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The first known case of inhalation of liquid typewriter correction fluid (TCF) is reported. Respiratory exposure to TCF can produce coma and death. Treatment is mainly supportive. Clinicians should be alerted to this new form of substance abuse.
Although inhaling is commonly thought of as a novel form of drug use, it has been customary for centuries with finely ground tobacco or with a wide variety of hallucinogenic powdered plant derivatives in tropical South America (de Rios). Nose pipes facilitate snuffing in some cultures, and in others, drugs are blown, by turn, through tubes into the nostrils of companions. Pictorial evidence illustrates the use of enemas as an alternative means of ingesting drugs, especially among a few pre-Columbian Indian populations in Central and South America. In light of the rapidity of absorption from the bowels to the bloodstream, one may wonder why it has been so little used (or at least reported) in recent years. Even within the modern, urban United States, the verbs drink, smoke, and eat have variously been used to characterize variant means of ingesting drugs. Dire predictions about a generation of hopeless "crack babies" have not been confirmed, but differential treatment and punishment of users has resulted in the unjust imprisonment of many more blacks and for longer periods, even though whites are more numerous among drug users.
A 19 year old patient presented with the typical constellation of sarcoidosis. In the presence of indefinable pulmonary infiltrates, hypercalcemia, raised angiotensin converting enzyme and even evidence of giant and epitheloid cell granulomas, cocaine abuse should be considered. Chronic inhalative cocaine abuse can cause foreign body associated granulomatosis of the lung and other organs. It is important to establish this differential diagnosis by confidential interview and systematic polarisation microscopy to detect foreign material in tissues: unnecessary therapies with potential side effects should be avoided and drug weaning with rehabilitation of the patient should be initiated. However the potential for rapid progressive respiratory failure should not be underestimated.
OBJECTIVES: Using two existing ethnographic studies of drug-involved adults, this study evaluates the association between child-abuse victimization and levels of involvement in inhalant use. METHODS: Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Crude and adjusted odds ratios were used to compare informants with no history of inhalant use with those having a history of light inhalant use and those having a history of heavy inhalant use. RESULTS: Heavy inhalant use was associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. CONCLUSIONS: Child abuse may be an important correlate of extensive involvement in inhalant use. The findings invite speculation with respect to a hypothetical causal role for child abuse in the etiology of inhalant use. The lack of support for causality in this study underscores the need for replication and more carefully designed longitudinal research.
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Intentional inhalation of volatile organic chemicals is not a new phenomenon. It has existed since ancient times. Abusing household and other commercially available products, containing volatile organic solvents, has been recognized since the early 1950s. Products containing volatile organic chemicals include everything ranging from gasoline to paints, aerosolized foods, cosmetics, and other solvent-based household products. These products are easily available, legal, and usually inexpensive when compared to the alternative, illegal substances. While inhalant abuse is small when compared to the abuse of other substances, the problem can, in some cases, be fatal to the abuser. The public sector, industry, and government all are trying to find a solution. This paper reviews the history of perverted use of commercial products, the inhalant abuser, the signs and symptoms, the pharmacotoxicology, and the various approaches to solutions.
Organic solvent inhalation is a serious problem among youths in Japan. It induces physical and mental disorders, and is related closely to crime and delinquency. The relationship between solvent inhalation and antisocial behavior was investigated in 75 youths. The subjects were divided into three groups according to the level of violent behavior and the time of appearance: a non-violent group, a late-onset group (violence occurred after the start of inhalation) and an early-onset group (violence had occurred before the start of inhalation). Various parameters were compared among the groups. The late-onset group showed the following characteristics; (i) the frequency of inhalation was high, and many subjects experienced hallucinations and mood changes caused by inhalation; (ii) the family environment was characterized by conflict; and (iii) the subjects had strong psychological conflicts and showed dissociative coping with frustration. The violence, psychological conflict and dissociation in this group were found to be related to the inhalation, with familial conflict as a background. The violence in the early-onset group was considered to be the manifestation of a violent personality as the frequency of inhalation and the incidence of mental symptoms were both low. The subjects in this group showed weak psychological conflict and tended to be demanding of others when attempting to cope with frustration. Two types of violent behaviors in the teenagers who inhaled solvents were identified. The violence of solvent inhalers should be managed according to the type.
Three patients with severe chronic lung disease had left ventricular failure develop with marked impairment of cardiac function. Ejection fractions by radioactive blood pool ventriculography were 0.17, 0.24, and 0.20. Right ventricular endomyocardial biopsy specimens showed interstitial hemorrhage and foci of interstitial polymorphonuclear leukocytes, strongly suggestive of catecholamine myocarditis. These patients had used beta-adrenergic agonist inhalants and methylxanthines. One of them clearly abused the inhalant and had elevated levels of urinary catecholamines. Progressive deterioration of pulmonary and cardiac function occurred in two patients, with death within three months of the initial myocardial biopsy. Concomitant use of beta-adrenergic agonists and methylxanthines may cause myocarditis with left ventricular failure in susceptible patients.
