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PubMed1988

Inner-city substance abuse patterns: a study of psychiatric inpatients.

Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to use hallucinogens, and schizophrenics were less likely to use opioids. In all cases in which sex, age, and personality disorder were significant, males, the young adult group, and those with personality disorder were more likely to be abusers. These three variables were all strong predictors of both multiple and extensive substance abuse. Overall, our findings suggest that in the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse. The coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls attention for changes within the conventional psychiatric milieu.

Adult↗
PubMed1994

Solvent abuse: a case report and a review.

The deliberate inhalation of solvents among children and adolescents "for kicks" is becoming more common in the West. It was generally regarded as a relatively harmless practice and consequently little attention had been paid to the isolation of the toxic agent from the variety of substances used. It is now well recognised that solvent abuse not only can result in sudden death but also cause pathological changes to the liver, kidney, brain, heart and lungs. A case of toluene associated death in Malaysia is discussed both from a medico-legal and pathological standpoint.

Adolescent↗
PubMed1993

Dextropropoxyphene addiction--a drug of primary abuse.

In order to establish a profile of the abuser of dextropropoxyphene (DPX) in our community, we reviewed all the records from the Detoxification Unit in the Mental Health Institute in Mexicali, Baja California, Mexico. A total of 209 records were reviewed, and 73 were included in our study. Those included had a diagnosis of DPX dependence according to DSM-III-R and no associated psychiatric pathology. Most of them were single, unemployed males, with a history of at least 4 years of continuous DPX abuse. They were consuming an average dose per day 3.5 times higher than the maximum therapeutic dose recommended. The onset of generalized seizures associated with the DPX abuse was confirmed in 53% of the cases. The drug most frequently abused along with DPX was a benzodiazepine (p < .01), followed by marijuana, heroin, alcohol, stimulants (cocaine and amphetamines), and inhalants; 17% of the cases were pure DPX abusers. DPX was the first opiate ever abused in 67% of the cases, 19% had abused heroin before DPX, and 14% started the use of both at the same time. The difference among these groups (p < .01) suggests DPX as an opiate of primary abuse and not as secondary to heroin dependence.

Adult↗
PubMed2005

Butane encephalopathy.

Volatile solvent abuse (VSA) is defined at the "intentional inhalation of a volatile substance for the purpose of achieving a euphoric state". The lifetime prevalence of VSA in the UK remains steady at around 15%, the fourth highest rate in Europe, and VSA is the most common form of drug abuse in the 11-15 year age group in England and Wales. A 13 year old girl presented to the accident and emergency unit following inhalation of butane based deodorant, which resulted in a prolonged semiconscious state with encephalopathic symptoms.

Adolescent↗
PubMed1985

Deaths from abuse of volatile substances: a national epidemiological study.

A survey of the United Kingdom detected 282 deaths from abuse of volatile substances during 1971-83. Deaths appeared to have increased in the most recent years, reaching 80 in 1983. Age at death ranged from 11 to 76 years but most deaths (72%) occurred under 20 years. Ninety five per cent of the subjects were male, and in 1983 deaths from volatile substance abuse accounted for 2% of all deaths in males aged 10-19. All areas of the United Kingdom were affected, the rates being highest in Scotland and urban areas. All social classes were affected, though rates were highest in social class V and the armed forces. The volatile substances abused were gas fuels (24%), mainly butane; aerosol sprays (17%); solvents in glues (27%); and other volatile substances, such as cleaning agents (31%). In 51% of cases death was attributed to the direct toxic effects of the substance abused, in 21% to plastic bag asphyxia, in 18% to inhalation of stomach contents, and in 11% to trauma. Deaths associated with the abuse of glues were more likely to be traumatic, but all substances appeared capable of killing directly by their toxic effects, probably by a cardiac mechanism. Only a small proportion of deaths (6%) were due to the abuse of glues among children under 16; hence current attempts to limit access of children to glues will probably have little impact on overall mortality.

Adhesives↗
PubMed2004

Analysis of toluene in exhaled air of glue sniffers and workers using thinner at work place.

Toluene concentrations in exhaled air of workers using thinner at work place and glue sniffers were measured by gas chromatography (GC). Toluene concentrations in exhaled air of workers were significantly lower than those of glue sniffers. This suggests that a worker does not inhale as much thinner as a sniffer and that the analysis of thinner in exhaled air can be an indicator for its inhalation. It is also considered that the analysis of toluene concentration in the exhaled air gives an important clue whether the person inhaled thinner during working or self-abuse.

Adolescent↗
PubMed1996

Drug use among street children in southern Brazil.

