IJCRR

IJCRR - 13(16), August, 2021

Pages: 63-67

Date of Publication: 30-Aug-2021

A Review on Inhalant Abuse Risk in Adolescents

Author: Sneha, Saini E

Category: Healthcare

Abstract:Inhalant abuse is a significant and precarious arising problem noticed among teens and youngsters throughout the world. Due to their high potential to rapidly induced euphoria and no prohibition to their use and purchase, they are highly misused by all ages. Some domestic inhalants of abuse containing volatiles and aerosols such as petroleum products, stationery products (glue, fluid, marker) and sometimes medical anaesthetic gases also and Bagging, snorting and huffing are some common methods adopted by users for inhalation. In the case of regular users or dependency, some serious consequences like the failure of kidney, liver, nervous system arising. This review studied the previous case reports and surveys performed in the field of inhalants abuse and highlight the issue of problems related to inhalant abuse by collecting data and record of past users.

Keywords: Inhalant, Abuse, Adolescents, Health risk, Society

Full Text:

Introduction

More than thousands of household products contain menacing chemicals.  When these dangerous chemicals are properly used they make  our life better  but people who handle these chemicals have to be careful to protect themselves and the others around them. Nowadays many parents are bothered about drugs such as marijuana,  cocaine,  LSD (Lysergic Acid)  and alcohol. They are always aware about the harmful effects and disorder related to these drugs of abuse but they usually disregard the popularity and risk produced to their children from familiar inhalants of abuse containing household volatile products such as spray paints, nail polish remover, glues,  petroleum products( gasoline, kerosene, diesel ) which can cause death  (regular use for a  long time),  toxicity or addiction; however, kids these days are quickly discovering that public household products are economical and easy to obtain. Inhalants are one of the least studied or discussed groups of abused substances and their rate of abuse is increasing as well.¹ Inhalant abuse means “breathing  intentionally”  of  gas  or  vapors  with  the  purpose  of  “getting  high’’  and  for “recreational’’ or  to  achieve  an  altered  mental  state.  Inhalants  are  the  chemicals  found  in  certain  household  and  workplace products  that  produce  chemical  vapours.  These vapours  can  be  used  by  individuals  to   produce   mind  alerting  affects   and   rapidly   absorbed  into  the  brain  to  produce  a  quick ‘high.² Usually  the  youth   or   adolescent  select  inhalants  because  of  their  ease  of access, low prices,  broad availability, legal vending  and  potential   to  rapidly  induce  euphoria.³ Abuse  of  inhalants  is  a  worldwide  problem  that  is  especially  common  in  individuals  from  minority  and  marginalized  populations, and  is  strongly  correlated  with  the  social  determinants  of  health . It frequently  affects  younger children,  compared  with  other  forms  of  substance  abuse  and  crosses  social  and  ethnic  boundaries . Sometimes  the   demand  of   the  inhalants  is due  to  peer  group   pressure  and  the  street  kids  mostly  start using  inhalants to  overcome  their  pain  of   hunger,  cold. This misusage starts providing opportunity for mind alerting experiences and becomes very soon a dependency.³Misuse  of  inhalant  is  sometimes  referred to  as “ the  forgotten  drug  epidemic”  because  a big part of  American  adolescents  have  been  involved  in  this  activity at  a  certain  age; yet  the  outcome  of  these  sort  of  drugs  of  abuse  are  not  reported  as  commonly  as  the  consequences  of  other  drugs   like  prescription  painkillers  or  even cocaine.⁴

Classification of Inhalants:

Inhalants broadly classified into four categories on the basis of their form.⁵

1. Volatile solvents –Liquids that are vaporizing at room temperature, when inhaled cause a   state of intoxication. As an examples- Paint thinner, dry cleaning fluids, petrol, kerosene, glues, correction fluids, felt tip markers, paint remover and so on.

2. Aerosols- Aerosols is the sprays that containing solvents and the propellants. An examples being- Spray paints, deodorants, hair sprays, fabric protector spray etc.