Midfacial necrosis due to the abuse of inhaled cocaine is a new entity that is included in the differential diagnosis of the midline destructive diseases such as Wegener's granulomatosis, polymorphic reticulosis, nasal lymphoma, infections and the idiopathic midline destructive disease. We report the case of a forty-year-old male who presented necrosis of the nasosinusal tract and optic neuropathy as complications due to the abuse of inhaled cocaine for more than twenty years and a discussion about the differential diagnosis.
The abuse of volatile organic solvents (inhalants) leads to diverse sequelae at levels ranging from the cell to the whole organism. This paper reviews findings from the last 10 years of animal models investigating the behavioral and mechanistic effects of solvent abuse. In research with animal models of inhalant abuse, NMDA, GABA(A), glycine, nicotine, and 5HT(3) receptors appear to be important targets of action for several abused solvents with emerging evidence suggesting that other receptor subtypes and nerve membrane ion channels may be involved as well. The behavioral effects vary in magnitude and duration among the solvents investigated. The behavioral effects of acute and chronic inhalant abuse include motor impairment, alterations in spontaneous motor activity, anticonvulsant effects, anxiolytic effects, sensory effects, and effects on learning, memory and operant behavior (e.g., response rates and discriminative stimulus effects). In addition, repeated exposure to these solvents may produce tolerance, dependence and/or sensitization to these effects.
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Isobutyl nitrite is a volatile liquid sold without a prescription as a "room odorizer" but is widely used as an inhalant to produce feelings of euphoria. Of the 173 13-22-year-olds (mean age, 16 years) clients of a long-term drug treatment facility who completed a questionnaire related to drug use, 74 (43%) admitted to having used isobutyl nitrite at least once, 22 (13%) had used the substance ten or more times, and eight (4%) used the substance 50 or more times. Inhalation of this malodorous substance leads almost universally to dizziness and lightheadedness and usually to severe symptoms of vasodilatation such as "pounding of the heart," blurred vision, and a "warm feeling." The feeling was unpleasant to 44 percent of the users in this study, and most also experienced pulsatile headache. In addition, contact dermatitis and irritation of the tracheobronchial tree and eyes occurred in some users. The primary use of this substance as an euphoric agent warrants consideration of banning its sale altogether.
Toluene is a widely abused solvent with demonstrated addictive potential in humans. Here we explore if conditioned place preference can be used to study the abuse-related effects of inhaled toluene in rats. Animals were confined to a distinctive compartment of a three-compartment chamber while exposed to toluene vapor and later tested for preference for that compartment compared to appropriate control subjects. In this study, a flame ionization detector was used for on-line monitoring of toluene vapor concentrations inside the conditioning apparatus coupled with computerized recording of the time spent by the animals on the test day in each of the chambers. Sprague-Dawley rats were exposed to 810, 1895 or 4950 ppm of toluene vapors in either the black or white compartment during 30-min pairing sessions given every other day alternating with air exposure for the total of six pairings for each treatment. Rats that received air in both sides (control group) did not show any preference for either side with approximately equal time spent in each compartment on the test day (241 +/- 33 and 234 +/- 34 s, for white and black box, respectively). However, the 1895- and 4950-ppm test groups, but not the 810-ppm group, demonstrated a significant preference for the side paired with toluene exposure. When a subsequent test session was performed during toluene exposures, no conditioned place preference was observed. Thus, toluene produced a clear conditioned place preference that appears to be most evident when animals are not intoxicated. This procedure should be useful for further studies of the abuse-related effects of abused inhalants.
Abuse of inhalants in today's society has become such a widespread problem among today's adolescents that in many parts of the world their use exceeds that of many other illicit drugs or alcohol. Even so, little is known how such inhalants affect brain function to an extent that can lead to an abuse liability. While methodologies exist for radiolabeling certain inhalants of interest with short-lived positron emitting radioisotopes that would allow their investigation in human subjects using positron emission tomography (PET), the purification methodologies necessary to separate these volatile substances from the organic starting materials have not been developed. We've adapted supercritical fluid technology to this specific PET application by building a preparative-scale supercritical CO2 fluid radiochromatograph, and applied it to the purification of [11C]toluene. We've demonstrated that [11C]toluene can be separated from the starting materials using a conventional C18 HPLC column and pure supercritical CO2 fluid as the mobile phase operating at 2000 psi and 40 degrees C. We've also shown that the purified radiotracer can be quantitatively captured on Tenax GR, a solid support material, as it exits the supercritical fluid stream, thus allowing for later desorption into a 1.5% cyclodextrin solution that is suitable for human injection, or into a breathing tube for direct inhalation.
