Intoxicative inhalant

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Intoxicative inhalants are a broad range of Substance intoxication|intoxicative drugs whose volatile vapors or gases are taken in via the nose and trachea.[1] They are taken by room temperature volatilization or from a pressurized container (e.g., nitrous oxide), and do not include drugs that are sniffed after burning or heating. For example, amyl nitrite and toluene are considered inhalants, but tobacco, cannabis, and crack are not, even though the latter are also inhaled (as smoke).[2][3]

While some inhalant drugs are used for List of medical inhalants|medical purposes, as in the case of nitrous oxide (a dental anxiolytic), this article focuses on inhalant abuse of household and industrial chemicals, in a manner not intended by the manufacturer. These products are used as recreational drugs for their intoxicating effect. Inhaling volatile substances because of their intoxicating effect is called huffing, sniffing, or bagging. According to a 1995 report by the National Institute on Drug Abuse, the most serious inhalant abuse occurs among children and teens who "...live on the streets completely without family ties."[4] Inhalant users inhale vapor or aerosol propellant gases using plastic bags held over the mouth or by breathing from a solvent-soaked rag or an open container.

The effects of inhalants range from an alcohol-like Substance intoxication|intoxication and intense euphoria to vivid hallucinations, depending on the substance and the dose. Some inhalant users are injured due to the harmful effects of the solvents or gases or due to other chemicals used in the products that they are inhaling. As with any recreational drug, users can be injured due to dangerous behavior while they are intoxicated, such as driving under the influence. In some cases, users have died from hypoxia (lack of oxygen), pneumonia, cardiac failure or arrest,[5] or aspiration of vomit. Brain damage is typically seen with chronic long-term use as opposed to short-term exposure.[6]

Even though many inhalants are legal, there have been legal actions taken in some jurisdictions to limit access by minors. While solvent glue is normally a legal product, a Scottish court has ruled that supplying glue to children is illegal if the store knows the children intend to abuse the glue. In the US, thirty-eight of 50 states have enacted laws making various inhalants unavailable to those under the age of 18, or making inhalant use illegal.

## Classification

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Inhalants can be classified by the intended function. Most inhalant drugs that are used non-medically are ingredients in household or industrial chemical products that are not intended to be concentrated and inhaled. A small number of recreational inhalant drugs are pharmaceutical products that are used illicitly.

### Chemical structure

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Inhalants can also be classified by chemical structure.[7] Classes include:

Category  | ICD-10 | Examples  | Example image

|
|
|

aliphatic hydrocarbons | T52.0 | petroleum products (gasoline and kerosene), propane, butane |
aromatic hydrocarbons | T52.1-T52.2 | toluene (used in paint thinner and model glue), xylene |
ketones | T52.4 | acetone (used in nail polish remover)  |
haloalkanes  | T53 | hydrofluorocarbons, [[chlorofluorocarbons (including many aerosols and propellants), 1,1,1-Trichloroethane, trichloroethylene, chloroform (the latter two being antiquated inhalational anaesthetics)  |
nitrites | T65.3, T65.5 | alkyl nitrites (poppers such as amyl nitrite)  |
nitrogen oxide | T59.0 | nitrous oxide (found in whipped cream canisters)  |

### Product category

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Another way to categorize inhalants is by their product category. There are three main product categories: solvents; gases; and medical drugs which are used illicitly.

#### Solvents

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A wide range of volatile solvents intended for household or industrial use are inhaled as recreational drugs. This includes petroleum products (gasoline and kerosene), toluene (used in paint thinner and model glue), and acetone (used in nail polish remover).

#### Gases

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A number of gases intended for household or industrial use are inhaled as recreational drugs. This includes chlorofluorocarbons used in aerosols and propellants (e.g., hair spray). A gas used as a propellant in whipped cream aerosol containers, nitrous oxide, is used as a recreational drug.

#### Medical anesthetics

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Several medical anesthetics are misused as recreational drugs, including diethyl ether and nitrous oxide. Diethyl ether has a long history of use as a recreational drug. The effects of ether intoxication are similar to those of alcohol intoxication, but more potent. Also, due to NMDA antagonism, the user may experience all the psychedelic effects present in classical dissociatives such as ketamine in forms of thought loops and feeling of mind being disconnected from one's body. Nitrous oxide is a dental anesthetic which is used as a recreational drug, either by users who have access to medical grade gas canisters (e.g., dental hygienists or dentists) or by using the gas contained in whipped cream aerosol containers. Nitrous oxide inhalation can cause analgesia, depersonalisation, derealisation, dizziness, euphoria, and some sound distortion.[8]

### Classification by effect

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It is also possible to classify inhalants by the effect they have on the body. Many inhalants act primarily as asphyxiant gases, with their primary effect due to oxygen deprivation.[9] Other agents may have more direct effects at receptors. Inhalants exhibit a variety of mechanisms of action. The mechanisms of action of many non-medical inhalants have not been well elucidated. Anesthetic gases used for surgery, such as nitrous oxide or enflurane, are believed to induce anesthesia primarily by acting as NMDA receptor antagonists, open channel blockers that bind to the inside of the calcium channels on the outer surface of the neuron, and provide high levels of NMDA receptor blockade for a short period of time.

This makes inhaled anesthetic gases different from other NMDA antagonists, such as ketamine, which bind to a regulatory site on the NMDA-sensitive calcium transporter complex and provide slightly lower levels of NMDA blockade, but for a longer and much more predictable duration. This makes a deeper level of anesthesia achievable more easily using anesthetic gases but can also make them more dangerous than other drugs used for this purpose.

