Epidemiology of Inhalant Abuse - Archives - National Institute on ...

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Volatile Substance <strong>Abuse</strong> in the United Kingdom John Ramsey, Jennifer Taylor, H. Ross Anderson, and Robert J. Flanagan INTRODUCTION The deliberate misuse <strong>of</strong> volatile compounds by inhalation in order to achieve intoxication has been a major problem in the United Kingdom since the early 1980s. Commonly referred to as “glue sniffing” or “solvent abuse,” the term “volatile substance abuse” (VSA) has now gained acceptance. Volatile compounds were inhaled to achieve intoxication even before their anaesthetic properties were recognized. Pseudoscientific demonstrations <strong>of</strong> the intoxication caused by nitrous oxide inhalation were a common stage act in the mid-1800s both in Britain and in the United States. Diethyl ether and chlor<strong>of</strong>orm also were freely available at this time and were inhaled or ingested commonly as alcohol substitutes. Nagle (1968) has surveyed the history <strong>of</strong> abuse <strong>of</strong> the early anaesthetic agents. It was not until the review by Press and Done (1967) and the paper by Bass (1970) on sudden “sniffing” deaths that the true nature and magnitude <strong>of</strong> the modem problem in the United States came to the attention <strong>of</strong> more than a handful <strong>of</strong> pathologists and toxicologists. In 1975, Joyce Watson first reported her experiences treating glue sniffers in Lanarkshire, Scotland (Watson 1975). In the late 1970s the United Kingdom’s <strong>National</strong> Poisons Information Service received an increasing number <strong>of</strong> requests for information about VSA (Francis et al. 1982), and toxicology laboratories analyzed samples from several deaths that had resulted mainly from the abuse <strong>of</strong> adhesives containing toluene or typewriter correction fluids containing halogenated solvents. This led to the recognition that VSA was becoming a major problem in the United Kingdom. A multidisciplinary workshop was held at Guy’s Hospital in 1981 to collate all available information. The results were reported by Volans and colleagues (1982). More importantly, a formal method <strong>of</strong> collecting VSA-related mortality data was established that addressed the shortcomings <strong>of</strong> the established methods (Anderson et al. 1982). Consequently, the United Kingdom has consistent mortality data from at 205
least as far back as 1983. However, the country does not have the benefit <strong>of</strong> national household survey data on drug-related issues paralleling that from the United States and countries influenced by the United States. The annual number <strong>of</strong> deaths from inhalant abuse in the United Kingdom has increased since 1983 by an average <strong>of</strong> 5.4 percent. In 1988, a second conference on VSA was held at Guy’s Hospital to reassess the state <strong>of</strong> knowledge and make further recommendations (Flanagan et al. 1989). Currently, two to three deaths occur each week, mostly among adolescent males. There is a trend toward the misuse <strong>of</strong> products containing gases, predominantly butane (Esmail et al. 1992). PRODUCTS ABUSED: GENERAL OBSERVATIONS For a product to have potential for misuse by inhalation, it must contain a suitable volatile compound that is readily accessible and free from irrespirable contaminants. For example, aerosols with high propellant content meet criteria for misuse (e.g., PR Freeze Spray and deodorants), whereas those with low propellant content (e.g., shaving foam) do not. In the case <strong>of</strong> deodorants, the propellant can be separated from the active ingredient (usually aluminum chlorhydrate) by inverting the can so that the dip tube is in the gas phase, not the liquid (figure 1). FIGURE 1. Method <strong>of</strong> misusing aerosols. 206
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National I
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ACKNOWLEDGMENT This monograph is ba
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Treatment Strategies for Volatile S
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extent of inhalant
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agencies. Dr. Carlini-Cotrim conclu
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prevalence, after alcohol and tobac
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Inhalant Use in th
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FIGURE 1. Lifetime prevalence for 1
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Reliability of the
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use beginning in 1987 when the surv
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TABLE 2. Current use of</st
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TABLE 3. Use of in
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TABLE 4. Inhalant
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TABLE 5. Lifetime prevalence and cu
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TABLE 7. Inhalant
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CONCLUSION Unlike other drugs in th
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AUTHORS Ruth W. Edwards, Ph.D. Rese
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Epidemiologic data were obtained fo
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perception of the
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Malaysia In Malaysia, the abuse <st
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The primary method of</stro
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them at least two to three times pe
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Curiosity is the most popular motiv
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Inhaling from a plastic bag: The vo
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(between US $0.04 and US $0.80) a d
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truant, who have money, and who are
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Edmondson, K. Review of</st
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Inhalant A
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Children working in the streets 280
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(1986), collected data on the preva
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Anecdotal information suggests that
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FIGURE 3. Psychological process mod
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ehavior. A secondary aim has been u
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REFERENCES ABC Communication. Consu
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Inhalant Use Among
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TABLE 1. Lifetime prevalence <stron
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TABLE 3. Lifetime prevalence <stron
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TABLE 4. Solvent use found for 1,83
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however, rarely is taken into consi
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TABLE 7. Weekly use (at least once
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TABLE 9. Use of dr
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Oetting, E.R.; Edwards, R.W.; and B
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RESULTS Prevalence Rates The findin
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TABLE 2. Use of in
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Incidence Rates Data from the surve