We studied the self-reported activities engaged in by children found wandering on the streets of Porto Alegre, Brazil, aiming to describe their drug abuse habits and practice of thefts or mendicancy. One hundred-and-five youngsters, 6-18 years old, were interviewed in the streets. Although the external appearance of the interviewed children lacked cues as to their life-style differences, three diverse life-style characteristics were depicted among them. Almost 25% of the children lived with their families and went to school (FAMSCH) and 46% lived with their families but didn't go to school (FAM). The other 29% spent all day long and slept in the streets (STREET). The most frequently used drug for the total group of children was tobacco, followed by alcohol, with a much higher prevalence of use of both alcohol and tobacco among children from the STREET subgroup. Alcohol was used by more than 25% of the STREET children and tobacco by 58% of the children from this subgroup, in a regular (almost daily) basis. Less than 12% of the FAMSCH children used illicit drugs. Inhalants were the preferred drugs for illicit drug experimental use. Only 4% of the children attending school sniffed solvents in a regular basis. Regular abuse of inhalants was reported much more frequently by the STREET subgroup of children, reaching a prevalence of 40%. Self-report of marijuana smoking was described to be regular by 4% of the FAMSCH children and 26% by the STREET children. A significantly higher number of the children who lived with their families in comparison to the STREET children described work activities (selling food, washing cars or polishing shoes) while out in the streets. On the other hand the practice of thefts was self-reported mainly by the children from the STREET group and only by the ones who used illicit drugs. Children who lived with their families reported less mendicancy and thefts than STREET children. These results show that very poor children might spend many hours of the day by themselves in the streets of a big city accompanied by children who are never under adult supervision. In spite of being alone for some hours a day and making friends with others who might use drugs, having a family and regularly attending school decreases the risk of delinquent acts and drug use.

Adolescent↗
PubMed1993

[Magnetic resonance imaging in chronic toluene abuse, and volitional hyperkinesia].

We described the central nervous system impairments and findings of magnetic resonance imaging (MRI) of the brain in three chronic toluene abusers. Patient 1 and 2 had a history of chronic toluene inhalation for 1 or 2 years and patient 3 has a history of it for 16 years. The patients were evaluated after an abstinence period of at least 4 weeks, to avoid neurologic effects of acute intoxication. Neurologic signs included cerebellar, cognitive and pyramidal dysfunctions in all 3 patients and hyperkinésie volitionnelle (HV; volitional hyperkinesia) in patient 3 who had a long history of toluene inhalation. This HV was found to be tremulous by surface electromyography. Appearance of HV in chronic toluene abuse seems to be related to a period or quantity of inhalation of toluene. T2-weighted MRI in the 3 patients revealed the following abnormalities: (1) increased signal intensity of middle cerebellar peduncle and cerebellar white matter, deep cerebral white matter, and posterior limb of internal capsule; and (2) decreased signal intensity of thalamus and basal ganglia. Proton-weighted MRI in patient 3 with HV showed decreased signal intensity of lateral portion of the thalamus and tegmentum of the brainstem. These MRI findings correlate remarkably well with the neurologic signs seen in the 3 patients. Cerebellar, cognitive, and pyramidal dysfunctions appear to be related to involvement of middle cerebellar peduncle (cerebellar white matter), deep cerebral white matter, and internal capsule, respectively, and HV seems to correlate with involvement of the thalamus or tegmentum of the brainstem, especially the latter.

Adult↗
PubMed1991

CNS depressant effects of volatile organic solvents.

Volatile chemicals used widely as solvents can produce acute effects on the nervous system and behavior after inhalation exposure, and many are subject to abuse. This review considers the nature of the acute effects of volatile organic solvents by comparing their actions to those of classical CNS depressant drugs such as the barbiturates, benzodiazepines and ethanol. Like CNS depressant drugs, selected inhalants have been shown to have biphasic effects on motor activity, disrupt psychomotor performance, have anticonvulsant effects, produce biphasic drug-like effects on rates of schedule-controlled operant behavior, increase rates of punished responding, enhance the effects of depressant drugs, serve as reinforcers in self-administration studies and share discriminative stimulus effects with barbiturates and ethanol. Toluene and 1,1,1-trichloroethane, as well as subanesthetic concentrations of halothane, have been the most extensively studied; however, it is unclear whether important differences may exist among solvents in their ability to produce a depressant profile of acute effects. The possibility that selected solvents can have acute effects similar to those of depressant drugs may shed light on the nature of their acute behavioral toxicology and on their abuse.

Animals↗
PubMed1995

Reproductive and developmental toxicity studies of toluene. I. Teratogenicity study of inhalation exposure in pregnant rats.