3. Gases- Gases usein the household products as well as in hospitals includes-nitrous oxide, ether, chloroform.

4. Nitrates – Inhalants of  this catagoriesdiverse  from  other  inhalants  because  they first  expand  blood  vessels  and  relaxing  the  muscles.

Such as-  Medical supplies – food  preservatives, amyl  nitrite  found  in  certain  adhesives  and  solvents etc.

From all the categories, the  volatile   substances  are  available  as  legal  ingredients  of  many  common  domestic  products. More than 1,000 products are used as inhalants in the world. Some  of  them  ordinary  household  goods, including -  nail polish remover,  petrol,  kerosene, glue, spray paint, correction fluid (liquid paper),shoe polish, spray paint,  cleaning fluids, rubber cement, headache balms.¹ Common  ways  that  are  used  by  the  teenagers  for  inhale  such  products  are  Huffing,  sniffing  or  snorting,  dusting,  bagging,  glading. ‘Sniffing’ implies  the  direct  inhalation  of  the  vapour  from  the  container . In ‘bagging’  a  plastic  or  paper  bag  sprayed  or  poured  with  fumes  and  hold  it  over  your  mouth  and  nose  and  inhales, this  method  increases  the  danger of  suffocating. In spraying aerosol is sprayed straight inside the nose and mouth. A  cloth  is  drowned  in  an  inhalant  and  pressed  into  the  mouth   during  ‘ huffing ’ .  Huffing  cause a  feeling  of  euphoria  that   may  take  about  15  to  45  minutes to pass.⁶First  the  use  of  gasoline  for  euphoric  and   recreational   purpose  becomes  popular  in  1940s.  In  the united states  demand  of  inhalants  raised  in 1950s   among  adolescents . Solvent  sniffing  spreader popularity  in 1960s of  some  household   items  including  nail  polish  remover,  lighter  fluid,  shoe polish, spray paints.⁷  In   most  recent  years, glue  sniffing  spreads  as  a  serious  problem  in  the  homeless  children  in  Mexico, south  Asia,  eastern  Europe, Kenya  and  other  undeveloped areas  on all sides of  the  world.⁸ Most  commonly  misused  products  reported  to  united  state  poison  center  are  petrol (41%), air  fresheners (6 %) , paint (13%), propane  (6%) during a period of 1996-2003.³ Such  household  products  have  been  misused by  different  sections  of  the  population but habit and dependency   are  raised  among  teens  (Creighton, 2010). In the USA, the starting age of early volatile substance misuse averages around 13 years old with white and Spanish children more probably to combat with abuse and dependency problems involving these substances than other classes of society. Inhalant abuse usually comes before another gateway drugs such as tobacco, alcohol, marijuana, or other substance abuse.⁴One  more  class  at  risk  of  becoming habitual to inhalants – Especially , the members of dental department ( nitrous oxide gas  as medical anesthetic) . Even if dependency and misuse risk are a compound of some still studied  psychological, environmental and genetic factors, peoples who works as the endodontist  or dental specialist have the association of misuse substance peril factor are probable to fight with dependency to such anasthetics, due to their near procedure to this inhalants. Function of nitrous oxide by dentists as an depressant in the surgery of withdraw four molar teeths . Nitrous oxide is abused by near about 5 % of dental practitioners, survey by ADA (American dentist association) Dentist Health and Awareness Committee.⁴

The Consultative  signs  of  the  substance   abuse  are  resemble  to that someone is  under the  impact of  alcohol . Frequent  key  indicators  includes– euphoria, dizziness, lightheadedness, blurred  vision, lack  of  coordination, Slurred  speech,  some harmful chemicals present in the many types of inhalant products may generate different indicators after and during the inhalant intake.   Abusing  inhalant  many times  leading to  symptoms  like as –vomiting, nausea, confusion, loss of  inhibitions, lack  of  control,  interval  of  dozing  dull   that  last  for  few  hours.⁹

