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PubMed1989

Pathology of volatile substance abuse: a case report and a literature review.

The medicolegal importance of volatile substance abuse, as an example of toxicological deaths, is reviewed. A case of a 13-year-old boy who died after inhalation of volatile substances from a deodorant spray tin is presented. Another similar case has been summarized in the discussion. Different aspects of volatile substance abuse are considered with special emphasis on those facets which are relevant to forensic pathology practice. The most important pathological alterations associated with the acute and chronic abuse of volatile substances are discussed and some histological features of these conditions are illustrated with photographs. These include some microscopic changes of the central nervous system, respiratory system and the kidneys. The roles of the pathologist and the toxicologist in the investigations of the fatalities resulting from the volatile substance abuse are reviewed and practical points are explained. Lastly, some relevant legal points are discussed.

Adolescent↗
PubMed1987

Pentobarbital-like discriminative stimulus properties of halothane, 1,1,1-trichloroethane, isoamyl nitrite, flurothyl and oxazepam in mice.

Volatile inhalants represent a diverse group of chemicals which pose a public health problem because of their abuse potential and neurobehavioral toxicity. Although relatively little is known about their pharmacology, they share certain pharmacological properties with classic central nervous system depressants. Drug discrimination procedures were used to compare the effects produced by pentobarbital (PB), oxazepam and several inhalants. Mice were trained to discriminate PB from saline injections in a two-lever operant task. Stimulus generalization was examined after 20-min inhalation exposures to halothane (500-8000 ppm), 1,1,1-trichloroethane (500-12000 ppm), isoamyl nitrite (150-1050 ppm), flurothyl (562-1300 ppm) and injections of oxazepam (0.1-20 mg/kg). Halothane, 1,1,1-trichloroethane and oxazepam produced discriminative stimulus effects similar to those produced by PB. Isoamyl nitrite and flurothyl, while decreasing rates of responding, were not consistently generalized from PB. Differences are apparent in the PB-like discriminative effects of inhalants. Toluene, as shown in a previous study, as well as halothane and 1,1,1-trichloroethane have PB-like discriminative effects which are also shared by oxazepam and may be another common effect of central nervous system depressants. Other chemicals, like isoamyl nitrite and flurothyl, are representative of qualitatively different classes of behaviorally active inhalants.

Administration, Inhalation↗
PubMed1993

Reduction of ethanol intake by aerosol inhalation of a beta-adrenergic agonist: new route--new treatment approach?

The quick, convenient, unobtrusive administration of a low dose of a drug that effectively reduces alcohol intake could be a useful adjunct to any program that aims to treat alcohol abuse. This study evaluates the ability of isoproterenol, a drug that has previously been shown to reduce ethanol intake, to exercise this action when administered as a metered aerosol mist. Rats were trained to self-administer ethanol using a procedure that limits access to a brief daily availability period. Once intake stabilized, animals were given isoproterenol by metered aerosol inhalation just before ethanol availability. A custom-designed helmet attached to a commercially available mistometer was used to deliver the drug. Isoproterenol produced a dose-dependent reduction in ethanol intake and an increase in water intake replicating the effects of parenterally administered isoproterenol on ethanol and water consumption. These findings demonstrate that the administration of isoproterenol in inhaled aerosol form can effectively reduce voluntary ethanol consumption in rats. The administration of pharmacologically active antialcohol agents via the inhalation route may be useful in the symptomatic treatment of alcohol abuse in humans.

Administration, Inhalation↗
PubMed1980

Profile of narcotic abuse in peninsula Malaysia.

Demographic and drug abuse characteristics of 3,484 new drug abuse contacts presenting to the General Hospital, Kuala Lumpur, Malaysia are reported. The large majority were heroin inhalers. They were different from the traditional Eastern opium inhalers and similar to Western heroin injectors in that they were young, male, single, and frequently unemployed. These features and the relative underrepresentation of Chinese suggest that the Chinese of this study did not learn narcotic abuse from opium-smoking relatives.