## Administration and effects

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Inhalant users inhale vapors or aerosol propellant gases using plastic bags held over the mouth or by breathing from an open container of solvents, such as gasoline or paint thinner. Nitrous oxide gases from whipped cream aerosol cans, aerosol hairspray or non-stick frying spray are sprayed into plastic bags. When inhaling non-stick cooking spray or other aerosol products, some users may filter the aerosolized particles out with a rag. Some gases, such as propane and butane gases, are inhaled directly from the canister. Once these solvents or gases are inhaled, the extensive capillary surface of the lungs rapidly absorb the solvent or gas, and blood levels peak rapidly. The intoxication effects occur so quickly that the effects of inhalation can resemble the intensity of effects produced by intravenous injection of other psychoactive drugs.[10]

The effects of solvent intoxication can vary widely depending on the dose and what type of solvent or gas is inhaled. A person who has inhaled a small amount of rubber cement or paint thinner vapor may be impaired in a manner resembling alcohol inebriation. A person who has inhaled a larger quantity of solvents or gases, or a stronger chemical, may experience stronger effects such as distortion in perceptions of time and space, hallucinations, and emotional disturbances.

In the short term, many users experience headache, nausea and vomiting, slurred speech, loss of motor coordination, and wheezing. A characteristic "glue sniffer's rash" around the nose and mouth is sometimes seen after prolonged use. An odor of paint or solvents on clothes, skin, and breath is sometimes a sign of inhalant abuse, and paint or solvent residues can sometimes emerge in sweat.[11]

According to NIH, even a single session of inhalant abuse "can disrupt heart rhythms and lower oxygen levels," which can lead to death. "Regular abuse can result in serious harm to the brain, heart, kidneys and liver."[12]

## Dangers and health problems

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Statistics on deaths caused by inhalant abuse are difficult to determine. It may be severely under-reported, because death is often attributed to a discrete event such as a stroke or a heart attack, even if the event happened because of inhalant abuse.[13] Inhalant use or abuse was mentioned on 144 death certificates in Texas during the period 1988–1998 and was reported in 39 deaths in Virginia between 1987 and 1996 from acute voluntary exposure to abused inhalants.[14]

### General risks

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Regardless of which inhalant is used, administration can lead to injury or death. One major risk is hypoxia, which can occur due to inhaling fumes from a plastic bag, or from using proper equipment but not adding oxygen or room air. When a gas that was stored under high pressure is released, it cools abruptly and can cause frostbite if it is inhaled directly from the container (when nitrous oxide is used as an automotive power adder, its cooling effect is used to make the fuel-air charge denser. In a person, this effect is potentially lethal). Many inhalants are volatile organic chemicals and can catch fire or explode, especially when combined with smoking. As with many other drugs, users may also injure themselves due to loss of coordination or impaired judgment, especially if they attempt to drive.

Solvents have many potential risks in common, including pneumonia, cardiac failure or arrest,[5] and aspiration of vomit. The inhaling of some solvents can cause hearing loss, limb spasms, and damage to the central nervous system and brain.[5] Serious but potentially reversible effects include liver and kidney damage and blood-oxygen depletion. Death from inhalants is generally caused by a very high concentration of fumes. Deliberately inhaling solvents from an attached paper or plastic bag or in a closed area greatly increases the chances of suffocation. Brain damage is typically seen with chronic long-term use as opposed to short-term exposure.[6] Parkinsonism (see: Signs and symptoms of Parkinson's disease) has been associated with huffing.[15]

Female inhalant users who are pregnant may have adverse effects on the fetus, and the baby may be smaller when it is born and may need additional health care (similar to those seen with alcohol - fetal alcohol syndrome). There is some evidence of birth defects and disabilities in babies born to women who sniffed solvents such as gasoline.

In the short term, death from solvent abuse occurs most commonly from aspiration of vomit while unconscious or from a combination of respiratory depression and hypoxia, the second cause being especially a risk with heavier-than-air vapors such as butane or gasoline vapor. Deaths typically occur from complications related to excessive sedation and vomiting. Actual overdose from the drug does occur, however, and inhaled solvent abuse is statistically more likely to result in life-threatening respiratory depression than intravenous use of opiates such as heroin. Most deaths from solvent abuse could be prevented if individuals were resuscitated quickly when they stopped breathing and their airway cleared if they vomited. However, most inhalant abuse takes place when people inhale solvents by themselves or in groups of people who are intoxicated. Certain solvents are more hazardous than others, such as gasoline.

In contrast, a few inhalants like amyl nitrate and diethyl ether have medical applications and are less harmful, though they are still dangerous when used recreationally. Nitrous oxide is thought to be particularly non-toxic, though long-term use can lead to a variety of serious health problems linked to destruction of vitamin B12 and folic acid.[16][17]

### Risks of specific agents

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The hypoxic effect of inhalants can cause damage to many organ systems (particularly the brain, which has a very low tolerance for oxygen deprivation), but there can also be additional toxicity resulting from either the physical properties of the compound itself or additional ingredients present in a product. Organochlorine solvents are particularly hazardous; many of these are now restricted in developed countries due to their environmental impact.

* Methylene chloride, after being metabolized, can cause carbon monoxide poisoning.[18]

* Gasoline sniffing can cause lead poisoning,[19] in locations where Banning of leaded petrol|leaded gas is not banned.

* Ingestion of alkyl nitrites can cause methemoglobinemia, although inhalation does not.[20]

* Carbon tetrachloride can cause significant damage to multiple systems, but its association with liver damage is so strong that it is used in animal models to induce liver injury.[21]

* Use of butane, propane, nitrous oxide and other inhalants that boil well below room temperature can create a risk of burns from contact with the extremely cold liquid (See Aerosol burn). The risk of such contact is greatly increased by the impaired judgement and motor coordination brought on by inhalant intoxication.

* Benzene use can cause bone marrow depression.[22] It is also a known carcinogen.

* Toluene can damage myelin.[23]

Toxicity may also result from the pharmacological properties of the drug; excess NMDA antagonism can completely block calcium influx into neurons and provoke cell death through apoptosis,[citation needed] although this is more likely to be a long-term result of chronic solvent abuse than a consequence of short-term use.