Common effects of abusing inhalants

Repeated  inhaling  high  concentration of   chemicals  in the  volatile  solvents  or  aerosols  spray  have the  potential  to  cause  heart  failure  and  death  within  minutes,  heart  starts overworking, rapidly,  and  irregularly that leads  to the cardiac  arrest or sudden  sniffing death  syndrome. It can happen at very first time or after several time use. Where the habit of inhalants misused repeatedly, dangerousness also increased in such cases. In  the  1999, NIDA  conduct  a  study  showed  that  19.7 %  of  10^th  students  and  15.4 %  of  12^th  students  said  they  had  at  least  once  time  misused  inhalants. According to 2011 article, Substance abuse and mental health  services  administration (SAMHSA ) investigate the issue of  misusing  inhalants amongs the teens and adults.¹⁰About  22 %  of  those  who  die  from  huffing  do  so  the  first  time  they  try  it. The use  of   inhalants  don’t  kill  on  the  instant,  it  takes  time  to  affect  the  body  and  the  brain.¹¹ A  few detrimental  and changeless consequences  of inhalant abuse contains - liver or  kidney  mutilate  (volatile  solvents), blood oxygen  depletion (paint thinners and varnish  removers), slurred, fatigue and headache,  weight  loss, and anemia, fatigue,   headache, brain and  CNS(central nervous system) damage (aerosols,  dewaxer , glues), connective tissue damage ( petrol),motor neuron disease and atrophy  results walk lamely and stumble( petrol, gas cylinders, glues, cream dispenser ), hearing impairment (correction fluids,  dry cleaning, gum, airbrush spray can ) etc.

The  activity  of  misusing  inhalants  replaced  air  in the lungs  and  to take from  the  body of  O2  causing  damage  cells  in  the  brain called as  hypoxia which  part  of  brain  is  affected  or  damaged  are  responsible  for  the  signs  and  symptoms  of  brain  hypoxia.  For   example –  Important  brain  area  for  memory  is an  hippocampus  that  is  high  sensitive  to  hypoxia .  If  someone  hippocampus  is  damaged  due  to  repeatedly  abusing  of  inhalant  results  in  lose  the  skill and  capability   to  learn  or  he  or  she  survive  a  difficult  time  period continue on  simple  conversation. Long  standing abuse  of  volatile  solvents, such  as  toluene  break  down  the  myelin  sheath  of  fatty tissue  that  surrounds  and  protect  nerves  fibers, transmit messages  effectively  and  quickly  its  break down leads  to  tremors or  muscle spamming arms  and  legs, learning  disabilities, hallucinations etc. Somebody can  be  suffocated because  volatile substance  are  absorbed  in  the  lobes of the  lungs  speedy  than  oxygen  and  finish  up  displacing  oxygen, causing  the  consumer   to  lose  sense  and stop breathing. Consciously, chances of suffocation increases when inhaling by using a plastic bag and paper in a closed area.

Therefore, the objective of this study was to trace the types (nature) of inhalants abused in India, Involvement of age group and gender type in these cases and trends (methods of use) commonly adopted by the addicts.

