing is an illicit method where volatile substances are soaked into a rag or cloth and inhaled directly. This practise is associated with numerous health risks, including respiratory distress, cardiac arrhythmias, and even sudden death. The method provides rapid intoxication but at a very high cost in terms of health risks. Huffing can cause permanent damage to the brain, liver, and kidneys. Many volatile substances used in huffing were not designed for human consumption, making this method incredibly dangerous.

Balloons and Whippets

Balloons filled with nitrous oxide or “whippets” are commonly used for recreational inhalation. The nitrous oxide is released from a whipped cream canister and inhaled into a balloon. While the high is relatively short-lived, the risks are significant. Oxygen deprivation can occur, leading to fainting or worse. Moreover, long-term use can result in neurological damage. This method of inhalant use is illegal in many jurisdictions due to its inherent risks.

Other Methods

Other less common methods include steam inhalation, often used for symptomatic relief from colds or respiratory conditions. Hot water is poured into a bowl, and the individual inhales the steam, sometimes with added medicinal herbs or essential oils. While generally considered safe, steam inhalation can cause burns if not done carefully. Another unconventional method involves directly sniffing or inhaling a substance from its container or surface, which is risky and not recommended.

The peril of inhalant abuse is of considerable concern, given the profound and often irreversible health implications it can engender. Inhalants, while typically not classified alongside other illicit substances, carry their unique array of dangers—these range from immediate physiological consequences to long-term psychological detriments. Addressing the signs, symptoms, and repercussions of inhalant misuse is instrumental for early intervention, treatment, and public awareness.

Signs of Abuse

• Initial Appeal: The immediacy of inhalants’ euphoric sensation is a pivotal factor in their allure. The rapid onset of effects serves as an enticing gateway, particularly for younger individuals who may not have access to other substances.
• Psychological Symptoms: Beyond the initial euphoria lies a troubling landscape of potential psychological outcomes. These may include a range of disturbances, such as acute hallucinations, mood swings, and profound disorientation.
• Physical Dependence: Although inhalants are not typically associated with physical dependency, psychological dependence can indeed develop. Individuals may increasingly resort to inhalant use as a coping mechanism, thereby exacerbating the underlying issue.

Consequences of Chronic Use

• Addiction: A psychological attachment to inhalants can develop over time, often underpinned by emotional or environmental triggers. While this is not akin to the physical dependency seen with opioids, the attachment can still be severe.
• Organ Damage: Sustained inhalant abuse can wreak havoc on essential physiological functions. Organs such as the liver, kidneys, and even the brain are susceptible to long-term damage, which may be irreversible.

Overdose Symptoms and Management

• Physiological Repercussions: An overdose from inhalants is not merely an amplification of their typical effects but can result in life-threatening conditions. These may include hypoxia, seizures, and, in extreme cases, a sudden cessation of vital bodily functions known as Sudden Sniffing Death Syndrome (SSDS).
• Preventive Measures: The severity of these outcomes necessitates proactive measures for prevention. Public education and awareness campaigns targeting at-risk populations can serve as foundational components for an overarching strategy to combat inhalant abuse.

The legal status of inhalants in the United Kingdom is defined by a series of laws and regulations, with the primary objective of mitigating the risks associated with the misuse of these substances. This legal framework operates within a broader societal context, attempting to safeguard public health while recognising the utility of these substances in various industrial and household applications.

Regulation of Common Inhalants

• General Legality: Unlike many stimulants, the substances often used as inhalants are typically legal to possess because they are common household or industrial items.
• Intoxicating Substances Act: The Intoxicating Substances (Supply) Act 1985 specifically targets the sale of volatile substances to individuals under 18 for abuse.
• Lack of Classification: These substances are generally not controlled under the Misuse of Drugs Act 1971, which categorises drugs into Classes A, B, and C, primarily because they have legitimate household or industrial uses.
• Retail Restrictions: Retailers are guided by law to exercise caution in selling volatile substances, particularly to young people who might misuse them. Failure to comply may result in legal penalties.
• Local Ordinances: Some local councils have also set guidelines and ordinances to manage the sale and use of potential inhalants within their jurisdiction.

Misuse and Legal Consequences

• Public Use: Using inhalants in public could potentially result in criminal charges related to public intoxication or disorderly conduct.
• Driving Under Influence: Inhalant use while operating a motor vehicle is illegal and subject to similar penalties as driving under the influence of alcohol or other drugs.
• Legal Consequences: Although possession of most inhalants is not illegal, misuse that leads to harm to oneself or others can result in criminal charges. These vary depending on the circumstances but may include imprisonment or fines.

The legal landscape regarding inhalants in the UK is intricate and multifaceted, a complex weave of different regulations and guidelines. For individuals, healthcare practitioners, and policymakers alike, a nuanced understanding of this framework is crucial for ensuring responsible usage and management of these substances. The repercussions of violating these laws can be serious, affecting not just individual lives but the community.

Introducing harm reduction and safe use guidelines for inhalants serves a twofold purpose. Firstly, these guidelines aim to educate the public about the inherent dangers of inhalants, which are often mistakenly viewed as harmless due to their ubiquity in household products. Secondly, they provide a structured approach to minimise the risks for those who might already be engaged in inhalant use. By instilling a sense of responsibility and caution, these guidelines can potentially serve as a lifesaving resource.

Dosage and Frequency Guidelines

• Non-Medical Nature: Inhalants are generally not used for medicinal purposes, and as such, there is no safe or prescribed dosage for their consumption. The absence of medical guidelines accentuates the risks and unpredictability associated with their use.
• High Risks: Without any established safe dosage, every use of an inhalant carries significant risks, including immediate life-threatening consequences. This lack of a safety net makes individuals need to avoid inhalant use altogether.