We hypothesized that the abuse potential of certain types of inhalants could be evaluated in animals by determining the overlap in their profile of behavioral effects with that of CNS depressant drugs and other depressant-like abused inhalants. For our first attempt in evaluating a solvent with an unknown abuse potential we tested ISOPAR-E. ISOPAR-E is a mixture of predominantly C8-C9 isoparaffinic hydrocarbons that is being used more and more frequently as a solvent in industrial and consumer products, including, but not limited to, typewriter correction fluids. Presently, nothing is known about the potential for abuse of products containing this solvent. In the present studies, we compared the volatility of ISOPAR-E and the abused solvent 1,1,1-trichloroethane (TCE) in our exposure systems. Additionally, five behavioral procedures were conducted in mice to compare the effects of the two compounds. The results demonstrate that: (1) ISOPAR-E was less volatile than TCE; (2) ISOPAR-E produced a somewhat different profile of effects than did TCE as assessed with a functional observational battery; (3) unlike TCE, ISOPAR-E did not affect performance on tests of motor coordination; (4) TCE and ISOPAR-E produced concentration-related decreases in schedule-controlled operant performance with recovery from TCE being somewhat more rapid; (5) ISOPAR-E produced cross dependence in TCE-dependent mice; and (6) both TCE and ISOPAR-E produced substantial levels of ethanol-lever responding in a drug discrimination procedure, although the ethanol-like effects of ISOPAR-E only occurred at response rate decreasing concentrations. Overall, there was a poorer separation of behavioral and lethal concentrations for ISOPAR-E than for TCE. Although a somewhat different profile of behavioral effects was obtained with ISOPAR-E and TCE, we cannot say with certainty if enough similarities exist with abused inhalants to predict that ISOPAR-E would be subject to depressant-like abuse. Nonetheless, the feasibility of preclinical assessment of abuse potential of inhalants was demonstrated.
Toluene and many toluene-containing products are abused via inhalation. Previous investigations have used the place preference paradigm to evaluate the rewarding effects of commonly abused drugs such as morphine, cocaine, and amphetamine. A conditioning paradigm of toluene inhalation was developed in order to estimate the rewarding effect in mice. Conditioning sessions (five for toluene, five for air) were conducted twice daily for 5 days using a newly developed airtight inhalation shuttlebox (15x30x15 cm: wxlxh), which was divided into two compartments of equal size. One compartment was white with a textured floor, and the other was black with a smooth floor. All conditioning sessions were 20 min in duration, with a minimum of 7 h between sessions. Test sessions were carried out 1 day after the final training session with mice in a drug-free state. The time spent in each compartment during a 20-min session was measured using a digital video camera. Exposure to toluene vapors (700-3200 ppm) produced a significant conditioned place preference in mice. These results suggest that the conditioned place preference procedure using the newly developed airtight inhalation shuttlebox constitutes an important tool for studying the rewarding effect of abused solvents.
In the present studies, drug discrimination procedures were used to compare the discriminative stimulus effects of ethanol (ETOH) and several volatile anesthetics. Male albino mice were trained to discriminate between IP injections of ETOH (1.25 g/kg) and saline in a two-lever operant task in which responding was under the control of a fixed-ratio 20 (FR20) schedule of food presentation. Stimulus generalization was examined after 20-min inhalation exposures to desflurane (4,000-32,000 ppm), enflurane (3,000-12,000 ppm), isoflurane (1,000-8,000 ppm) and ether (4,000-32,000 ppm). Concentration-related increases in ETOH-lever responding were observed for all four volatile anesthetics. For enflurane and ether, maximal levels of > 85% ETOH-lever responding were obtained at one or more concentrations. For desflurane and isoflurane, the maximal mean percentages of ETOH-lever responding were somewhat lower, but 6 out of 7 mice showed full substitution with desflurane and 5 out of 7 for isoflurane. The shared discriminative properties of these compounds with ETOH suggest that these anesthetics may share some of ETOH's pharmacological properties. These results are similar to previous research results showing ETOH-like discriminative stimulus effects in mice with other anesthetics and abused volatile inhalants (i.e. halothane, toluene and 1.1,1-trichloroethane) and may reflect the CNS-depressant drug-like effects of inhaled anesthetics and abused solvents.
OBJECTIVE: To determine the incidence of off-label use of, abuse of, and dependence on prescription nicotine inhaler. DESIGN: Prospective telephone and internet interviews for six months. PARTICIPANTS: 535 new inhaler users. MAIN OUTCOME: Structured interview about off-label use (that is, use of inhaler for non-cessation reasons or concurrent use of inhaler and cigarettes) and Diagnostic and statistical manual, fourth edition (DSM-IV) and International classification of diseases, 10th edition (ICD-10) criteria for abuse and dependence RESULTS: Although many used inhaler and cigarettes concurrently at some time (43-55%), few used inhaler for non-cessation reasons (4-9%) and few persisted in off label use (8-16%; 95% confidence interval (CI) 5% to 19%). No participant met ICD-10 criteria for harmful use/abuse (95% CI 0% to 3.3%). Eight subjects (1.4%) appeared to meet DSM-IV or ICD-10 criteria for dependence on inhaler, but none were found dependent in a clinical expert interview (95% CI 0% to 3.3%). CONCLUSIONS: Although transient concurrent use of inhaler and cigarettes often occurs, use for non-cessation reasons, abuse and dependence are rare.