Status of inhalants among adolescent

 Survey in Virginia from 1887 to 1996 revealed that 13-22 years aged males are more abusing inhalants as compare to females. A computerized report of deaths in Virginia was investigate to recognition of all deaths during this inhalants products misuse event. Report include the record of time/day, month, location of death, gender, substance misuse, past of drug abuse, anybody markings Survey results more than fifty deaths associated with intentionally abusing of volatile substance.¹² Abusing from some household products arising the high risk of mortality and morbidity in adolescents all over the world because they are often unaware of health related issue and serious damage to their organs by inhalation of such products.¹³The negligence of substance abuse by adolescents was also discussed in literature. According to the survey nearly about 20% high and middle school students experiments with different delivery methods of inhalants substance. So it is need to emphasize on education and awareness among young, their parents and community.¹⁴An data of 2000-2001 NSDUH (National household surveys on drug abuse) in United states found that amid  adolescents under the age of 17, the preponderance  of lifespan use and history of use in past 8.8%, about 50.9% of inhalant users noticed using many types inhalants, 46.4% started using before their 13 age and nearly about 19.8% abused inhalant in one time in a weak. Adolescent also reported with the delinquent behavior, dependency, progression, multiple drug abuse.¹⁵ Some common inhalants like Glue sniffing demand and its threat to health in adolescents and children in India is a big problem for medical community. The popularity of glue sniffing increases continuously due to its easy availability, cheap rate and their misuse causes major risk for vital organs and sometimes results death. Therefore, awareness and education necessarily required to control of spreading of inhalant abuse.¹⁶ Key aspects of inhalant abuse, various methods used for different types of inhalants, chronic effects, morbidity and mortality rate among  the youth and adolescents was discussed in clinical report which advised the requirement of realization  and attention of the peoples regarding of misuse of substances by children and suggested  the pediatrician’s  role in prevention and identification.¹⁷ Sometimes peer group pressure, curiosity unemployment, poor family support makes it a primary initiative of abuse among the adolescents. Inhalant abuse and dependency from India include sniffing (67%), huffing (19%), bagging (14%) of typewriter erasing fluid due to their low prices, no legal control on sale, easily purchase from at all stationary/ general stores.¹⁸

It was also noticed that misuse of inhalants is a spreading problem amid those children who were lived with their families in the streets, with domestic violence was in their life, hunger, 7-8% of  school droplet who had run away from villages.¹⁹The trend of substance abuse were high in male students, as the age increases the tendency of using inhalant also increase. A survey in district Ambala, Haryana (India) among the 7^th to 12^th standard students of age 13 to 19 years revealed 42% students used combination of more than one drugs also with alcohol (44.49%) and tobacco (14.42%) . Also the extent and addiction of substance abuse high in north areas and causing serious health impacts among students.²⁰ Another structured questionnaire from the ‘UNDCP/WHO global in Manipur, (India) on primary prevention of substance abuse’ also concluded that males are more likely to be forever users. Also indicated that glue is the most commonest abusing inhalants in participants about 98(52.7%). Preponderance of inhalant abuse offers a demand to parents, society, health organization as well as state Govt. to should take up action at stage of school or at primary level.²¹As  determined  by a study in 2011, about 1/10th of the US population has misused or addicted  to inhalants  at  a certain  moment  in  their  lives – we’re  talking  about 22.5 million people in the USA. The  group at-risk for  abusing  these  products  are  the  youth, especially  the  underage. In  another  analysis  of  people   subjected  to  this  misuse  for the first time in the previous  one year, more than 68% of these users were  the underage  and  were  new  to  this  activity. In one more study, about 58% of people who used inhalants initiated towards  the end of ninth class. A 3rd survey showed that near about   20 % of middle and secondary school students had abused inhalants at one day in their life.⁴Near about 52 street children (5-17 year aged) in Nepal were addicted to glue sniffing for last 1 year. Among users 54.35% was tried more than 5 times in a day, Prevalence was 89.13% in those who had not awareness and knowledge about side effects of glue sniffing and 52.17% children sniffing such inhalant to overcome their problems or stress and also results of peer group pressure.²² Therefore, study for evaluation of public health and impact of substance misuse in adolescents should be conducted at various interval of time. Also, there is need of attention among street children because lack of   guidance, without security, education, they are moving towards an dubious futurity.

Some reported Case study

Case 1. A case report of 32 year old patient who had the boot polish and alcohol dependency. Examination revealed that he was abusing boot polish for about last 6 months. In the beginning, he used to inhales a little bit but as the time progressed, then he started inhaling multiple times in a day. There was no family history of drug or alcohol dependence among first degree relatives.²³

Sudden sniffing death of  a 24-year old male which cause the cardiovascular and multi-organ system toxicity after inhaling a halogenated hydrocarbon containing keyboard dust cleaner.²⁴