Adolescent↗
PubMed1989

Osteocartilaginous necrosis of the sinonasal tract following cocaine abuse.

As cocaine abuse has become increasingly widespread, there has been a concomitant rise in associated medical complications. Nasal inhalation ("snorting") causes profound effects on the upper respiratory tract in addition to the well known nasal septal perforation. Septal necrosis can be accompanied by bleeding, granulation tissue, ulceration, and sinusitis. There are few reports of extensive sinonasal tract osteocartilaginous necrosis from cocaine abuse. We present five patients with this complication, which must be distinguished from other destructive midface lesions such as Wegener's granulomatosis and polymorphic reticulosis.

Adult↗
PubMed1996

Factors influencing the early prediction of outcome from burns.

OBJECTIVE: 1. To reexamine the predictive value of the variables usually used in admission scores in burned patients (age, total body surface area burned (TBSAB), full thickness burn (FTB), inhalation injury (IHT) and sex). 2. To evaluate whether risk factors (alcohol abuse (AA), nicotine abuse (NA)) or preexisting diseases influence outcome significantly. DESIGN: Retrospective study of prospectively collected data. PATIENTS: 498 burned patients admitted to the burn ICU within a 5 years period. The mean TBSAB was 29% and the mean age 38 years. 42% of the patients suffered burns greater than 30% and the incidence of IHT amounted to 43%. METHODS: Univariate analyses were used to determine the independent relation of the variables to mortality. The relative weight of the variables was estimated using the step-wise logistic regression model. An additional analysis of subgroups was performed using classification and regression trees (CART). RESULTS: The univariate analyses identified the following variables to have significant influence on mortality: age, TBSAB, FTB, IHT, sex, AA, NA, the combination of AA and NA, preexisting neurological diseases and cardiovascular diseases. The step-wise logistic regression analysis identified age and TBSAB to have the most important influence on the outcome. Of minor weight was IHT followed by FTB and sex. The weight of IHT was found to be 1.7 fold higher than the impact of FTB and sex. A significant influence of IHT was found in all patients, but especially in patients with a medium risk of death (20%-45%) regarding age and TBSAB. In this group AA and NA additionally caused a significant impact on mortality. In patients with a higher or lower probability of survival AA and NA did not influence the outcome. The CART analysis identified TBSAB to be the most discriminative variable followed by age. In the group up to 20% TBSAB age was the only additionally significant variable regarding the outcome. In the group with a TBSAB between 20% and 60% age, sex and AA became important variables. In patients up to 72 years with a medium risk of mortality (20%-70%) IHT, AA, combined AA and NA, sex, preexisting neurological diseases and cardiovascular diseases significantly influenced outcome. In older patients IHT was the only additional variable of importance. CONCLUSIONS: The study demonstrates that besides the "classical" variables of bum scores as age, TBSAB and IHT other variables such as sex, AA, NA and preexisting diseases have significant influence on the outcome. These variables especially gain important predictive value in patients with a medium risk of mortality.

Adult↗
PubMed1995

Drug testing in the workplace: could a positive test for one of the mandated drugs be for reasons other than illicit use of the drug?

This manuscript reviews data available in the scientific literature relative to drug testing for the five mandated drug classes and circumstances other than abuse of the drug itself that could result in a positive test. For marijuana, passive inhalation, unknowing oral ingestion, and the use of Marinol are discussed. Data are presented on the concentration of delta9-tetrahydrocannabinol (THC) and its precursors, acid-A and acid-B, in illicit marijuana and the extent of extraction of THC in boiled (tea) or cooked products. For cocaine, passive inhalation and passive exposure issues are reviewed. For opiates, poppy seed ingestion and guidelines for exclusion of poppy seeds as a cause for a positive test are discussed. For amphetamines, issues such as the presence of other phenethylamines, l-methamphetamine (Vicks' inhalers), and other prescription drugs are discussed. Although passive inhalation of methamphetamine and phencyclidine is theoretically possible, no data were available on these issues.

