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Inhalant Abuse in the United States

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Title: Inhalant Abuse in the United States


1
Inhalant Abuse in the United States
  • Dr. Minda R. Lynch
  • National Institute on Drug Abuse
  • National Institutes of Health/DHHS
  • Bethesda, Maryland

2
Some Powerpoint Slides Courtesy of
  • Robert L. Balster, Ph.D.
  • Director, Institute for Drug and Alcohol Studies
  • Butler Professor of Pharmacology
  • Research Professor of Psychology and Psychiatry
  • Virginia Commonwealth University

3
Inhalant Abuse in ContextDrug Abuse Problems in
Alaska
  • Slides courtesy of Dr. Kathy Etz,
  • Division of Epidemiology, Services and Prevention
    Research
  • National Institute on Drug Abuse
  • Expert in Native American and Native Alaskan Drug
    Abuse and Addiction

4
Past Year Marijuana Use, Cocaine Use, and Needing
but Not Receiving Treatment for Illicit Drug Use
among Persons Age 12 or Older, by Substate
Region Percentages, Annual Averages Based on
2002, 2003 and 2004 NSDUHs






Note Large, diverse areas combined as rural
5
Past Month Marijuana Use, Any Illicit Drug Use,
and Any Illicit Drug Other than Marijuana among
Persons Aged 12 or Older, by Substate Region,
Percentages, Annual Averages Based on 2002, 2003,
and 2004 NSDUHs









6
Past Month Cigarette Use, Any Tobacco Product
Use, Binge Alcohol Use among Persons Aged 12 or
Older, by Substate Region Percentages, Annual
Averages Based on 2002, 2003, and 2004 NSDUHs


7
Leading Drug Abuse Issues
  • Tobacco use
  • Iqmik (smokeless tobacco fungal ash mixed with
    tobacco leaves)
  • Used by Alaska Natives
  • 22 continue use through pregnancy
  • Given to infants for teething pain, etc.
  • Western part of state (YK Delta) med chart review
    shows rates 25 at age 6, 80 age 16 then to
    cigarettes
  • Inhalant Abuse
  • Marijuana Abuse

8
Alaska Natives
  • Approximately 16 of population
  • Health Disparitiesrepresent approximately 33 of
    disease (suicide, mental health disorders, etc.)
  • Alaska Natives
  • Age Adjusted Death Rate 40 Higher
  • (from Alaska Dept of Vital Statistics)

9
Suicide Alaska Non Native vs. US
10
Suicide Among Youth
Alaska vs. US
Native vs. Non-Native
Data Source Alaska Bureau of Vital Statistics
11
From the National Institute on Drug Abuse
  • From the Director
  • Although many parents are appropriately
    concerned about illict drugs such as marijuana,
    cocaine, and LSD, they often ignore the dangers
    posed to their children from common household
    projects that contain volatile solvents or
    aerosols.

12
And
  • Many young people inhale the vapors from these
    sources in search of quick intoxication without
    being aware of the serious health consequences
    that can result.

13
Types of abused inhalants
  • Volatile Solvents, liquids that vaporize at room
    temperature, present in certain industrial or
    household products, such as paint thinner, nail
    polish remover, degreaser, dry-cleaning fluid,
    gasoline, and contact cement
  • Some art or office supplies, such as correction
    fluid, felt-tip marker fluid, and electronic
    contact cleaner
  • Aerosols, sprays that contain propellants and
    solvents, including spray paint, hair spray,
    deodorant spray, vegetable oil sprays, and fabric
    protector spray
  • Gases, that may be in household or commercial
    products, or used as medical anesthetics, such as
    in butane lighters, propane tanks, whipped cream
    dispensers, and refrigerant gases
  • Anesthetics, including ether, chloroform,
    halothane, and nitrous oxide

14
What Are the Common Street Names?
  • Common slang for inhalants includes "laughing
    gas" (nitrous oxide), "snappers" (amyl nitrite),
    "poppers" (amyl nitrite and butyl nitrite),
    "whippets" (fluorinated hydrocarbons, found in
    whipped cream dispensers), "bold" (nitrites), and
    "rush" (nitrites).