### Sudden sniffing death syndrome

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Inhaling butane gas can cause drowsiness, narcosis, asphyxia, cardiac arrhythmia and frostbite. Butane is the most commonly misused volatile solvent in the UK and caused 52% of solvent-related deaths in 2000. When butane is sprayed directly into the throat, the jet of fluid can cool rapidly to −20 °C by adiabatic expansion, causing prolonged laryngospasm. Sudden sniffing death syndrome is commonly known as SSDS. Some inhalants can also indirectly cause sudden death by cardiac arrest, in a syndrome known as "sudden sniffing death".[24] The anaesthetic gases present in the inhalants appear to sensitize the user to adrenaline and, in this state, a sudden surge of adrenaline (e.g., from a frightening hallucination or run-in with aggressors), may cause fatal cardiac arrhythmia.[25]

Furthermore, the inhalation of any gas that is capable of displacing oxygen in the lungs (especially gasses heavier than oxygen) carries the risk of hypoxia as a result of the very mechanism by which breathing is triggered. Since reflexive breathing is prompted by elevated carbon dioxide levels (rather than diminished blood oxygen levels), breathing a concentrated, relatively inert gas (such as computer-duster tetrafluoroethane or nitrous oxide) that removes carbon dioxide from the blood without replacing it with oxygen will produce no outward signs of suffocation even when the brain is experiencing hypoxia. Once full symptoms of hypoxia appear, it may be too late to breathe without assistance, especially if the gas is heavy enough to lodge in the lungs for extended periods. Even completely inert gases, such as argon, can have this effect if oxygen is largely excluded.

## Legal aspects

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### Solvent glue

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Even though solvent glue is normally a legal product, there is a case where a court has ruled that supplying glue to children is illegal. Khaliq v HM Advocate was a Scotland|Scottish criminal case decided by the High Court of Justiciary on appeal, in which it was decided that it was an offence at common law to supply glue sniffing materials that were otherwise legal in the knowledge that they would be used for self-harm. Two shopkeepers in Glasgow were arrested and charged with supplying to children ‘glue-sniffing kits’ consisting of a quantity of petroleum-based glue in a plastic bag. They argued there was nothing illegal about the items that they had supplied. On appeal, the High Court took the view that, even though glue and plastic bags might be perfectly legal, everyday items, the two shopkeepers knew perfectly well that the children were going to use the articles as inhalants and the charge on the indictment should stand.[26] When the case came to trial at Glasgow High Court the two were sentenced to three years’ imprisonment.

"Thirty-eight of 50 states have enacted laws making various inhalants unavailable to those under the age of 18. Other states prohibit the sale of these items to anyone without recognition of purpose for purchase. Some states mandate laws against using these products for purposes of getting high, while some states have laws about possessing certain inhalants. Nearly every state imposes fines and jail terms for violation of their specific laws."[27]

"Connecticut law bans the unauthorized manufacture or compounding, possession, control, sale, delivery, or administration of any “restricted substance.” It defines restricted substances as... specific volatile substances if they are sold, compounded, possessed or controlled, or delivered or administered to another person for breathing, inhaling, sniffing, or drinking to induce a stimulant, depressant, or hallucinogenic effect. Violators can be fined up to $100." As well, 24 states "ban the use, possession, or sale or other distribution of inhalants... like glue and solvents."[28]

"Louisiana prohibits the sale, transfer, or possession of model glue and inhalable toluene substances to minors. In Ohio, it is illegal to inhale certain compounds for intoxication — a common, general prohibition other states have enacted. Some states draw their prohibitions more narrowly...In Massachusetts, retailers must ask minors for identification before selling them glue or cement that contains a solvent that can release toxic vapors."[29]

### Propellant gases

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"New Jersey... prohibits selling or offering to sell minors products containing chlorofluorocarbon that is used in refrigerant."[29]

### Poppers

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Main article: Poppers

The sale of alkyl nitrite-based poppers was banned in Canada in 2013. Although not considered a narcotic and not illegal to possess or use, they are considered a drug. Sales that are not authorized can now be punished with fines and prison.[30] Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe because only isobutyl nitrite is prohibited. In France, the sale of products containing butyl nitrite, pentyl nitrite, or isomers thereof, has been prohibited since 1990 on grounds of danger to consumers.[31] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[32] After litigation by sex shop owners, this extension was quashed by the [[Council of State (France)|Council of State on the grounds that the government had failed to justify such a blanket prohibition: according to the court, the risks cited, concerning rare accidents often following abnormal usage, rather justified compulsory warnings on the packaging.[33]

In the United Kingdom, poppers are widely available and frequently (legally) sold in Gay bar|gay clubs/bars, sex shops, drug paraphernalia head shops, over the Internet and on markets.[34] It is illegal under Medicines Act 1968 to sell them advertised for human consumption, and in order to bypass this, they are usually sold as odorizers. In the U.S., originally marketed as a prescription drug in 1937, amyl nitrite remained so until 1960, when the Food and Drug Administration removed the prescription requirement due to its safety record. This requirement was reinstated in 1969, after observation of an increase in recreational use. Other alkyl nitrites were outlawed in the U.S. by Congress through the Anti-Drug Abuse Act of 1988. The law includes an exception for commercial purposes. The term commercial purpose is defined to mean any use other than for the production of consumer products containing volatile alkyl nitrites meant for inhaling or otherwise introducing volatile alkyl nitrites into the human body for euphoric or physical effects.[35] The law came into effect in 1990. Visits to retail outlets selling these products reveal that some manufacturers have since reformulated their products to abide by the regulations, through the use of the legal cyclohexyl nitrite as the primary ingredient in their products, which are sold as video head cleaners, polish removers, or room odorants.

### Nitrous oxide

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In the United States, possession of nitrous oxide is legal under federal law and is not subject to DEA purview.[36] It is, however, regulated by the Food and Drug Administration under the Food Drug and Cosmetics Act; prosecution is possible under its "misbranding" clauses, prohibiting the sale or distribution of nitrous oxide for the purpose of human consumption. Many states have laws regulating the possession, sale, and distribution of nitrous oxide. Such laws usually ban distribution to minors or limit the amount of nitrous oxide that may be sold without special license.[citation needed] For example, in the state of California, possession for recreational use is prohibited and qualifies as a misdemeanour.[37] In New Zealand, the Ministry of Health has warned that nitrous oxide is a prescription medicine, and its sale or possession without a prescription is an offence under the Medicines Act.[38] This statement would seemingly prohibit all non-medicinal uses of the chemical, though it is implied that only recreational use will be legally targeted. In India, for general anaesthesia purposes, nitrous oxide is available as Nitrous Oxide IP. India's gas cylinder rules (1985) permit the transfer of gas from one cylinder to another for breathing purposes. Because India's Food & Drug Authority (FDA-India) rules state that transferring a drug from one container to another (refilling) is equivalent to manufacturing, anyone found doing so must possess a drug manufacturing license.

