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Inhalant use ... What is it?... Is it really a serious problem?... Can it affect my children?... My community?
Physicians can expect to face questions such as these with increasing frequency. Why? Because inhalant use has emerged over the past several years as the drug use problem most likely to inflict serious damage upon youth, even with transient involvement.
Inhalant use has also been the problem most resistant to drug use prevention efforts. From 1980 to 1990, it was the only drug abuse problem monitored by the National Institute on Drug and Alcohol Abuse that demonstrated an overall increase in prevalence. It has also been particularly elusive to early diagnosis and resistant to intervention and treatment efforts. Yet, parents, physicians, educators, and law enforcement officers tend to have limited awareness of the problem.
With continued occurrence of inhalant-abuse related complications, physicians will be called upon ever more frequently to provide information and services for inhalant-abuse related problems. The following are concise answers to eleven representative questions frequently directed to physicians regarding inhalant abuse. Equipped with basic information such as this, physicians can become valuable resources in preventive, intervention, and treatment efforts directed at our inhalant use problem:
Inhalant use refers to the purposeful utilization of any of a very large and diverse group of volatile compounds to produce euphoria.
Historically, environmentally accessible household or commercial products, especially those containing toluene, have been utilized most frequently. Beginning with paint products, glues, and gasoline the number of abused compounds has expanded exponentially such that today literally hundreds of familiar volatile products have been abused.
Inhalant use appears to be a very significant form of youth drug use. Self-report surveys in Texas suggest that at least one-in-five junior and senior high school students have used inhalants, thus surpassing the frequency of use of such highly publicized drugs as cocaine, methamphetamine, LSD, and in some cases, marijuana.
Disturbing trends have been noted, including
a) relative increases in the use of substances with greater sudden death potential
b) increased incidence of inhalant use among females, and
c) increased utilization in settings associated with youth violence.
Various factors operate here. Most inhalants are commercial products composed of a variety of chemicals. Each of these chemicals caries it's own potential for toxic damage to vital organ systems. When the multiple toxic ingredients act together, a multiplied, synergistic in-vivo toxicity can be projected. This toxic impact is then augmented by the typical developmental immaturity of the user, the massive concentrations of these substances achieved in abuse settings, the efficiency of the lungs at delivering these toxic chemicals to vital tissues at high concentrations, and the tendency for lipid-rich vital organs to avidly retain these lipid-like organic toxins. The summation of these and yet other factors confers upon inhalants as a class a more formidable toxic profile than any other type of drug of abuse.
Typical onset of experimentation with inhalants occurs earlier than with most other drugs of abuse, in the preteen years, coinciding with the time of initiation of crucial steps of physical, cognitive, and emotional development. Because inhalants bring to bear at this crucial developmental interval chemicals of unsurpassed toxicity the projected developmental impact would be expected to be great, probably exceeding that of other drugs of abuse.
It appears that the risk of sudden death with any given episode of inhalant use exceeds that presented with any other drug of abuse. Death has been noted to occur via a variety of cardiovascular, pulmonary, accidental, and violence-related mechanisms. Of particular importance is death via the induction of refractory cardiac rhythm disturbances, referred to as the "sudden sniffing death syndrome". Sudden death risk appears to be prominent, even with initial experimentation. In British studies of sudden death related to inhalant use, of every ten persons who died from inhalants, up to three of these victims died during their initial inhalant use experience.
Clinical studies investigating this question are few and have been criticized on methodological grounds. Nevertheless, the aggregate weight of these studies suggests that chronic long-term use of inhalants is likely to result in neurologic deficits and cognitive impairment.
Much of what is known relates to toluene exposure in occupational and abuse settings. There is evidence to suggest that chronic toluene abuse may incur chromosome damage in the user, and that extensive exposure during pregnancy is capable of producing many serious intrapartum derangements. These include disruptions of the physiology of pregnancy and birth, as well as a variety of fetal toxic effects, ranging from fetal growth retardation and fetal death to a syndrome of fetal teratogenic effects analogous to the fetal alcohol syndrome.
Youth with a history of chronic inhalant use appear to be particularly resistant to outpatient and inpatient treatment efforts. Compared with other forms of drug abuse, they exhibit strikingly high rates of relapse and treatment failure. In particular, longer term treatment efforts appear to be necessary to produce reasonably successful results. While many professionals believe that specific programs and approaches are needed to address inhalant abuse effectively, very few programs are available. In fact, because of the difficult problems associated with inhalant abuse treatment, these youth are specifically excluded from some drug abuse treatment programs. Treatment resource availability for the large number of youth with significant inhalant use problems is at best problematic, and often nonexistent.
The first problematic concept is to have "no concept," to have no awareness that a problem exists. Another is that inhalant abuse is a "harmless and passing phase" typical of normal adolescent development, and as such is not worthy of much concern since it will spontaneously resolve without difficulty. The frequency of sudden death among initial users exposes the inappropriateness of this view. A third is that the problem mainly affects minority and socio-economically disadvantaged youth. While certainly such youth are affected, a careful examination of Texas statistics indicates that inhalant use affects youth of all racial socio-economic groups, and that among them, Caucasians tend to be most affected.
Inhalant use tends to be under recognized as a serious threat to youth: it affects substantial numbers, and because of inherent toxicity and sudden death risk, it presents hazard of serious injury, long and short-term interference with quality of life, and death even to those who experiment briefly. For the physician desiring to contribute to the health of our youth, some basic information and a watchful eye can be sufficient resources to allow earlier diagnosis and intervention, and to convey desperately needed preventive information to youth, their parents, and others who care for them, including school personnel and community agencies. A worthy challenge is to take this information, build on it, apply it in your practice, and convey it to others with a view to addressing this relatively untouched serious youth drug use concern. Why not be a physician who helps to clear the air regarding inhalant abuse?
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