Inhalant Abuse
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Inhalant abuse is often overlooked.  Rarely do in-patient units ask about it and patients are unlikely to volunteer the information.  Inhalants often cause brain damage and kill a surprising number of Americans each year, especially teenagers and young adults.  I haven't found anything written on treatment with the exception of using melatonin in an animal study to reduce brain damage.  Melatonin has been shown useful in many animal studies for reducing the brain damage of strokes and closed head trauma, so this finding on inhalant damage makes sense.

Melatonin Protects Rat Brains Against Toluene-containing Thinner Intoxication by Reducing Reactive Gliosis: Baydas G, et al. Firat University, Turkey. Toxicol Lett. 2003 Feb 3;137(3):169-74. Also, see J Pineal Res. 2005 Aug;39(1):50-6 by the same authors showing protection against brain damage and learning disabilities.

Gasoline, Freon, Butane, Glue, Nitrous Oxide Most Frequent: In 285 adolescents in correctional facilities in Virginia, European-American youths (36.1%) and youths from other ethnic backgrounds (44.4%) are significantly more likely to report past inhalant use than African-American youths (1.4%). The median age reported for first-time use of inhalants was 13 years. Huffing was preferred by 60%. Of the youths, 52% reported using inhalants with friends present, whereas 34% used inhalants when they were alone. Sites where youths reported inhalant use include at a friend's home (68%), at home (54%), on the street (40%), at parties (28%), on school grounds (26%), and at school (18%). There are no gender differences in age of onset of inhalant use, lifetime frequency of inhalant use, frequency of inhalant use in the past year, or preferred method of using inhalants. The five substances most frequently used as inhalants include gasoline (by 57.4%), Freon (40.45%), butane lighter fluid (38.3%), glue (29.8%), and nitrous oxide (23.4%). Adolescent inhalant abuse: environments of use. McGarvey EL, et al. University of Virginia. . Hypertension 2005 Mar;45(3):368-73.

Inhalant Abuse of Volatile Solvents Can Cause Schizophrenic Disease: Solvent-induced psychosis is very similar in clinical presentation to standard schizophrenia.  Amotivational symptoms are somewhat more common, but delusions, hallucinations, emotional instability are all typical. Symptomatological structure of volatile solvent-induced psychosis: is "solvent psychosis" a discernible syndrome? Wada K, et al. Tokyo, Japan. Nihon Arukoru Yakubuzu Zasshi 2005 Oct;40(5):471-84.

Poppers Common in Alcohol and Drug Abusing Teens: In teens 12-17 from the 2000 and 2001 National Household Surveys on Drug Abuse, 1.5% reported any lifetime use of nitrite inhalants. The prevalence of lifetime nitrite inhalant use increased to 12% and 14% among adolescents who were dependent on alcohol and any drug in the past year, respectively. Many nitrite inhalant users used at least three other types of inhalants (68%) and also met the criteria for alcohol (33%) and drug (35%) abuse or dependence. Increased odds of nitrite inhalant use were associated with residing in nonmetropolitan areas, recent utilization of mental health services, delinquent behaviors, past year alcohol and drug abuse and dependence, and multi-drug use. Use of nitrite inhalants ("poppers") among American youth. Wu LT et al. . J Adoles Health 2005 Jul;37(1):52-60.

Mothballs, Spray Paint, Nail Polish Remover, Room Fresheners Abused: Mothballs are one of a number of volatile compounds including model airplane glue, spray paint, nail polish remover, room fresheners, and gasoline that are intentionally inhaled for the purpose of recreational self-intoxication. Their inhalation produces a rapid 'high' characterized by euphoria and generalized intoxication. Chronic abuse can be associated with significant organ impairment. Mothballs contain the aromatic compound naphthalene and/or paradichlorobenzene. Prolonged exposure can cause hepatic failure and severe hemolytic anemia. Concealed mothball abuse prior to anesthesia: mothballs, inhalants, and their management. Kong JT, et al. Stanford University. Acta Anesthesiol Scand 2005 Jan;49(1):113-6.

Glue Vapors Also Damage Bone: Bone mineral density was measured in 25 children and adolescents with inhalant abuse and 30 controls. Teenagers with glue vapor abuse may carry an increased risk of future fracture. Evaluation of bone mineral density in chronic glue sniffers. Dundaroz MR, et al. Ankara, Turkey. Turk J Pediatr 2002 Oct-Dec;44(4):326-9.

Brain Damage Common with Paint Thinner: Chronic abuse of toluene by inhalation causes brain damage with white matter changes and thalamic hypointensity on MRI. In a study of 41 patients who chronically abused thinner, a toluene-containing solvent, MR images revealed white matter lesions in 46% of the patients, atrophic dilatation of ventricles and sulci in 27%, and thalamic hypointensity in 20%. White matter changes were restricted in 53% and diffuse in 47%. The development of white matter changes and thalamic hypointensity were significantly associated with duration of abuse longer than 4 years (P <.05 and P <.01, respectively). Cranial MR findings in chronic toluene abuse by inhalation. Aydin K, et al. Istanbul University Medical School, Turkey. Amer J Neurordiol 2002 Aug;23(7):1173-9.

Inhalant Kill Many in Texas: From 1988 to 1998, 144 Texans were documented as having inhalants as a contributing cause of death. The mean age of death was 26, ranging from 8 to 62. There were 92% males, 81% European-American, and 17% Hispanics. Of the death certificates, 35% mentioned Freon, and 25% mentioned chlorinated hydrocarbons. Of those with the mention of Freon, 42% were students, and 37% were mechanics, installers, and repairers, occupations in which Freon can be readily available. Of the chlorinated hydrocarbon deaths, 49% were students (mean age 17.5 years), and 51% were from other occupations (mean age 27.4 years). Deaths related to the inhalation of volatile substances in Texas: 1988-1998. Maxwell JC. Texas Commission on Alcohol and Drug Abuse, Austin. Amer J Drug Alcohol Abuse 2001 Nov;27(4):689-97.

Brain Damage Common: In long-term inhalant abusers of toluene, acetone, benzene and derivatives, brain damage was found to be common in a study of 10 teens ages 16-18, using an average of 4 years. The mean IQ level was 84. Brain SPECT findings in long-term inhalant abuse. Kucuk NO, et al. Ankara University Medical School, Turkey. Nucl Med Commun. 2000 Aug;21(8):769-73.

Inhalants Kill Many in Virginia: Death records from the Commonwealth of Virginia from 1987 to 1996 document 39 deaths related to inhalant abuse.  Age of death ranged from 13 to 42 years with the majority of deaths (70%) occurring at 22 years of age or younger. Ninety-five per cent of the individuals were male, with volatile substance abuse deaths accounting for 0.3% of all deaths in males aged 13-22 years. The chief volatile substances used were gas fuels (46%), predominately butane and propane, chlorofluorocarbons (26%), chlorinated hydrocarbons and alkylbenzenes (21%), and other volatile substances including volatile anesthetics. Deaths associated with inhalant abuse in Virginia from 1987 to 1996. Bowen SE, et al. Medical College of Virginia. Drug Alcohol Depend 1999 Feb 1;53(3):239-45. Ed: Extrapolating Texas and Virginia, I estimate 200 deaths per year nationwide.  There are undoubtedly some additional number who are not reported due to family pressures or misdiagnosis.