Amphetamines↗
PubMed1990

[Chronic inhalation of organic solvents and neuropathy. Clinical case].

A young man had indulged in chronic solvent vapor abuse for 14 years. After an abstinence period of 4 months, neurological evaluation showed distal limb weakness, predominantly of the lower extremities, and moderate loss of reflexes. Sensory signs were absent. Electromyographic evidence of chronic partial denervation was shown. Maximal motor conduction velocities were reduced and distal motor and sensory latencies were increased, presumably because of secondary demyelinating changes. CT revealed diffuse atrophy of cerebral hemispheres, however the mental status of the patients was judged normal. Thus, chronic exposure to solvent vapor may cause peripheral nervous system impairment without evidence of clinical effects on the central nervous system.

Adult↗
PubMed1991

Organic solvent and aerosol abuse.

Volatile organic solvents and aerosols are available in a wide variety of household and commercial products. Inhalation of these substances produces euphoria, excitement, sedation, delusions, and visual and auditory hallucinations. With acute and chronic use, organic solvents and aerosols cause slurred speech, ataxia, frank intoxication, and poor insight and judgment. Both acute and chronic toxic effects can occur, and addiction can develop with chronic use.

Aerosols↗
PubMed2000

Relationship between pharmacokinetics and hemodynamic effects of inhaled isobutyl nitrite in conscious rats.

Our objective was to examine the pharmacokinetic/hemodynamic properties of inhaled isobutyl nitrite (ISBN) in rats. ISBN is one of the volatile organic nitrites that has been used primarily as a drug of abuse. Recent studies indicate, however, that these compounds may be superior to organic nitrates for cardiovascular use because they do not produce vascular tolerance. Rats inhaled ISBN over an exposure range of 20 to 1200 ppm for 1 hour. The effects of ISBN on blood pressure and heart rate were determined and blood concentrations of ISBN were analyzed with use of gas chromatography. Apparent steady-state blood levels of ISBN were achieved during inhalation and were linear with exposure concentration (blood concentration: 0.05 to 3.5 microM; exposure concentration: 23 to 1177 ppm; r2= 0.92). Inhaled ISBN caused rapid, dose-dependent, and parallel reductions in systolic and diastolic pressure, while heart rate increased maximally to 22%. A sigmoid Emax model could describe the mean arterial pressure effect of inhaled ISBN (Emax= 55%; EC50= 0.51 microM). After inhalation, blood pressure and heart rate quickly returned to baseline, without any withdrawal rebound effect. Inhaled ISBN produced a rapid onset of action on heart rate and blood pressure, and these effects were sustained over 60 minutes of exposure. Abrupt drug withdrawal did not lead to hemodynamic rebound. The blood pressure effects were related to ISBN blood concentration by the sigmoid Emax model. These results provide new information on the pharmacokinetic/pharmacodynamic relationship of a representative nitrite inhalant.

Administration, Inhalation↗
PubMed2006

Occupational exposure to methamphetamine in workers preparing training AIDS for drug detection dogs.

As a part of ongoing testing of personnel preparing training aids for drug detection dogs at the Naval Criminal Investigative Service Regional Forensic Laboratory, personnel handling methamphetamine (MTH) were subject to voluntary urine drug testing. This provided a model of potential unwitting or environmental exposure contribution to MTH concentrations in urine. Urine samples were collected from multiple individuals on the day before, the day of, and the day after the individuals had handled up to 500-g quantities of MTH during the assembly of training aids. Personnel wore gloves, dust masks, and lab coats during the preparation of training aids. A total of 101 urine samples were analyzed for the presence of MTH and amphetamine (AMP) by gas chromatography-mass spectrometry after solid-phase extraction and derivatization. Urine samples collected during and after personnel handled drug yielded a mean MTH concentration of 48 ng/mL with a maximum concentration of 262 ng/mL and a minimum detected concentration of approximately 1.6 ng/mL. Thirty-five of the 52 post drug-handling samples had detectable MTH. Ten of the samples had MTH concentrations above the method limit of quantitation of 15 ng/mL. Only one sample had a concentration greater than 50 ng/mL. None of the samples had detectable AMP. From this limited study, it was evident that handling of MTH under these conditions resulted in minimal exposure and small but detectable concentrations of MTH in urine.