## Patterns of non-medical use

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Inhalant drugs are often used by children, teenagers, incarcerated or institutionalized people, and impoverished people, because these solvents and gases are ingredients in hundreds of legally available, inexpensive products, such as deodorant sprays, hair spray, and aerosol air fresheners. However, most users tend to be "...adolescents (between the ages of 12 and 17)."[39] In some countries, chronic, heavy inhalant use is concentrated in marginalized, impoverished communities.[40][41] Young people who become chronic, heavy inhalant abusers are also more likely to be those who are isolated from their families and community. The article "Epidemiology of Inhalant Abuse: An International Perspective" notes that "[t]he most serious form of obsession with inhalant use probably occurs in countries other than the United States where young children live on the streets completely without family ties. These groups almost always use inhalants at very high levels (Leal et al. 1978). This isolation can make it harder to keep in touch with the sniffer and encourage him or her to stop sniffing."[4]

The article also states that "...high [inhalant use] rates among barrio Hispanic and Latino Americans|Hispanics almost undoubtedly are related to the poverty, lack of opportunity, and social dysfunction that occur in barrios" and states that the "...same general tendency appears for Native-American youth" because "...Indian reservations are among the most disadvantaged environments in the United States; there are high rates of unemployment, little opportunity, and high rates of alcoholism and other health problems."[4] There are a wide range of social problems associated with inhalant use, such as feelings of Suffering|distress, anxiety and grief for the community; violence and damage to property; violent crime; stresses on the juvenile delinquency|juvenile justice system; and stresses on youth agencies and support services.[citation needed]

### Africa and Asia

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File:Big-ox-oxygen-canisters.pngThe canister on the left is whipped cream, a product which is pressurized with nitrous oxide.

Glue and gasoline sniffing is also a problem in parts of Africa, especially with street children, and South Asia. Three of the most widely abused inhalants are the Dendrite (adhesive)|Dendrite brand and other forms of contact adhesives and rubber cements manufactured in Kolkata, and toluenes in paint thinners. Genkem is a brand of glue which had become the generic name for all the glues used by glue-sniffing children in Africa before the manufacturer replaced n-hexane in its ingredients in 2000.[42]

The United Nations Office on Drugs and Crime has reported that glue sniffing is at the core of “street culture” in Nairobi, Kenya, and that the majority of street children in the city are habitual solvent users.[43] Research conducted by Cottrell-Boyce for the African Journal of Drug and Alcohol Studies found that glue sniffing amongst Kenyan street children was primarily functional – dulling the senses against the hardship of life on the street – but it also provided a link to the support structure of the ‘street family’ as a potent symbol of shared experience.[43]

Similar incidents of glue sniffing among destitute youth in the Philippines have also been reported, most commonly from groups of street children and teenagers collectively known as Rugby boy|"Rugby" boys,[44] which were named after a brand of toluene-laden contact cement. Other toluene-containing substances have also been subject to abuse, most notably the Vulca Seal brand of roof sealants. Bostik Philippines, which currently owns the Rugby and Vulca Seal brands, has since responded to the issue by adding bitterants such as mustard oil to their Rugby line,[45] as well as reformulating it by replacing toluene with xylene. Several other manufacturers have also followed suit.

Another very common inhalant is Erase-X, a correction fluid that contains toluene. It has become very common for school and college students to use it, because it is easily available in stationery shops in India. This fluid is also used by street and working children in Delhi.[46]

### Europe and North America

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In the UK, marginalized youth use a number of inhalants, such as solvents and propellants. In Russia and Eastern Europe, gasoline sniffing became common on Russian ships following attempts to limit the supply of alcoholic beverage|alcohol to ship crews in the 1980s. The documentary Children Underground depicts the huffing of a solvent called Aurolac (a product used in chroming) by Romanian homeless children. During the Interbellum the inhalation of ether (etheromania) was widespread in some regions of Poland, especially in Upper Silesia—tens of thousands of people were affected by this problem.[47]

In Canada, Native children in the isolated Northern Labrador community of Davis Inlet, Newfoundland and Labrador|Davis Inlet were the focus of national concern in 1993, when many were found to be sniffing gasoline. The Canadian and provincial Newfoundland and Labrador governments intervened on a number of occasions, sending many children away for treatment. Despite being moved to the new community of Natuashish in 2002, serious inhalant abuse problems have continued. Similar problems were reported in Sheshatshiu, Newfoundland and Labrador|Sheshatshiu in 2000 and also in Pikangikum First Nation.[48] In 2012, the issue once again made the news media in Canada.[49] In Mexico, the inhaling of a mixture of gasoline and/or industrial solvents, known locally as "Activo" or "Chemo", has risen in popularity among the homeless and among the street children of Mexico City in recent years. The mixture is poured onto a handkerchief and inhaled while held in one's fist.

In the US, ether was used as a recreational drug during the 1930s Prohibition era, when alcohol was made illegal. Ether was either sniffed or drunk and, in some towns, replaced alcohol entirely. However, the risk of death from excessive sedation or overdose is greater than that with alcohol, and ether drinking is associated with damage to the stomach and gastrointestinal tract.[50] Use of glue, paint and gasoline became more common after the 1950s. Abuse of aerosol sprays became more common in the 1980s, as older propellants such as CFCs were phased out and replaced by more environmentally friendly compounds such as propane and butane. Most inhalant solvents and gases are not regulated under drug laws such as the United States' Controlled Substances Act. However, many US states and Canadian cities have placed restrictions on the sale of some solvent-containing products to minors, particularly for products widely associated with sniffing, such as model cement. The practice of inhaling such substances is sometimes colloquially referred to as huffing, sniffing (or glue sniffing), dusting, or chroming.