Toluene is a widely used solvent in industry which is the subject of abuse among the younger generation. A teratogenicity study of toluene by inhalation exposure was carried out in Sprague-Dawley rats and the effects on dams, fetuses and offspring were assessed. Pregnant females were exposed to 600 or 2000 ppm toluene for 6 h/day from day 7 to day 17 of pregnancy. The control group inhaled conditioned clean air under the same exposure conditions. Maternal exposure to 2000 ppm toluene caused significant toxic effects such as body weight suppression of dams and offspring, high fetal mortality and embryonic growth retardation, but no external, internal or skeletal anomalies were observed in the fetuses of any treated group. In addition, there were no differences in the results of pre- and postweaning behavioral tests of the offspring. However, no toxic or teratogenic changes which could be related to toluene exposure were apparent in the 600 ppm group. Further studies are warranted with toluene at higher concentrations applied during the period of organogenesis.

Abnormalities, Drug-Induced↗
PubMed1979

Intravenous prophylhexedrine (Benzedrex®) abuse and sudden death.

Propylhexedrine was implicated in 15 deaths investigated by the Dallas County Medical Examiner since 1973. Twelve of the deaths were attributable to intravenous abuse of the contents of the Benzedrex® inhaler. Each death could be defined as sudden. Pulmonary edema, foreign body granulomas, fibrosis and evidence of pulmonary hypertension were frequent postmortem findings. Right ventricular hypertrophy was present in nine of the 12 subjects who died of intravenous propylhexedrine abuse. Two homicides and one suicide were propylhexedrine-related. Intravenous propylhexedrine abuse should be considered in the differential diagnosis of right ventricular hypertrophy and/or pulmonary hypertension, and it should be suspected in cases of sudden death involving young adults displaying evidence of intravenous drug abuse.

Adult↗
PubMed1994

Solvent vapor abuse leukoencephalopathy. Comparison to adrenoleukodystrophy.

Chronic organic solvent vapor inhalation can cause permanent damage to the central nervous system. Clinical features and radiologic abnormalities are well known, but pathology has not been definitely established. This study describes the gross, microscopic and ultrastructural changes and fatty acid composition of cholesterol esters in the brain of two chronic paint sniffers as well as the electron microscopic findings from a third, all with permanent neurological impairment. The abnormalities which were the same in all cases consisted of a demyelinating process which grossly manifested itself as brain atrophy and subtle discoloration of the cerebral and cerebellar white matter. Periodic acid-Schiff-positive macrophages in the absence of foamy macrophages were the histological hallmark of this process. Electron microscopy revealed oval membrane-bound cytoplasmic bodies filled with bundles of trilaminar inclusions composed of 3 nm paired dense leaflets separated by a space 3-7 nm wide in macrophages. Biochemical analysis showed an increase of very long chain fatty acids in the white matter cholesterol esters. This study defines the morphologic substrate of solvent vapor abuse leukoencephalopathy. The novel ultrastructural observations in conjunction with biochemical findings provide a link with adrenoleukodystrophy and raise the possibility of similar mechanisms of myelin degradation in both.

Administration, Inhalation↗
PubMed2003

Myeloneuropathy from nitrous oxide abuse: unusually high methylmalonic acid and homocysteine levels.

A 23-year-old patient developed diffuse paresthesias and sensory loss. He had mildly reduced serum vitamin B12 (B12) concentration with unusually high levels of methylmalonic acid (MMA) and homocysteine and no evidence of B12 malabsorption. Following parenteral B12 administration, his neurological deficit promptly resolved and B12 and MMA levels normalized, but elevated levels of homocysteine persisted. One year later, he admitted to inhaling nitrous oxide (N2O). After halting N2O abuse his homocysteine level normalized. This case demonstrates the importance of serum homocysteine level measurements in cases of suspected N2O toxicity [corrected].

Adult↗
PubMed1983

Phencyclidine-dependent chemiluminescence of rat alveolar macrophages.

Phencyclidine (PCP) is a drug of abuse which is commonly taken by inhalation or snorting. By this pathway, it comes in direct contact with the alveolar macrophages (AM) which phagocytize inhaled particles. The activated AM produce reactive oxidative products and release photons with resulting chemiluminescence (CL) that can be quantified in the presence of luminol. The effect of PCP on this functional ability has been studied. PCP-treated rat-AM in vitro causes a two-to threefold increase in CL emission, after challenging with zymosan particles. This CL augmentation by PCP appears not to be associated with increased phagocytosis. Several metabolic inhibitors have been studied, and only rotenone has been found to inhibit CL production to a greater degree with PCP than in its absence. It may be assumed that the enhanced CL produced in the presence of PCP is due to activation of the drug by some reactive oxygen state or states that are affected by rotenone.