15
Sources
  • In 1988 and 1990 Congress prohibited sale of
    alkyl nitrites, such as isobutyl nitrite, under
    the Consumer Product Safety Act
  • Manufacturers switched to cyclohexyl nitrite,
    which is not an alkyl nitrite
  • Many online sites sell as aromas
  • http//www.poppersonline.com/
  • http//www.realpoppers.com/
  • Estimates place annual sales in the tens of
    million dollars

16
Nitrous Oxide
  • How is it obtained?
  • cylinders for anesthesia
  • racing fuels (after filtering)
  • dairy industry foaming agent
  • whipped creme chargers
  • How is it used?
  • balloons

17
Commonly Abused Solvents in Household Products
  • Toluene
  • Xylene
  • Trichloroethane
  • Methylene chloride
  • Butane
  • Many others, many combinations

18
Where are they found?
  • Paint thinners and removers
  • Stains and Varnishes
  • Adhesives
  • Nail polish and removers
  • Inks
  • Spot removers, cleaning agents
  • Gasoline
  • Lighter Fuels
  • Dry Erase Markers
  • Dusters

19
How are solvents used?
  • "sniffing" or "snorting" fumes from containers
  • spraying aerosols directly into the nose or mouth
  • sniffing or inhaling fumes from substances
    sprayed or placed into a plastic or paper bag
    ("bagging")
  • "huffing" from an inhalant-soaked rag stuffed in
    the mouth
  • inhaling from balloons filled with nitrous oxide

20
Patterns of use
  • Because intoxication lasts only a few minutes,
    abusers frequently try to make the high last
    longer by inhaling repeatedly over several hours.

21
Health Effects
  • Breaks down myelin
  • Induces hypoxia loss of oxygen to the brain
  • Regular abuse of inhalants can cause serious harm
    to vital organs besides the brain, including the
    heart, kidneys, and liver.
  • Certain inhalants can also cause the body to
    produce fewer blood cells, which may result in a
    condition known as aplastic anemia (in which the
    bone marrow is unable to produce blood cells).

22
Examples of Effects by Type of Inhalant
23
Lethal Effects
  • Prolonged sniffing of the highly concentrated
    chemicals in solvents or aerosol sprays can
    induce irregular or rapid heart rhythms and can
    lead to heart failure and death within minutes of
    a session of prolonged sniffing.
  • This "sudden sniffing death" is particularly
    associated with the abuse of butane, propane, and
    chemicals in aerosols.

24
Scope of Use National Data
  • According to the Monitoring the Future survey,
    more 8th graders (15.7) have tried inhalants in
    their lifetime than any other illicit drug,
    including marijuana.
  • Lifetime use (at least once during a respondents
    lifetime) of inhalants was reported by 15.7 of
    8th graders, 12.8 of 10th graders and 9.9 of
    12th graders in 2008.

25
Data from Monitoring the Future 2008 Data from
In-School Surveys
26
Table 2. Trends in Past Year Use of Specific
Types of Inhalants among Past Year Inhalant
Initiates Aged 12 to 17 in 2007
Source 2002 to 2007 SAMHSA National Surveys on
Drug Use and Health (NSDUHs).
27
Future Trends?
  • The perception of harm associated with trying
    inhalants once or twice is at its lowest level
    among 8th graders in 2008, 34 of 8th graders
    perceived harm, compared to 46 in 2001.

28
Signs of Inhalant Abuse
  • A person who is using inhalants might have
    chemical odors on their breath or clothing paint
    or other stains on their face, hands, or
    clothing nausea or loss of appetite weight
    loss muscle weakness disorientation or
    inattentiveness, uncoordinated movement,
    irritability, and depression.

29
How do Inhalants Produce their Effects?
  • Almost all inhalants induce pleasurable effects
    via action on the central nervous system.
  • Animal studies reveal that a number of commonly
    abused volatile solvents and anesthetic gases
    induce effects on brain and behavior resembling
    those produced by depressants, which include
    alcohol,sedatives and anesthetics.