### Australia

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See also: Indigenous Australian § Substance abuse

Australia has long faced a petrol (gasoline) sniffing problem in isolated and impoverished Australian Aborigines|aboriginal communities. Although some sources argue that sniffing was introduced by United States soldier|servicemen stationed in the nation's Top End during World War II[51] or through experimentation by 1940s-era Cobourg Peninsula sawmill workers,[52] other sources claim that inhalant abuse (such as glue inhalation) emerged in Australia in the late 1960s.[4] Chronic, heavy petrol sniffing appears to occur among remote, impoverished indigenous communities, where the ready accessibility of petrol has helped to make it a common substance for abuse.

In Australia, petrol sniffing now occurs widely throughout remote Aboriginal communities in the Northern Territory, Western Australia, northern parts of South Australia and Queensland. The number of people sniffing petrol goes up and down over time as young people experiment or sniff occasionally. "Boss", or chronic, sniffers may move in and out of communities; they are often responsible for encouraging young people to take it up.[53]

A 1983 survey of 4,165 secondary students in New Lydiate showed that solvents and aerosols ranked just after analgesics (e.g., codeine pills) and alcohol for drugs that were abused. This 1983 study did not find any common usage patterns or social class factors.[4] The causes of death for inhalant users in Australia included pneumonia, cardiac failure/arrest, aspiration of vomit, and burns. In 1985, there were 14 communities in Central Australia reporting young people sniffing. In July 1997, it was estimated that there were around 200 young people sniffing petrol across 10 communities in Central Australia. Approximately 40 were classified as chronic sniffers. There have been reports of young Aboriginal people sniffing petrol in the urban areas around Darwin, Northern Territory|Darwin and Alice Springs, Northern Territory|Alice Springs.

In 2005, the Government of Australia and BP Australia began the usage of Opal (fuel)|opal fuel in remote areas prone to petrol sniffing.[54] Opal is a non-sniffable fuel (which is much less likely to cause a high) and has made a difference in some indigenous communities.

## In popular culture

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### Music and musical culture

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One of the early musical references to inhalant use occurs in the 1974 Elton John song "The Bitch Is Back," in the line "I get high in the evening sniffing pots of glue." Inhalant use, especially glue sniffing, is widely associated with the late-1970s Punk subculture|punk youth subculture in the UK and North America. Raymond Cochrane and Douglas Carroll claim that when glue sniffing became widespread in the late 1970s, it was "...adopted by punks because public [negative] perceptions of sniffing fitted in with their self-image" as rebels against societal values.[55] While punks at first used inhalants "...experimentally and as a cheap high, adult disgust and hostility [to the practice] encouraged punks to use glue sniffing as a way of shocking society." As well, using inhalants was a way of expressing their anti-corporatist Do it yourself|DIY (do it yourself) credo;[55] by using inexpensive household products as inhalants, punks did not have to purchase industrially manufactured liquor or beer.

One history of the punk subculture argues that "substance abuse was often referred to in the music and did become synonymous with the genre, glue sniffing especially" because the youths' "...faith in the future had died and that the youth just didn't care anymore" due to the "awareness of the threat of nuclear war and a pervasive sense of doom." In a BBC interview with a person who was a punk in the late 1970s, they said that "there was a real fear of imminent nuclear war — people were sniffing glue knowing that it could kill them, but they didn't care because they believed that very soon everybody would be dead anyway."

A number of 1970s punk rock and 1980s hardcore punk songs refer to inhalant use. The Ramones, an influential early US punk band, referred to inhalant use in several of their songs. The song "Now I Wanna Sniff Some Glue" describes adolescent boredom, and the song "Carbona not Glue" states, "My brain is stuck from shooting glue." An influential punk fanzine]] about the subculture and music took its name (Sniffin' Glue]]) from the Ramones song. The 1980s punk band The Dead Milkmen wrote a song, "Life is Shit" from their album Beelzebubba, about two friends hallucinating after sniffing glue. Punk-band-turned-hip-hop group the Beastie Boys penned a song "Hold it Now – Hit It," which includes the line "cause I'm beer drinkin, breath stinkin, sniffing glue." Pop punk band Sum 41 wrote a song, "Fat Lip", which refers to a character who does not "... make sense from all the gas you be huffing..." The song Lança-perfume, written and performed by Brazilian popstar Rita Lee, became a national hit in 1980. The song is about chloroethane and its widespread recreational sale and use during the rise of Brazil's carnivals.

Inhalants are referred to by bands from other genres, including several grunge bands—an early 1990s genre that was influenced by punk rock. The 1990s grunge band Nirvana (band)|Nirvana, which was influenced by punk music, penned a song, "Dumb (Nirvana song)|Dumb", in which Kurt Cobain sings "my heart is broke/But I have some glue/help me inhale /And mend it with you". L7 (band)|L7, an all-female grunge band, penned a song titled "Scrap" about a skinhead who inhales spray-paint fumes until his mind "starts to gel". Also in the 1990s, the Britpop band Suede (band)|Suede had a UK hit with their song "Animal Nitrate" whose title is a thinly veiled reference to amyl nitrite. The Beck song "Fume" from his "Fresh Meat and Old Slabs" release is about inhaling nitrous oxide. Another Beck song, "Cold Ass Fashion", contains the line "O.G. – Original Gluesniffer!" Primus (band)|Primus's 1998 song "Lacquer Head" is about adolescents who use inhalants to get high. Hip hop performer Eminem wrote a song, "Bad Meets Evil", which refers to breathing "...ether in three lethal amounts." The Brian Jonestown Massacre, a retro-rock band from the 1990s, has a song "Hyperventilation", which is about sniffing model-airplane cement. Frank Zappa's song "Teenage Wind" from 1981 has a reference to glue sniffing: "...Nothing left to do but get out the 'ol glue; Parents, parents; Sniff it good now..."

