Inhalants (Glue Sniffing; Volatile Substance Abuse)

INHALANTS (GLUE SNIFFING; VOLATILE SUBSTANCE ABUSE)

Inhalant drugs (volatile substances) are widely available and frequently abused, especially by adolescents from poor socio- economic background. These substances are mostly volatile hydrocarbons which are used as solvents, propellants, thinners, pouring into a container for “sniffing”, a rag or sock for “huffing”, or a plastic/paper bag for “bagging” (Fig 20.4). Abusers often begin with “sniffing” (lower concentrations), and progress subse-The most commonly abused inhalants include toluene from paints and glues; petrol; butane from cigarette lighter fluids; butyl and isobutyl nitrite; and halogenated hydrocarbons from typewriter correction fluids, propellants, and dry cleaning fluids.

Inhalation of volatile substances produces intoxicating effects rapidly. They are well absorbed through the lungs and distributed quickly to the CNS. One or two huffs will begin to intoxicate the user within seconds, and the effects usually last for several hours. Chronic users can maintain a prolonged high with periodic inhalations every few hours.

Clinical (Toxic) Features

Acute

·              CNS—Excitation, agitation, hallucinations, headache,vertigo, nystagmus, ataxia, convulsions, lethargy, stupor, respiratory depression.

·              CVS—Arrhythmias and sudden death (“sudden sniffing death”).

·              Other Effects—

o     Methaemoglobinaemia (butyl and isobutyl nitrites).

o     Carbon monoxide poisoning (methylene chloride).

o     Hepatitis (chlorinated hydrocarbons).

o     Metabolic acidosis, rhabdomyolysis, renal failure, hypokalaemia (toluene).

Chronic

·              Chronic painter syndrome—A neurobehaviouralsyndrome due to solvent-induced encephalopathy,

·              characterised by memory loss, anxiety, depression, sleep disorders, neurasthenia, and personality changes. CT scan often reveals areas of atrophy, and EEG read-ings are usually abnormal.

·              Cerebellar dysfunction with chorea (petrol).

·              Peripheral neuropathy (n-hexane).

·              Increased incidence of leukaemia, aplastic anaemia, and multiple myeloma (benzene).

·              Abdominal pain, nausea, vomiting, haematemesis.

·              Cardiomyopathy.

·              Hepatotoxicity.

·              Pulmonary disorders—pulmonary hypertension, acute respiratory distress.

·              Dementia (leaded petrol, toluene).

Medicosocial and Forensic Issuess

Hallucinogen abuse has been traditionally a Western phenom-enon, and drugs of abuse such as LSD and phencyclidine have always been popular only in countries such as the USA, UK, Australia, and parts of Europe. The popularity of such drugs has been fuelled by their glamorous representation in films and rock music. The 1960s saw an explosion of hallucinogen use almost in the form of an epidemic, and though it declined steeply in the 1970s and 1980s, there has been an alarming resurgence over the last decade.

The dangers of hallucinogen use do not have as much to do with acute toxicity, as with long-term psychological damage. The inevitable fallout is violent crime manifesting as assaulta-tive behaviour, homicides, and suicides. Several horrific crimes have been committed by drug-crazed individuals acting out their bizarre fantasies.

Volatile substance abuse (VSA) is a uniquely adolescent phenomenon, and is particularly common among lower socio-economic classes, mainly because these substances are cheap, easily available, and legal to possess. Also, the mode of intake is relatively simple. VSA is quite common among street urchins of major Indian cities, probably because these inexpensive substances offer a rare exciting experience to escape from the daily misery of poverty. Persons with adolescent conduct disorder and adult antisocial personality disorder are especially prone to VSA.