30
The Chemical Toluene
Human research reveals that toluene, a solvent
found in many commonly abused inhalants,
including model airplane glue, paint sprays, and
paint and nail polish removers, induces a marked
brain atrophy (shrinkage). In this figure,
the top image is from a normal control, and the
bottom, from a toluene abuser.
31
Why are inhalants abused?
  • Easy to obtain
  • To produce intoxication
  • But what kind of intoxication?

32
Inhalant Intoxication
  • Inhalants produce very strong effects similar to
    those of subanesthetic doses of general
    anesthetics
  • Users feel "high." The effects are similar to
    those produced by alcohol and may include slurred
    speech, lack of coordination, euphoria, and
    dizziness. Inhalant users may also experience
    lightheadedness, hallucinations, and delusions.
    The high usually lasts only a few minutes.
  • Effects occur very rapidly and dissipate rapidly
    as well
  • With repeated inhalations, many users feel less
    inhibited and less in control.
  • Some may feel drowsy for several hours and
    experience a lingering headache.

33
What are the health consequences of inhalant
abuse?
  • Short-term effects
  • Accidents and injuries
  • Overdose producing anesthesia and respiratory
    depression
  • Sudden sniffing death
  • Heart stoppage

34
What are the health consequences of inhalant
abuse?
  • Long-term Effects
  • Depends on specific solvent
  • Some more toxic than others (e.g. aerosols)
  • Nose and mouth lesions, runny nose
  • Brain damage
  • Liver and kidney damage
  • Fetal solvent syndrome
  • No solid epidemiological evidence on actual
    prevalence of organic damage associated with
    inhalants, but widely encountered clinically

35
Treatment Issues
  • There are no controlled trials supporting an
    evidence based treatment for inhalant abuse
  • Treatment should probably be focused on adding
    skills to typical adolescent care
  • Canada has some models for inhalant specific
    treatment programs
  • http//www.members.shaw.ca/ysac/default.htm

36
Overview of NIDA Sponsored Research in Alaska
  • Presenter
  • Knowlton Johnson, , MS, MSW, PhD

37
(No Transcript)
38
What is the Level of Use of Harmful Legal
Products in the Targeted Communities
39
The Alaska Drug Use and Attitude SurveyIndex of
30-day and Lifetime Use
40
What is the difference between parent
self-reported use of harmful legal products and
their childs actual reported use?
41
Inhalant Prevention NIDA Research
  • Study Period 2005-2008
  • Randomized Clinical Trials with 16 Frontier
    Alaska Communities
  • Implementation Quality Study Sample Eight
    intervention communities

42
Community Prevention Model
  • we implemented a three-component CPM consisting
    of (1) Mobilization of communities (2)
    Environmental strategies (retailers, parents,
    schools) and (3) Schoolbased prevention
    curriculum (Think Smart) targeting drug use and
    related behaviors.
  • We demonstrated that this model could effectively
    engage and interest communities in community
    prevention approaches.
  • Further, we successfully implemented the model in
    frontier Alaska.
  • Most importantly, we were able to produce
    evidence that the community mobilization and
    environmental strategies could produce change in
    the targeted proximal outcomes (mediators) in a
    positive direction.

43
Contact Information
  • Knowlton Johnson
  • kwjohnson_at_pire.org

44
Inhalant Treatments
  • The Canadian YSAC Group is a Network of 9 First
    Nation Youth Residential Treatment Centres spread
    throughout various regions of Canada.  The
    centres were established between 1995 and 2005.  
  • Health Canada, through the Brighter Futures/
    Solvent Abuse Initiative, began the development
    phase for several First Nations Treatment Centres
    geared toward adolescent Solvent Abuse.
  • http//www.members.shaw.ca/ysac/default.htm

45
Some Sources For More Information
  • National Inhalant Prevention Coalition
  • www.inhalants.org
  • National Clearinghouse for Alcohol and Drug
    Information
  • www.health.org
  • National Institute on Drug Abuse
  • www.nida.nih.gov
  • SAMHSA (Inhalant Trends 2002-2007)
  • http//oas.samhsa.gov/2k9/inhalantTrends/inhalantT
    rends.cfm
  • Partnership for a Drug Free America
  • www.drugfree.org

46
The end!
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