### Films

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A number of films have depicted or referred to the use of solvent inhalants. In the 1980 comedy film Airplane!]], the character of McCroskey (Lloyd Bridges]]) refers to his inhalant use when he states, "I picked the wrong week to quit sniffing glue." In the 1996 film Citizen Ruth]], the character Ruth (Laura Dern]]), a homeless drifter, is depicted inhaling patio sealant]] from a paper bag in an alleyway. In the tragicomedy Love Liza]], the main character, played by Philip Seymour Hoffman]], plays a man who takes up building remote-controlled airplanes as a hobby to give him an excuse to sniff the fuel in the wake of his wife's suicide.

Harmony Korine]]'s 1997 Gummo]] depicts adolescent boys inhaling contact cement for a high. Edet Belzberg's 2001 documentary Children Underground]] chronicles the lives of Romanian street children addicted to inhaling paint. In The Basketball Diaries (film)|The Basketball Diaries]], a group of boys are huffing carbona cleaning liquid at 3 minutes and 27 seconds into the movie; further on, a boy is reading a diary describing the experience of sniffing the cleaning liquid.

In the David Lynch film Blue Velvet (film)|Blue Velvet, the bizarre and manipulative character played by Dennis Hopper uses a mask to inhale amyl nitrite.[citation needed] In Little Shop of Horrors (film)|Little Shop of Horrors, Steve Martin's character dies from nitrous oxide inhalation. The 1999 independent film Boys Don't Cry (film)|Boys Don't Cry depicts two young low-income women inhaling aerosol computer cleaner (compressed gas) for a buzz. In The Cider House Rules (film)|The Cider House Rules, Michael Caine's character is addicted to inhaling ether vapors.

In Thirteen (2003 film)|Thirteen, the main character, a teen, uses a can of aerosol computer cleaner to get high. In the action movie Shooter (2007 film)|Shooter, an ex-serviceman on the run from the law (Mark Wahlberg) inhales nitrous oxide gas from a number of Whip-It! whipped cream canisters until he becomes unconscious. The film Fear and Loathing in Las Vegas describes how the two main characters inhale diethyl ether and amyl nitrite. The South African film The Wooden Camera also depicts the use of inhalants by one of the main characters, a homeless teen, and their use in terms of socio-economic stratification. The titular characters in Samson and Delilah (2009 film)|Samson and Delilah sniff petrol; in Samson's case, possibly causing brain damage.

In the 2004 film Taxi (2004 film)|Taxi]], Queen Latifah]] and Jimmy Fallon]] are trapped in a room with a burst tank containing nitrous oxide. Queen Latifah's character curses at Fallon while they both laugh hysterically. Fallon's character asks if it is possible to die from nitrous oxide, to which Queen Latifah's character responds with "It's laughing gas, stupid!" Neither of them suffered any side effects other than their voices becoming much deeper while in the room.

In the French horror film Them (2006 film)|Them]], (2006) a French couple living in Romania are pursued by a gang of street children who break into their home at night. Olivia Bonamy's character is later tortured and forced to inhale aurolac from a silver-colored bag. During a flashback scene in the 2001 film Hannibal (film)|Hannibal]], Hannibal Lecter gets Mason Verger high on amyl nitrite poppers, then convinces Verger to cut off his own face and feed it to his dogs.

### Books

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The science fiction]] story "Waterspider]]" by Philip K. Dick]] (first published in January 1964 in If (magazine)|If magazine]]) contains a scene in which characters from the future are discussing the culture of the early 1950s. One character says: "You mean he sniffed what they called 'airplane dope'? He was a 'glue-sniffer'?", to which another character replies: "Hardly. That was a mania among adolescents and did not become widespread in fact until a decade later. No, I am speaking about imbibing alcohol."[56]

In the 1999 horror-thriller novel "Hannibal (Harris novel)|Hannibal" by Thomas Harris, psychiatrist Hannibal Lecter gets his patient Mason Verger high on amyl nitrite poppers, then convinces the intoxicated Verger to cut off his own face and feed it to his dogs.

### Television

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In the comedy series Newman and Baddiel in Pieces, Rob Newman's inhaling gas from a foghorn was a running joke in the series. One episode of the Jeremy Kyle Show featured a woman with a 20-year butane gas addiction.[57] In the series It's Always Sunny in Philadelphia, Charlie Kelly (It's Always Sunny in Philadelphia)|Charlie Kelly has an addiction to huffing glue. Additionally, season nine episode 8 shows Dennis, Mac and Dee getting a can of gasoline to use as a solvent, but instead end up taking turns huffing from the canister.

A 2008 episode of the reality show Intervention (TV series)|Intervention (season 5, episode 9) featured Allison, who was addicted to huffing computer duster for the short-lived, psychoactive effects. Allison has since achieved a small but significant cult following among bloggers and YouTube users. Several remixes of scenes from Allison's episode can be found online.[citation needed] Since 2009, Allison has worked with drug and alcohol treatment centers in Los Angeles County. In the third episode of season 5 of American Dad!, titled "Home Adrone", Roger Smith (American Dad!)|Roger asks an airline stewardess to bring him industrial adhesive and a plastic bag. In the seventh episode of the fourteenth season of South Park, Towelie, an anthropomorphic towel, develops an addiction to inhaling computer duster. In the show Squidbillies|Squidbilles, the main character Early Cuyler is often seen inhaling gas or other substances.