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TABLE 7. Use of in
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FIGURE 2(a). Proportion and number
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TABLE 8. Regression analysis: Use <
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TABLE 10(a). Mean age at first inha
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TABLE 13. Percentage of</st
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FIGURE 3. Opinion on health consequ
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The conduct of con
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Inhalant A
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The lack of epidem
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FIGURE 1. Substance abusers treated
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FIGURE 2. Drug used at initiation <
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The registered inhalant abusers ran
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medication, and jumping from a tall
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(with the main psychoactive compone
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In 1990, a World Health Organizatio
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FIGURE 7. Number of</strong
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of an epidemic, wh
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Oetting, E.R.; Beauvais, F.; and Ed
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FIGURE 1. Arrests for drug statute
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had inhaled the vapor from lacquer
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FIGURE 4. Numbers of</stron
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TABLE 3. Age appeared to consultati
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TABLE 5. Present occupational situa
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FIGURE 5. SOURCE: Longitudnal patte
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FIGURE 7. Longitudinal pattern <str
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Epidemiology <stro
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TABLE 1. National
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(Hughes et al. 1980). The system ha
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TABLE 2. National
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TABLE 3. National
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FIGURE 1. National
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FIGURE 3. Drug Registry System (SRI
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TABLE 5. National
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TABLE 6. National
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Page 169 and 170: The longest running institution, th
Page 171 and 172: Several programs have been develope
Page 173 and 174: Thus, substance abuse research has
Page 175 and 176: 3. Alcohol and tobacco were not con
Page 177 and 178: Leal, H., and Pacheco, G. Estrategi
Page 179 and 180: Division of <stron
Page 181 and 182: mind the fact that a sizeable numbe
Page 183 and 184: Adults and Older Students I
Page 185 and 186: Method Participants. Participants w
Page 187 and 188: TABLE 6. Types of
Page 189 and 190: TABLE 9. Sources of</strong
Page 191 and 192: THE NEED FOR MORE RESEARCH ON INHAL
Page 193 and 194: funding. However, by encouraging th
Page 195 and 196: AUTHOR Isidore Silas Obot, Ph.D., M
Page 197 and 198: abuse and their biomedical, social,
Page 199 and 200: nitrites—is virtually unknown in
Page 201 and 202: TABLE 3. Frequency of</stro
Page 203 and 204: TABLE 5. Lifetime prevalence and cu
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Page 213 and 214: TABLE 1. Phase-out schedule for ozo
Page 215 and 216: inquisitorial, unlike the procedure
Page 217 and 218: UNITED KINGDOM VSA-RELATED MORTALIT
Page 219 and 220: FIGURE 5. United Kingdom VSA-relate
Page 221 and 222: TABLE 2. United Kingdom VSA-related
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Page 229 and 230: NATIONAL VSA STATISTICS The only <s
Page 233 and 234: TABLE 7. Local surveys giving infor
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Page 237 and 238: presented as a confidential “Scho
Page 239 and 240: TABLE 8. Surveys of</strong
Page 241 and 242: Children’s Act 1989: Section 17 r
Page 243 and 244: problem would go away like other te
Page 245 and 246: Children ages 14-16 “should have
Page 247 and 248: contributions from many small group
Page 249 and 250: Chadwick, O.; Anderson, R.; Bland,
Page 251 and 252: Market and Opinion Research Interna
Page 253 and 254: Streete, P.J.; Ruprah, M.; Ramsey,
Page 255 and 256: Treatment Strategies for Volatile S
Page 257 and 258: that they chose solvents not only b
Page 259 and 260: Medical management and detoxificati
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challenges to a healthy readjustmen
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REFERENCES Beauvais, F. Social and
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Gathering Epidemiologic Information
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DIRECT POPULATION SURVEYS Cross-sec
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The findings in the two surveys wer
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TABLE 1. Recent use a of</s
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are due to the fact that inhalants
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number usually is advertised in tel
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REFERENCES Beauvais, F. Volatile so
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Inhalants: A Polic
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predominated, but it seems clear th
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classes containing these substances
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justify their positions more on pri
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eformulation of pr
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with abuse potential, and additiona
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TABLE 2. Type of l
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TABLE 3. Type of d
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TABLE 4. Type of b
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TABLE 5. Specified products regulat
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TABLE 6. Prevention curricula and i
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appear to enter treatment that prog
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Policy Alternative 1: Change Produc
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outcome evaluations. Ideally, such
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Mata, A.G., Jr., and Andrew, S.R. <
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Recommendations and Conclusions Zil
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AUTHORS Zili Sloboda, Sc.D. Nichola
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26 42 50 52 53 54 56 61 62 THE BEHA
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80 82 83 84 85 87 88 89 92 NEEDLE S
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102 106 107 108 109 111 112 113 ANA
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124 NEUROBIOLOGICAL APPROACHES TO B
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138 139 140 141 142 143 IMAGING TEC
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NIH Publication No 95-3831 Printed
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