Inhalant abuse treatment and prevention.
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Recreational abuse of toluene-containing volatile inhalants by adolescents is a significant public health problem. The mechanisms underlying the abuse potential of such substances remain unclear, but could involve increased activity in mesoaccumbal dopamine (DA) afferents innervating the nucleus accumbens (ACB). Here, using in vitro electrophysiology, we show that application of behaviorally relevant concentrations of toluene directly stimulates DA neurons in the ventral tegmental area (VTA), but not surrounding midbrain regions. Toluene stimulation of VTA neurons persists when synaptic transmission is reduced. Moreover, unlike non-DA neurons, the magnitude of VTA DA neuron firing does not decline during longer exposures designed to emulate 'huffing'. Using dual-probe in vivo microdialysis, we show that perfusion of toluene directly into the VTA increases DA concentrations in the VTA (somatodendritic release) and its terminal projection site, the ACB. These results provide the first demonstration that even brief exposure to toluene increases action potential drive onto mesoaccumbal VTA DA neurons, thereby enhancing DA release in the ACB. The finding that toluene stimulates mesoaccumbal neurotransmission by activating VTA DA neurons directly (independently of transynaptic inputs) provide insights into the neural substrates that may contribute to the initiation and pathophysiology of toluene abuse.
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A neuropsychological battery of 67 measures was completed by 68 inhalant-abusing and 41 other-drug-abusing adolescent subjects. The measures tapped both global and specific functioning. Analysis of covariance was used to control effects of age and other drug use. These analyses indicated that inhalant abusers performed significantly more poorly than other drug abusers on 20 of the 67 measures. Deficits were observed on both global measures (WAIS and WRAT) and specific measures (perception of speech sounds, visual suppression, sensory perception, and Trails). These deficits suggest that the effect of inhalant abuse may be severe and widespread.
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Thirty-four cases of death related to the deliberate inhalation of various solvents or gases were studied regarding the toxicology and pathology of this phenomenon. A method was developed for detection of these agents in blood and other autopsy specimens, utilizing flame ionization gas chromatography. The detection in the blood of components of the products inhaled usually confirmed the recent use of the substances. Death was usually sudden, occurring during or shortly after use of the inhalants, and was consistent with the development of cardiac arrhythmias. Of the cases available for histological evaluation, liver damage was apparent in some cases.
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In order to measure urinary level of hippuric acid among Brazilian homeless youth suspected of having inhaled toluene in previous hours, urine samples were voluntarily collected from the youth around two hours after they arrived at an "open-school" in Porto Alegre, Brazil. Hippuric acid levels were determined by gas chromatography in urine specimens of 50 homeless children and adolescents. In 86% of the urine specimens, hippuric acid levels were within the range of 3.6 g/g creatinine and 46.1 g/g creatinine. Very high urinary hippuric acid level may indicate voluntary toluene abuse. A cut-off urinary hippuric acid level value needs to be established for toluene self-exposure diagnosis.
There is in vitro evidence that some of the effects of abused volatile solvents may be produced by actions at the NMDA receptor. In addition, some solvents produce phencyclidine-like discriminative stimulus effects. The major goal of the present study was to further compare abused solvents to NMDA antagonists by testing them in two strains of mice trained to discriminate 0.17 mg/kg of the very selective uncompetitive NMDA antagonist, dizocilpine, from saline and contrast those results with several GABA(A)-positive modulators, PCP and ethanol. The results indicated that the discriminative stimulus produced by 0.17 mg/kg dizocilpine was highly specific in both mouse strains. PCP produced 91% dizocilpine-lever responding in C57BL/6J mice, but only 56% dizocilpine-lever responding in DBA/2J mice. Pentobarbital, midazolam and ethanol produced at least some overlap in discriminative stimulus effects with dizocilpine in one or both mouse strains. In contrast, toluene, 1,1,1-trichloroethane (TCE), xylene and methoxyflurane produced saline-appropriate responding almost exclusively. These data indicate that, at least under the specific conditions tested, abused volatile solvents do not have substantial dizocilpine-like discriminative stimulus effects in either C57BL/6J or DBA/2J mice, providing little support that NMDA antagonism plays a central role in the production of this abuse-related effect.
Acute subjective and physiological effects were examined to provide information relevant to abuse liability of new nicotine delivery systems. Subjects (n = 12) were overnight-deprived smokers who received 0, 4, 8 and 16 active puffs from nicotine-containing cigarettes (0.1 mg per puff), 0, 1, 2 or 4 nasal sprays (0.5 mg nicotine per spray) and 0, 30, 60 and 120 vapor inhalations (estimated 0.013 mg nicotine per inhalation) in a within-subject single blinded design. While smokers clearly liked cigarette puffs, there was much less evidence of liking produced by either nasal spray or vapor inhaler; only modest elevations on a measure of good drug effects were observed. The novel delivery products engendered unpleasant effects of burning throat and nose, watery eyes, runny nose, coughing and sneezing that might be expected to limit abuse liability. Nicotine plasma level and heart rate increase was dose-related for cigarettes and nasal spray but not for vapor inhaler, indicating limited nicotine delivery with the latter device. Overall, results are consistent with the conclusion that the nicotine nasal spray and vapor inhaler are of substantially lower abuse liability than cigarettes in experienced cigarette smokers receiving initial exposure to these products.
A questionnaire survey of 285 consecutively recruited adolescents who were adjudicated to juvenile correctional facilities in Virginia was conducted using the Inhalant Use Questionnaire (1). White youths (36.1%) and youths from other ethnic backgrounds (44.4%) are significantly more likely to report past inhalant use than black youths (1.4%). The median age reported for first-time use of inhalants is 13 years. Youths were divided between those who experimented with inhalants (27%) and those who were heavy users (27%). Huffing was preferred by 60% of youths. 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%). There were no gender differences for use of other products.
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There is sufficient clinical and epidemiological evidence to suggest that HIV infection alone does not cause Kaposi's sarcoma (KS) in AIDS. Several possible "cofactors" have been proposed. There are several reasons to consider nitrite inhalants as a plausible choice as the KS cofactor. Identifying the KS cofactor in AIDS could prove valuable for prevention of the most common cancer afflicting AIDS patients. Clarifying the mechanisms by which HIV infection and the KS cofactor produce disease may have implications for other cancers and diseases.