## See also

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* Inhaler or puffer, a medical device used for delivering medication into the body via the lungs (often used in the treatment of asthma)
* Mt Theo Program, a successful petrol-sniffing prevention program run by the indigenous Warlpiri community in Central Australia
* Jenkem

## References

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Notes

1. ↑ Template:DorlandsDict
2. ↑ Michael B. First; Allan Tasman (2 October 2009). Clinical Guide to the Diagnosis and Treatment of Mental Disorders. John Wiley and Sons. p. 203\. ISBN 978-0-470-74520-5. Retrieved 20 April 2010.
3. ↑ Sharp, Charles W; Rosenberg, Neil L (2005). "Inhalants". In Lowinson, Joyce H; Ruiz, Pedro; Millman, Robert B; Langrod, John G. Substance Abuse: A Comprehensive Textbook (4th ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-7817-3474-6. Retrieved 2 December 2010.CS1 maint: display-editors (link)
4. ↑ 4.0 4.1 4.2 4.3 4.4 Epidemiology of Inhalant Abuse: An International Perspective, National Institute on Drug Abuse, NIDA Research Monograph 148, 1995
5. ↑ 5.0 5.1 5.2 "Inhalants - Facts and Statistics". Greater Dallas Council on Alcohol & Drug Abuse. March 4, 2006. Archived from the original on 2009-04-08.
6. ↑ 6.0 6.1 eMedicine – Inhalants : Article by Timothy Kaufman
7. ↑ "Inhalants: eMedicine Neurology". Retrieved 2010-04-18.
8. ↑ Giannini, A. J. (1991). Miller, N. S., ed. Volatiles. New York: Marcel Dekker. p. 396\. ISBN 0-8247-8474-X.
9. ↑ Joseph LaDou (23 October 2006). Current occupational and environmental medicine. McGraw-Hill Professional. pp. 517–. ISBN 978-0-07-144313-5. Retrieved 20 April 2010.
10. ↑ Joseph, Donald E. (2005). "Inhalants" (PDF). Drugs of Abuse. United States Drug Enforcement Administration. Retrieved 2011-01-26.
11. ↑ "The Public Health Bush Book". Northern Territory Government, Department of Health and Community Services. 2002. Retrieved 2006-12-27.
12. ↑ http://www.nlm.nih.gov/medlineplus/inhalants.html
13. ↑ National Inhalant Prevention Coalition. Inhalants.org. Retrieved on 2010-12-12.
14. ↑ Bowen, Scott E; Daniel, Jack; Balster, Robert L (1999). "Deaths associated with inhalant abuse in Virginia from 1987 to 1996". Drug and Alcohol Dependence. 53 (3): 239–45. doi:10.1016/S0376-8716(98)00139-2. PMID 10080050.
15. ↑ Uitti, Ryan J.; Snow, Barry J.; Shinotoh, Hitoshi; Vingerhoets, Francois J. G.; Hayward, Margo; Hashimoto, Stanley; Richmond, John; Markey, Sanford P.; Markey, Carol J. (1994). "Parkinsonism induced by solvent abuse". Annals of Neurology. 35 (5): 616–9. doi:10.1002/ana.410350516. PMID 8179306.
16. ↑ Weimann, J (2003). "Toxicity of nitrous oxide". Best practice & research. Clinical anaesthesiology. 17 (1): 47–61. doi:10.1053/bean.2002.0264. PMID 12751548.
17. ↑ Koblin, DD; Tomerson, BW; Waldman, FM; Lampe, GH; Wauk, LZ; Eger Ei, 2nd (1990). "Effect of nitrous oxide on folate and vitamin B12 metabolism in patients". Anesthesia and analgesia. 71 (6): 610–7. doi:10.1213/00000539-199012000-00007. PMID 2240633.
18. ↑ Fagin J, Bradley J, Williams D (November 1980). "Carbon monoxide poisoning secondary to inhaling methylene chloride". Br Med J. 281 (6253): 1461. doi:10.1136/bmj.281.6253.1461. PMC 1714874. PMID 7437838.CS1 maint: Multiple names: authors list (link)
19. ↑ Ross CA (December 1982). "Gasoline sniffing and lead encephalopathy". Can Med Assoc J. 127 (12): 1195–7. PMC 1874752. PMID 7139470.
20. ↑ O'Toole JB, Robbins GB, Dixon DS (November 1987). "Ingestion of isobutyl nitrite, a recreational chemical of abuse, causing fatal methemoglobinemia". J. Forensic Sci. 32 (6): 1811–2. PMID 3430141.CS1 maint: Multiple names: authors list (link)
21. ↑ Yu C, Wang F, Jin C, Wu X, Chan WK, McKeehan WL (December 2002). "Increased carbon tetrachloride-induced liver injury and fibrosis in FGFR4-deficient mice". Am. J. Pathol. 161 (6): 2003–10. doi:10.1016/S0002-9440(10)64478-1. PMC 1850898. PMID 12466116.CS1 maint: Multiple names: authors list (link)
22. ↑ Robert B. Wallace (2008). Wallace/Maxcy-Rosenau-Last public health & preventive medicine. McGraw-Hill Professional. pp. 624–. ISBN 978-0-07-144198-8. Retrieved 20 April 2010.
23. ↑ Filley CM, Halliday W, Kleinschmidt-DeMasters BK (January 2004). "The effects of toluene on the central nervous system". J. Neuropathol. Exp. Neurol. 63 (1): 1–12. PMID 14748556.CS1 maint: Multiple names: authors list (link)
24. ↑ "'Huffing' More Popular Among 12 Year Olds Than Street Drugs". Fox News. 2010-03-11.
25. ↑ Shepherd, RT (1989). "Mechanism of sudden death associated with volatile substance abuse". Human toxicology. 8 (4): 287–91. doi:10.1177/096032718900800406. PMID 2777268.
26. ↑ SCCR p 492
27. ↑ "Inhalant Laws in the United States".
28. ↑ "State Laws on Inhalants".
29. ↑ 29.0 29.1 "Inhalants: Legal consequences".
30. ↑ Rob Salerno (Jun 25, 2013). "Health Canada cracks down on poppers". Canada (Note: this article uses the term 'nitrates' in error): Pink Triangle Press.
31. ↑ "Decree 90–274 of 26 March 1990" (in français). Legifrance.gouv.fr. 2009-05-15. Retrieved 2012-07-26.
32. ↑ "Decree 2007-1636 of 20 November 2007" (in français). Legifrance.gouv.fr. Retrieved 2012-07-26.
33. ↑ Council of State, Ruling 312449, 15 May 2009
34. ↑ "Advice - Poppers". BBC. 1970-01-01. Retrieved 2012-07-26.
