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PubMed2002

An unusual presentation of inhalant abuse with dissociative amnesia.

A 38-y-old male with occult inhalant abuse underwent an 18-mo evaluation for presumed seizure disorder. Although past medical history was significant for alcohol abuse, his wife confirmed a 6-y histoy of abstinence. His seizures were characterized as episodes of unconsciousness preceded by a feeling of "things slowing down". No muscular activity was witnessed during these episodes, and upon regaining consciousness the patient had slurred speech, disorientation, dissociative amnesia, and bizarre behavior that resolved spontaneously. Despite 4 emergency department visits, 4 hospital admissions, 5 neurologic and 7 psychiatric outpatient evaluations, extensive work-up was non-diagnostic. These episodes recurred until his wife found him huffing trichloroethylene. Questioning of the patient revealed that huffing always preceded these episodes and that he started huffing after discontinuing alcohol. The patient underwent addiction treatment. Toxic inhalants should be suspected as a substitute drug of abuse in patients attempting abstention. Disorientation clinically similar to dissociative amnesia can occur following loss of consciousness during an episode of trichloroethylene use.

Administration, Inhalation↗
PubMed1997

Epidemiology of inhalant abuse reported to two regional poison centers.

BACKGROUND: The regional poison information center is a potential sentinel for substance abuse patterns. Its central data collection system allows it to access information from large population groups. We report results from a one year prospective cases series of inhalation abuse from two regional poison information centers. DESIGN: Prospective case series. All inhalation exposures reported to two regional poison information centers with a reason of intentional abuse were included. RESULTS: One hundred sixty-five cases were collected. One hundred twenty-four exposures (75%) were male. Age ranged from 4 to 45 y, with a mean, median and mode of 16.6 (SD 7.3), 15 and 13, respectively. Nine children were < 6 years old. There were 22 substances involved, but two substances (spray paint and gasoline) accounted for more than 61% of all cases. In children < 9 y (n = 18, 11%) gasoline alone accounted for 83% of exposures. Abuse occurred statewide, in both urban and rural settings, but tended to occur more often in rural environments (75%). Abuse was reported throughout the day with a peak incidence at 8 pm. One hundred twenty-three patients received direct medical evaluation or care. There was one fatality in this series and 15 patients were described as having life threatening symptoms. CONCLUSIONS: Inhalation abuse may begin very early in childhood and abuse appears to peak in adolescence. The regional poison information center can act as a sentinel for abuse patterns. This information can assist health care providers in poison and abuse prevention efforts.

Administration, Inhalation↗
PubMed2005

Alterations in glutamatergic and gabaergic ion channel activity in hippocampal neurons following exposure to the abused inhalant toluene.

Toluene, a representative member of the large class of abused inhalants, decreases neuronal activity and depresses behavior in both animals and humans. The sites of action of toluene are not completely known but recent studies suggest that ion channels that regulate neuronal excitability may be particularly sensitive. Previous studies with recombinant receptors showed that toluene decreases currents carried by N-methyl-D-aspartate (NMDA)-glutamate receptors without affecting those gated by non-NMDA receptors. In addition, toluene increases currents generated by GABA and glycine receptors. In the present study, primary cultures of rat hippocampal neurons were used to investigate the effects of acute and chronic toluene exposure on native excitatory and inhibitory ligand-gated ion channels. Toluene dose-dependently inhibited NMDA-mediated currents (IC50 1.5 mM) but had no effect on responses evoked by the non-NMDA agonist kainic acid. Prolonged treatment of neurons with toluene (1 mM; 4 days) increased whole-cell responses to exogenously applied NMDA, reduced those evoked by GABA but did not alter responses generated by kainic acid. Immunoblot analysis revealed that prolonged toluene exposure increased levels of NR2A and NR2B NMDA receptor subunits with no change in NR1. Immunohistochemical analysis with confocal imaging showed that toluene-treated neurons had significant increases in the density of NR1 subunits as compared with control neurons. Toluene exposure increased the amplitude of synaptic NMDA currents and decreased those activated by GABA. The results from this study suggest that toluene induces compensatory responses in the functional expression of ion channels that regulate neuronal excitability.

Amino Acid Transport System X-AG↗
PubMed1994

Inhalation abuse of fentanyl patch.