Air Pollutants, Occupational↗
PubMed2005

Total necrosis of the intranasal structures and soft palate as a result of nasal inhalation of crushed OxyContin.

Nasal inhalation of substances such as cocaine has long been linked to septal necrosis and more recently to palatal perforation. This report describes the case of a 37-year-old man who was addicted to crushed OxyContin (sustained-release oxycodone HCl) tablets and who presented with total necrosis of the septum, sinuses, and soft palate. To the best of the author's knowledge, this is the first reported case of nasal and palatal necrosis linked to nasal inhalation of crushed OxyContin, which is a relatively new form of drug abuse. The pathophysiology of drug-induced sinonasal disease and a review of the literature are also presented.

Administration, Intranasal↗
PubMed1991

Atropine intoxication from the ingestion and smoking of jimson weed (Datura stramonium).

Anticholinergic effects occur due to jimson weed intoxication. The most common intoxication involves teenagers desiring mind-altering properties from the plant. We report 4 cases of jimson weed intoxication due to ingestion and inhalation (smoking) of jimson weed. Clinicians should be aware of the potential abuse of botanicals such as jimson weed.

Adolescent↗
PubMed1978

Organic fluorides: implications for psychiatry.

The widespread use of synthetic organic fluorides has recently received attention as a potential health hazard. There are a number of organic fluorides which have become important considerations in psychiatry. Therapeutically the organic fluorides include the neuroleptics trifluoperazine, fluphenazine, triflupromazine, and haloperidol, the benzodiazepine flurazepam and the polyfluorinated inhalant convulsant indoklon. On the negative side, deliberate inhalation of fluorocarbon aerosol propellants has become a modern form of drug abuse among the young. A review is presented on the biochemistry and toxicology of organic fluorides with special emphasis on implications to the field of psychiatry.

Aerosols↗
PubMed1996

[Heroin abuse among Danish prisoners on remand. II. Consequences related to form of administration].

Heroin-abusing Danish prisoners remanded in custody were based on interviews grouped as either smoking dependent (n = 18) or intravenous dependent (n = 55). Intravenous users had a longer duration and earlier debut of abuse than users who smoked opiates. Only intravenous users had serious somatic complications. Both groups of opioid dependent prisoners were marked by severe psychosocial dysfunction and considerable psychiatric co-morbidity. The intravenous users were generally more affected than the smokers concerning social and psychiatric parameters and earlier criminality, perhaps due to their longer duration of abuse.

Administration, Inhalation↗
PubMed1987

Intravenous epinephrine abuse.

A 19-year-old man with a history of intravenous cocaine and amphetamine abuse injected 1.1 mg of epinephrine intravenously from an over-the-counter bronchodilator inhaler. Within seconds, headache, nausea, numbness of hands and feet, precordial chest discomfort, and palpitations developed. The patient was given a sublingual nitroglycerin tablet by a bystander and promptly had a syncopal episode. Hypotension was observed in the emergency department 10 minutes later. Administration of 2 L of Ringer's lactate maintained blood pressure at 80-90 mm Hg systolic. An electrocardiogram showed ischemic changes in the precordial leads. Cardiac enzymes remained normal. Mild hypokalemia and hyperglycemia were observed. This case illustrates an unusual route of abuse of an over-the-counter epinephrine bronchodilator.

Adult↗