Safe Use Practises

• Abstention: Abstaining from inhalant use is the most effective harm reduction method. This is particularly important because inhalants can cause irreversible damage even upon first use.
• Secure Storage: Household items used as inhalants should be stored securely, particularly when children are present. This measure serves as a proactive step in preventing accidental or experimental misuse.
• Environmental Context: Awareness of how prevalent inhalants are in daily life helps make informed choices. Common household items can become dangerous substances when misused.
• Education: Knowledge is a powerful tool for harm reduction. An understanding of the grave risks associated with inhalant use can deter initial experimentation and ongoing misuse.

Resources for Help and Support

• Treatment Programmes: Specialised programmes often offer the most comprehensive approach to treating inhalant abuse, integrating medical and psychological therapies.
• Counselling and Therapy: Individualised psychological support can be instrumental in addressing the underlying issues contributing to inhalant abuse.
• Peer Support Groups: Peer-led groups offer emotional and moral support. Sharing experiences and coping strategies often helps individuals realise they are not alone.

Safer Consumption Tips

• Safety First: Given the extremely high risks involved, the most practical tip for safer consumption of inhalants is not to consume them at all.
• Immediate Medical Help: If inhalant use is suspected and immediate adverse effects are observed, seeking prompt medical assistance is imperative.
• Public Awareness: Public education campaigns can effectively alert the community to the dangers of inhalant use, thereby reducing its prevalence.

Inhalant abuse is a public health issue that often goes underappreciated in discussions around substance misuse and addiction. Frequently overshadowed by the opioid epidemic or the widespread use of stimulants and depressants, the abuse of inhalants represents a unique and equally pressing challenge. These substances are easily accessible and predominantly used by younger populations, particularly teenagers, often because of their availability in common household products.

Firstly, the allure of inhalants stems from their easy procurement. The substances misused can be found in simple household items like paint thinners, air fresheners, and whipped cream dispensers. This accessibility poses an alarming risk, making preventative measures vital in stemming the tide of inhalant misuse. Parents and guardians need to be vigilant in monitoring the presence and usage of these substances in the home.

Secondly, the health ramifications of inhalant abuse are severe and can be long-lasting. Acute effects include nausea, headaches, and impaired judgement, while chronic misuse can lead to irreversible damage to the kidneys, liver, and brain. The lethal repercussions, such as “sudden sniffing death syndrome,” cannot be overstated. Such fatalities occur when the concentrated inhalation of these chemicals leads to heart failure. Consequently, educational programmes should aim to impart the seriousness of these health risks, targeting younger demographics who are statistically more likely to experiment with inhalants.

Moreover, the legal landscape around inhalants is murky. While these substances are often legal to purchase, their misuse may fall under laws governing substance abuse. This creates complications for law enforcement and social services aiming to tackle the problem. The absence of a stringent legal framework emboldens potential misusers, requiring the development of policy measures that adequately address the unique challenges posed by inhalant abuse.

Additionally, treatment and intervention methodologies for inhalant abuse are not as well-established as those for other substances. This is partly because inhalants don’t fit neatly into the categories set for more common drugs like opioids, stimulants, or hallucinogens. Given this, customised intervention strategies are required, possibly involving psychological counselling and behavioural therapies.

Lastly, harm reduction is complex in the context of inhalants. Most harm reduction strategies that apply to other substances like alcohol or opioids don’t translate easily to inhalants because of their volatile nature and the immediacy of their health effects. Thus, awareness-raising and education become the cornerstone of any strategy to reduce the harm associated with inhalant use.

In conclusion, inhalant abuse is a critical issue demanding targeted research, strong policy measures, comprehensive educational programmes, and effective treatment options. Society must not underestimate the severity of inhalant abuse due to its lesser-known status. The devastating impact it can have on an individual’s health, family, and community warrants immediate and robust action. The stakes are indeed high, and a multi-pronged approach is essential for mitigating the complex challenges associated with inhalant abuse.

National Institute on Drug Abuse – Drug Facts: https://www.nida.nih.gov/publications/drugfacts/inhalants

National Institute on Drug Abuse – Research Reports: https://www.nida.nih.gov/publications/research-reports/inhalants/what-are-inhalants

Alcohol and Drug Foundation: https://adf.org.au/drug-facts/inhalants/

U.S. Drug Enforcement Administration – Factsheets: https://www.dea.gov/factsheets/inhalants

Centre for Addiction and Mental Health: https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/inhalants

Better Health Channel: https://www.betterhealth.vic.gov.au/health/healthyliving/inhalants

U.S. Drug Enforcement Administration – PDF: https://www.dea.gov/sites/default/files/2020-06/Inhalants-2020_1.pdf

MedlinePlus: https://medlineplus.gov/inhalants.html

Cleveland Clinic: https://my.clevelandclinic.org/health/diseases/15742-inhalant-abuse

Addiction Centre: https://www.addictioncenter.com/drugs/inhalants/

Rehab Spot: https://www.rehabspot.com/drugs/inhalants/

MyDr: https://mydr.com.au/addictions/inhalants-what-are-the-effects/

MyHealth Alberta: https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=uq2427

Banyan Treatment Centre: https://www.banyantreatmentcenter.com/2021/06/21/different-inhalant-drugs-pompano/

Mass.gov: https://www.mass.gov/info-details/inhalant-use

UK Rehab: https://www.uk-rehab.com/drug-addiction/inhalants/

UKAT: https://www.ukat.co.uk/addiction/volatile-substance/inhalant/

Catch Recovery: https://www.catchrecovery.com/substance-abuse/inhalants/

Health Victoria – PDF: https://www.health.vic.gov.au/sites/default/files/migrated/files/collections/research-and-reports/i/in_commwork—pdf.pdf