A 36-year-old male became intoxicated from fentanyl by heating and inhaling the contents from a fentanyl patch. He collapsed immediately after one inhalation with a respiratory rate of 6/m, heart rate of 120 bpm, and unobtainable blood pressure. He responded to a naloxone injection. Inhalation abuse of fentanyl base is a novel phenomenon. In two studies of nebulized fentanyl at doses of 64-318 micrograms of fentanyl base, analgesia was achieved with these doses, and small decreases in respiratory rate occurred with the larger dose. The greater absorption expected from inhaling the volatilized product, the large quantity of fentanyl available in a patch, and the high potency of fentanyl produces a high potential for abuse and overdose.

Administration, Inhalation↗
PubMedDate not supplied

Neural basis of inhalant abuse.

It should be apparent from this review that far less is known about the neural basis for inhalant abuse than for other forms of drug abuse. This reflects a lack of research interest in this area (Balster, 1997). Indeed, conclusions are difficult to draw. In the case of the volatile alkyl nitrites, the most reasonable hypothesis at this time is that the cellular basis for their abuse resides in their actions on smooth muscles to produce vasodilation and relaxation, however, direct effects on the brain cannot be ruled out. Although there is some evidence that analgesic effects of nitrous oxide may involve opiate systems, even this conclusion is controversial. There is no evidence that opiate systems play a role in nitrous oxide intoxication or reinforcement. The mechanisms for these effects are unknown. They may reflect the same actions on lipid membranes or on hydrophobic sites on unspecified proteins that have been proposed as mechanisms for nitrous oxide anesthesia. In the case of the volatile solvents, fuels and anesthetics we are faced with a wide variety of specific chemicals which may produce different profiles of pharmacological effects. There is evidence that the prototypic abused solvents toluene and trichloroethane produce acute effects similar to subanesthetic concentrations of general anesthetics, as well as to the effects of classical CNS depressant drugs, such as alcohol and the barbiturates. For the anesthetics, evidence suggests that enhancement of GABAergic inhibition may be an important cellular target for their acute effects, just as it is for alcohol and other depressant drugs. For toluene, as with alcohol, recent evidence suggests a possible role for inhibition of glutamatergic neurotransmission involving NMDA receptors. Toluene has also been shown to have some dopaminergic effects which may be important to its abuse. As for the large number of other abused vapors, practically no information can be found on their cellular actions, and certainly not on actions that may be relevant to their abuse. This entire area would seem an important direction for future research.

Administration, Inhalation↗
PubMed1993

Inhalant abuse: assessment guidelines.

It is important that nurses have full access to information that would help them identify inhalant abuse. Nurses need to take the leadership in assessing clients, in educating health care professionals and the public, and in promoting legislation to prevent minors from obtaining inhalants.

Adolescent↗
PubMed1997

Acute blood toxicity of the abused inhalant, cyclohexyl nitrite.

Cyclohexyl nitrite is an abused nitrite inhalant. This is the first report of toxicity of cyclohexyl nitrite. Mice were exposed to 300-900 ppm cyclohexyl nitrite in an inhalation chamber for 45 min and then bled. Such treatment resulted in a 7-10% reduction in red blood cell counts, haemoglobin and haematocrit levels. Both blood leucocyte counts and spleen cellularity were reduced by 40%. Unlike isobutyl nitrite, subchronic treatment of mice with cyclohexyl nitrite did not impair macrophage tumoricidal activity or production of reactive nitrogen intermediates, but did modulate B and T cell mitogen responses. The data suggest that cyclohexyl nitrite had cytotoxic activity, comparable to that of isobutyl nitrite, which might be related to the anaemia reported in abusers. The immunomodulatory properties of cyclohexyl nitrite differed from those of isobutyl nitrite.

Administration, Inhalation↗
PubMed1987

Toward a clear definition of inhalant abuse.

The study of the nature and extent of the use of volatile, psychoactive substances has been hampered by a confusing terminology. Widely disparate substances such as glue, gasoline, anesthetic gases, and nitrites have all been discussed under the single rubric of "inhalant abuse." A classification scheme is proposed which differentiates users of substances such as volatile hydrocarbons (gasoline, glue, etc.) from users of the anesthetic gases and of the amyl and butyl nitrites. Since users of these three types of volatile chemicals differ on predisposing factors, level of dysfunction, and consequences of use, the former group should be classed generically as "inhalant" users, while the latter should be diagnosed as users of a specific drug.

Administration, Inhalation↗
PubMed1994

Freon inhalational abuse presenting with ventricular fibrillation.