Case 2. Another case  report on  use of  inhalants showing that it is not only present among  male  adolescent but it’s also a  reason of concern  for  females. An episode of an adolescents female from New Delhi  who  randomly  came in contact  with this act of inhalation. At the age of 13 years  patient  discovered for the first time  attraction to patrol’s smell  and  fell in dependency of  its pleasant  effect on  herself . She started inhaling frequently not only from patrol but also from similar products kerosene. Unfortunately in unawareness of phenomena her family tried to stop her only by arguing with her without taking any professional help. Their relations kept worsening. Her school failures in sixth class and fourth class also had negative effects on her life. She hadn’t any other neurological disorder apart from this addiction. Overwhelming anxiety, personal failures or schizophrenia and some character disorders can bring assumptions of inhalants for self-treatment.²⁵

Case 3. A case history of schizophrenia and petrol dependence of a 37 years old patient reported in psychiatry OPD, PGIMS, Rohtak.  Parents complained of his petrol sniffing for 10 years. Patient used the cannabis in his adolescent age and when he was not able to get cannabis and he looked for alternate mean. Firstly patient inhales the boot polish and after few weeks also started petrol inhalation. He feels relaxed and hallucinogens after inhaling. In the starting patient only a bit inhales petrol but after a few months sniffing whole the day. His parents and neighbors noticed his dependency toward petroleum when he would shout, abusing and remain confined to his room and sniff large amount. On patient Mental examination found increased psychomotor activity but general physical examination was normal. After such findings patients were managed with tablets Risperidone 2mg 1HS, Baclofen 20m.²⁶

Case 4. A 14 year old boy belonged to a lower working class family brought with grievance of deceptive onset or gradually gait instability for about last 50 days. Leading questions disclose that the child sniffing glue from polythene bags (5-6 times/day) for last 1 year. Examination showed he had neurosyphilis, motor ataxia. Other vital organs test resulted normal functions but MRI of brain showed mild diffuse cerebral atrophy and change in white matter. Counseling and management of patient for near about one month results his gait ataxia partially resolved. This study also discussed about another consequences and complications regarding to glue sniffing.²⁷

Conclusion

Nowadays, abuse and pervasiveness of volatile substance in children and adolescents became a challenge for parents, society and heath community.  According to record of last 2-3 years it is found that the problem of inhalant abuse is significantly present all over the world and is growing gradually among youth.

In India, it is observed that easy approachability at each home, absence of legal restriction of domestic use products such as glue, petroleum products, fluid makes them the most demandable inhalant objects in school age children. The category which is known to be the main target is formed by younger teens, even a part of adults and majority in homeless, uneducated and migrant status street  children.  All the previous studies and surveys indicated that males were more likely than females to have used inhalants for get a buzz.  Also to be noticed that huffing, bagging, sniffing are the most popular pattern adopted by the users. In some users this activity can cause serious damage and failure of vital organs and could result in deaths. Therefor there is a strong need to understand and take some useful steps regarding this perilous problem. Some new tactics should be adopted such as family based treatment program, strong management strategies, increasing education level and efforts to replace danger and mind alerting substance in familiar products with low harmful alternative. According to forensic point of view it is found that there are some studies done in field of detection, identification, analysis of inhalants by the use of   conventional and modern hyphenated techniques. Review concluded  that  there is also need of more  knowledge and  research of more  sensitive  methods  and  instrumental  hyphenated  techniques in all areas of identification,  analysis of inhalants in metrics of toxicological importance is also significant. There is not sufficient work done according to forensic point of view. So, for this reason, its necessary to always update our education and information to select and established more approach, techniques for detection of inhalants.²⁸ Therefore a global consciousness is much required to accept the use of inhalants as a high-risk problem and to face it in all respective fields in order to find some suitable solutions (to save more lives).

Acknowledgement:

I am grateful to all the authors/editors/publishers whose articles are cited and included in references of this manuscript.

Conflict of Interest

The authors declare that they have no conflict of interest.

Funding:                                

No funding.

Author Contributions:

S. drafted and conceived the article  E.S and revised the manuscript.

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