35. ↑ Anti-Drug Abuse Act of 1988 (Public Law 1QO-690,section 2404) (15 U.S.C. 2d57a(e)(2)).
36. ↑ "US Nitrous Oxide Laws (alphabetically) Based on a search of online free legal databases. Conducted May 2002". Center for Cognitive Liberty and Ethics.
37. ↑ "CAL. PEN. CODE § 381b : California Code – Section 381b". Lp.findlaw.com.
38. ↑ Anderton, Jim (26 June 2005). "Time's up for sham sales of laughing gas". Beehive.govt.nz.
39. ↑ For example, studies on inhalant use in New Zealand showed that "...most of the inhalant abusers are within the 14- to 18-year-old age group"; in the Philippines, the mean age of sniffers was 15; in Korea, a 1992 study showed "86 percent are male and are below the age of 20"; about 3/4 of Singapore inhalant users in a 1987 study were 19 or younger. Nicholas Kozel et al. (Ed.) Epidemiology of Inhalant Abuse: An International Perspective, National Institute on Drug Abuse, NIDA Research Monograph 148, 1995
40. ↑ Williams, Jonas (March 2004). "Responding to petrol sniffing on the Anangu Pitjantjatjara Lands: A case study". Social Justice Report 2003. Human Rights and Equal Opportunity Commission. Archived from the original on 27 September 2004. Retrieved 2006-12-27.
41. ↑ Native children in Canada's isolated Northern Labrador community of Davis Inlet were the focus of national concern in 1993 when many were found to be sniffing gasoline. The federal Canadian and provincial Newfoundland and Labrador governments intervened on a number of occasions, sending many children away for treatment. Despite being moved to the new community of Natuashish in 2002, serious inhalant abuse problems have continued. Similar problems were also reported in Sheshatshiu in 2000.
42. ↑ Cassere, Di (November 14, 2000). Glue loses high to save street-kid addicts. The Independent
43. ↑ 43.0 43.1 Cottrell-Boyce, Joe (2010). "THE ROLE OF SOLVENTS IN THE LIVES OF STREET CHILDREN" (PDF). African Journal of Drug & Alcohol Studies. 9 (2): 93–102. doi:10.4314/ajdas.v9i2.64142. Retrieved 28 January 2014.
44. ↑ "'Rugby:' cheap high for city's street kids (First of two parts) | Cebu News, The Freeman Sections, The Freeman | philstar.com". The Philippine Star. Retrieved 17 April 2013.
45. ↑ "EcoWaste Coalition: Government Urged to Step Up Drive vs. Inhalant Abuse (Watchdog Pushes Ban on Sale to Children of Rugby, "Vulca Seal" and Allied Products)". Blogger. EcoWaste Coalition. Retrieved 17 April 2013.
46. ↑ Seth, Rajeev; Kotwal, Atul; Ganguly, K. K. (2005). "Street and working children of Delhi, India, misusing toluene: an ethnographic exploration". Substance Use & Misuse. 40 (11): 1659–79. doi:10.1080/10826080500222792. PMID 16253933.
47. ↑ Abucewicz, Monika (2005). "Narkomania w Polsce jako problem społeczny w perspektywie konstrukcjonistycznej Część pierwsza: okres międzywojenny" (PDF). Alkoholizm i Narkomania (in Polish). 18 (3): 79–107. Unknown parameter `|trans_title=` ignored (help)CS1 maint: Unrecognized language (link)
48. ↑ Lauwers, Bert (2011-06-01). "The Office of the Chief Coroner's Death Review of the Youth Suicides at the Pikangikum First Nation, 2006 – 2008". Office of the Chief Coroner of Ontario. Retrieved 2011-10-02.
49. ↑ "Labrador Innu kids sniffing gas again to fight boredom". CBC.ca. Retrieved 2012-06-18.
50. ↑ Brecher, Edward M. (1972). The Consumers Union Report on Licit and Illicit Drugs. Consumer Reports Magazine. ISBN 0-316-15340-0.
51. ↑ Wortley, R. P. (29 August 2006). "Anangu Pitjantjatjara Yankunytjatjara Land Rights (Regulated Substances) Amendment Bill". Legislative Council (South Australia). Hansard. Archived from the original (– Scholar search) on 29 September 2007. Retrieved 2006-12-27.
52. ↑ Brady, Maggie (27 April 2006). "Community Affairs Reference Committee Reference: Petrol sniffing in remote Aboriginal communities" (PDF). Official Committee Hansard (Senate). Hansard: 11. Retrieved 2006-03-20.
53. ↑ Williams, Jonas (March 2004). "Responding to petrol sniffing on the Anangu Pitjantjatjara Lands: A case study". Social Justice Report 2003. Human Rights and Equal Opportunity Commission. Retrieved 2006-12-27.
54. ↑ Submission to the Senate Community Affairs References Committee by BP Australia Pty Ltd Parliament of Australia Web Site. Retrieved 2007-06-08.
55. ↑ 55.0 55.1 Raymond Cochrane, Douglas Carroll, Psychology and Social Issues: A Tutorial Text, published 1991, Routledge 227 pages ISBN 1-85000-836-1
56. ↑ Philip K. Dick: Minority Report, Millennium Books, 2000 (ISBN 978-1-85798-947-2). See page 221.
57. ↑ Rochdale Woman with Butane Gas Addiction (part one)

## Further reading

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* Burk, Isabel. Inhalant Prevention Resource Guide. The Health Network. 2001.
* Chier, Ruth. Danger: Inhalants (The Drug Awareness Library).Powerkids Pr, 1997.
* Lobo, Ingrid A. Inhalants (Drugs: the Straight Facts). April 1, 2004.

## External links

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* Inhalants.Drugabuse.gov (National Institute on Drug Abuse)
* Inhalants – Facts and Figures (Office of National Drug Control Policy)
* What Parents Should Know About "Huffing" by Alan Greene, MD
* Information and harm reduction strategies on inhalants and other psychoactive drugs
* National Institute on Drug Abuse: "NIDA for Teens: Inhalants".

Template:Poisoning and toxicity