Inhalation of volatile halogenated hydrocarbons may produce life-threatening cardiac and neurological toxicity. A 15-year-old boy developed ventricular fibrillation immediately after intentional inhalation of a fluorinated hydrocarbon from an automobile air conditioner recharge unit. After the use of intravenous bretylium, a hemodynamically stable sinus tachycardia was restored. Aspiration pneumonitis and rhabdomyolysis complicated his hospital course before complete neurological recovery. The mechanism and treatment of cardiac arrhythmias after volatile fluorinated hydrocarbon inhalation are reviewed.

Administration, Inhalation↗
PubMed2004

Rapid and sensitive static headspace gas chromatography-mass spectrometry method for the analysis of ethanol and abused inhalants in blood.

A sensitive and specific method using static headspace gas chromatography coupled with mass spectrometry (GC/MS) has been developed for the quantitative determination of ethanol in biological fluids using n-propanol as internal standard. Gas chromatography was performed in isothermal mode with a GC run time of 2.6 min. The quantification was performed using scan mode abstracting a quantitative ion and a qualifier ion for ethanol and for the internal standard. The method was linear (r(2), 0.999, in the concentration range of 5-200 mg/dl), specific (no interference from methanol acetaldehyde, acetone or from endogenous materials), sensitive (limit of quantification and limit of detection of 0.2 and 0.02 mg/dl, respectively) and robust (less than 5% inter- and intra-assay coefficient of variation). A slightly modified method was also developed for the quantification of five commonly abused inhalants (dichloromethane, ethyl acetate, benzene, toluene and xylene) in blood. The method used a gradient GC program with a run time of 8 min. The quantification was performed using scan mode and integrating the area under the peak using trichloroethane as an internal standard. Without optimization, the method was linear (from 5 to 100 mg/l) and sensitive.

Administration, Inhalation↗
PubMed2003

Volatile substance and other drug abuse inhalation in Spain.

OBJECTIVE: Inhalant misuse is the intentional inhalation of volatile substances in order to obtain euphoric, disinhibiting, and exciting effects. Solvents, glues, adhesives, paints, varnishes, paint removers, dry cleaning agents, spray paints, nail polish removers, typewriter correction fluids, and aerosol propellants are common sources of volatile substance abuse. In recent years the abuse of inhalant substances, not only among those who abuse other drugs but also in teenagers and younger children, has been reported. We reviewed retrospectively the cases of inhalant misuse reported to the Spanish Poison Control Center. METHODS: Human intoxications from abuse of inhalant substances registered by our service from 1991 to 2000 were studied. Data analyzed were relative to age, gender, signs and symptoms, drug dependence antecedents, and severity of symptoms of the patients. The type of product and composition were also investigated. RESULTS: During the study period 109 cases of patients aged from 8 to 50 years were collected. A percentage of 36.6% was less or equal to 20 years old. Seventy percent corresponded to males. Of the patients, 11% presented dependence antecedents to other abuse drugs and 72.5% were symptomatic. In the symptomatic exposures clinical features affected the following systems: CNS (62.8%), gastrointestinal (8.1%), cardiovascular (8.1%), respiratory (2.9%), peripheral nervous system (1.1%), renal (1.1%), haematological (1.1%), hepatic (1.7%), and other (13.1%). The commercial products more frequently inhaled were solvents (34.9%) and glues/adhesives (22.9%). We noted the use of medicines with ethyl chloride-local anaesthetic (8.3%), three cases with aerosol bronchodilator (with fluorocarbons as propellants), and one case of xylazine inhalation. The composition most often involved was aromatic hydrocarbons (46.9%), halogenated hydrocarbons (16.5%), aliphatic hydrocarbons (11.4%), ketones (10.1%), local anaesthetic (ethyl chloride) (8.4%), ethers (2.5%), nitrous oxides (2.5%), and aliphatic nitrites (1.7%). The calls received were 59.6% from health care units and 22% from general public. Only 14% of cases were at home and 48% had moderate to severe clinical effects. Acute intoxications occurred in 82% of cases. CONCLUSIONS: Inhalation of volatile substance as abuse drugs has been detected in different age groups, including very young people. Although the principal source was industrial products, the use of drugs such as local anaesthetics and aerosol broncodilators was also detected. Based on epidemiological studies in the Spanish population (essentially adolescents and childhood) together with the ability of a Poison Center to detect sentinel-events, the community and authorities should develop strategies to prevent these exposures and the later use of other substances of abuse. In fact, recently a Law on Drug Dependences and Other Addictive Alterations has been approved in Madrid in order to take precautionary measures.

Administration, Inhalation↗
PubMedDate not supplied

Inhalant abuse.