Animals↗
PubMed1985

Transport of molecules from nose to brain: transneuronal anterograde and retrograde labeling in the rat olfactory system by wheat germ agglutinin-horseradish peroxidase applied to the nasal epithelium.

Transneuronal anterograde labeling with the conjugate wheat germ agglutinin-horseradish peroxidase (WGA-HRP) has been documented in the mammalian and immature avian visual system [6,14]. Transneuronal retrograde labeling was significant only in the chick [6]. The present study was performed to determine whether transneuronal labeling could be shown in the mammalian olfactory system, whether the phenomenon was robust in adults, and whether transneuronal retrograde transport could label several transmitter-specific centrifugal afferent projections to the olfactory bulb. In addition we wished to learn whether molecules that enter the nasal cavity can undergo transport to brain neurons. Gelfoam implants soaked with 1% WGA-HRP, surgically implanted into the nasal cavity, produced transneuronal labeling patterns that affirmed all of these questions. Transneuronal anterograde transport labeled the appropriate zones in the olfactory bulb and in all second order olfactory targets. In addition, there was transneuronal retrograde labeling of neurons in the olfactory bulb, anterior olfactory nucleus and in transmitter-specific projection neurons from the diagonal band (cholinergic), raphe (serotonergic) and locus coeruleus (noradrenergic). Transneuronal labeling was robust and consistent. The patterns of labeling indicated that transneuronal anterograde and retrograde transport occurred along known, specific circuits in the olfactory system. The present results suggest that nasal epithelial application of WGA-HRP may be a useful tool for assessing regeneration of primary olfactory neurons and the status of central circuitry following regeneration. The method should also facilitate the study of central olfactory connections after surgical or genetic lesions of the olfactory bulb. Finally, these experiments suggest the possibility that inhaled molecules including, possibly substances of abuse, may be transported to, and, possibly, influence the function of neurons in the brain, including some (diagonal band, raphe, locus coeruleus) which have extensive projections to wide areas of the CNS.

Animals↗
PubMed2004

History of marijuana use and tobacco smoking topography in tobacco-dependent adolescents.

Adolescent tobacco smokers have higher rates of marijuana (MJ) use than nonsmokers. Because MJ smoking typically involves deeper inhalation and longer breathholding than tobacco smoking, we hypothesized greater puff volume, longer puff duration and puff interval, and higher puff velocity during tobacco smoking among (1) MJ-using teens; (2) teens whose onset of MJ smoking occurred before tobacco (MBT). One hundred and three tobacco-dependent adolescents presented for smoking cessation treatment (66.0% female, 71.0% European American, mean age 15.3+/-1.25 years) smoked one cigarette of their own brand in the laboratory prior to study entry. Topography and associated physiological measures among current recreational (<5 days in a 14-day period) MJ users (n=25), current heavy (>/=5 days in a 14-day period) MJ users (n=22) and current non-MJ-smoking teens (n=56) were compared. There were no differences in tobacco smoking topography or physiological measures by recent MJ-smoking history or by order of substance initiation. Significantly more African American than European American adolescent smokers reported MJ use before tobacco. Our findings in adolescent smokers are consistent with results from adult studies in which history of MJ smoking was not associated with changes in tobacco smoking topography.

Adolescent↗
PubMedDate not supplied

Methamphetamine-related stroke: four cases.

Amphetamine use in certain parts of the United States has risen dramatically. Methamphetamine, the most-common illicitly abused type of amphetamine, can be inhaled, injected intravenously, or smoked. It is a potent sympathomimetic that may lead to vascular events including myocardial infarction and stroke. Because of the demographics of drug use, these potentially devastating events usually occur in relatively young patients. The pathophysiology of stroke related to amphetamine use is multifactorial. Elevation in blood pressure, vasculitis, or other vascular toxicity are postulated as major mechanisms. Four cases of stroke associated with the use of methamphetamine, all occurring in patients ranging in age from 29-45 years, are described. Methamphetamine use appears to be a risk factor for the development of stroke. The rise in methamphetamine use will undoubtedly result in increased Emergency Department admissions with clinical presentations very similar to those of cocaine intoxication.

Adult↗
PubMed1990

Aerosol addiction.

A case of dependency on prescribed pressurised aerosols in a patient with asthma and mild mental handicap is reported. The majority of reported cases involve young asthmatics, abuse being reported mainly using salbutamol inhalers although other inhalers have also given cause for concern. The agent of addition is uncertain although it may be the fluorinated hydrocarbons used as propellants, rather than the active substance itself.

Adult↗