Explore the source record for details and available documents.

Administration, Inhalation↗
PubMed1988

Social and psychological factors underlying inhalant abuse.

There are three distinct types of inhalant users: young inhalant users, adolescent polydrug users, and inhalant-dependent adults. Young inhalant users have a modal age of 12 to 13. They use inhalants and may also use alcohol and marijuana. They are likely to have more emotional problems than nondrug users or young marijuana users. These problems, particularly when they involve feelings of anger and alienation, increase the chances that they will identify with other youth who have similar feelings. When this happens, young people form peer clusters; they find a best friend or form a small gang that has a high potential for getting involved with drugs. Most of these peer clusters use inhalants only a few times a month, although some may become obsessed with inhalant use to the exclusion of nearly all other activities. The data showing that young inhalant users have more emotional problems than either nondrug users or young marijuana users suggest that treatment should involve therapy as well as drug avoidance approaches. Every youth caught using inhalants, however, should not automatically be sent for therapy. Sometimes a youth caught using a drug is not really drug involved and overreaction can be damaging. In addition, the emotional problems of all young inhalant users are not identical. A higher average level of emotional problems only means that some of the young inhalant users have those problems, not all of them. Older adolescents, including those who used inhalants earlier, are not likely to use inhalants. Since young inhalant users seem to be troubled youth, have shown an early penchant for drug use, and have drug-using associates, it seem unlikely that they quit using drugs. They probably move on to other drugs, leaving inhalants behind. The older adolescents who do use inhalants are adolescent polydrug users, with a modal age of around 15 to 16. They take many different drugs, and some of them use inhalants as well. The adolescents who use inhalants are probably using a wider range of drugs than other adolescents and are probably getting high more often. Furthermore, they are likely to be more deviant and may be involved in more aggression and more crime. Inhalant-dependent adults usually have a long history of alcohol and other drug involvement. At some point, inhalants have become their preferred drug. By that time, they are usually in their midtwenties to early thirties. They have serious problems.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Inhalation↗
PubMed2002

Inhalant abuse among American Indian, Mexican American, and non-Latino white adolescents.

The abuse of volatile solvents, or inhalants, is an enduring problem among adolescents although a number of factors obscure the nature and extent of this drug using behavior. The data presented here indicate that a number of social and perceptual correlates of inhalant use operate similarly across Mexican American, American Indian and non-Latino white adolescents. Peer factors appear to dominate, although they are somewhat less important for Mexican American and Indian youth. Increased perception of harm reduces inhalant use for all groups. Of particular significance in the findings here are the continued increase of inhalant use among females compared to males and the strong pattern of decreases in inhalant use among American Indian adolescents over the last decade. A number of implications for increased effectiveness of prevention are discussed.

Administration, Inhalation↗
PubMed2004

Repeated exposure to the abused inhalant toluene alters levels of neurotransmitters and generates peroxynitrite in nigrostriatal and mesolimbic nuclei in rat.

Toluene, a volatile hydrocarbon found in a variety of chemical compounds, is misused and abused by inhalation for its euphorigenic effects. Toluene's reinforcing properties may share a common characteristic with other drugs of abuse, namely, activation of the mesolimbic dopamine system. Prior studies in our laboratory found that acutely inhaled toluene activated midbrain dopamine neurons in the rat. Moreover, single systemic injections of toluene in rats produced a dose-dependent increase in locomotor activity which was blocked by depletion of nucleus accumbens dopamine or by pretreatment with a D2 dopamine receptor antagonist. Here we examined the effects of seven daily intraperitoneal injections of 600 mg/kg toluene on the content of serotonin and dopamine in the caudate nucleus (CN) and nucleus accumbens (NAC), substantia nigra, and ventral tegmental area at 2, 4, and 24 h after the last injection. Also, the roles of nitric oxide, peroxynitrite, and the production of 3-nitrosotyrosine (3-NT), in the CN and NAC were assessed at the same time points. Toluene treatments increased dopamine levels in the CN and NAC, and serotonin levels in CN, NAC, and ventral tegmental area. Measurements of the dopamine metabolite dihydroxyphenylacetic acid (DOPAC) further suggested a change in transmitter utilization in CN and NAC. Lastly, 3-NT levels also showed a differential change between CN and NAC, but at different time points post-toluene injection. These results point out the complexity of action of toluene on neurotransmitter function following a course of chronic exposure. Changes in the production of 3-NT also suggest that toluene-induced neurotoxicity may mediate via generation of peroxynitrite.

Animals↗