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propellant. In the United Kingdom, products with a high propellant content, principally deodorants, pain relief spray, and air fresheners, are preferred (table 3). There is a potential hazard from exposure to aluminum chlorhydrate in deodorants. Based on the mortality data, abuse <strong>of</strong> spray paint is rare in the United Kingdom, in marked contrast to the United States (Goodwin 1988; Streicher et al. 1981; Voigts and Kaufman 1983) and Japanese experience (Suwaki, this volume). 3. Solvents from adhesives: Contact adhesives containing toluene are responsible for most <strong>of</strong> the deaths from the abuse <strong>of</strong> glue in the United Kingdom (table 4). The adhesives contain many other volatile components in addition to toluene, which, although probably not responsible for intoxication, are important when assessing possible toxicity from chronic VSA. 4. Other products: A wide range <strong>of</strong> other products are misused (table 5). A major cause <strong>of</strong> death is misuse <strong>of</strong> typewriter correction fluid or its thinner, which once contained 1, 1, 1-trichloroethane. <strong>Abuse</strong> <strong>of</strong> fire extinguishers containing BCF is an important if highly TABLE 3. United Kingdom VSA-related deaths from aerosols. Product Deaths Deodorant 111 Pain relief spray 53 Air freshener 24 Hair spray 16 Cleaning fluid 12 Paint 5 Glue 3 Unspecified aerosol 27 Total 255 217
TABLE 4. United Kingdom VSA-related deaths from adhesives. Product Deaths Contact adhesives 129 Bicycle tube repair cement 9 Model glue/plastic cement 3 Unspecified adhesive 94 Total 235 variable cause <strong>of</strong> death (figure 6). Anesthetics (predominantly nitrous oxide and halothane) and solvents used as cleaning or degreasing agents (1, 1, 1-trichloroethane, trichloroethylene, and tetrachloroethylene) are also responsible for deaths. In summary, using the product classification above, abuse <strong>of</strong> gasoline fuels caused 35 percent <strong>of</strong> VSA deaths, other products caused 24 percent, aerosols caused 21 percent, and adhesives caused 19 percent, with only 1 percent <strong>of</strong> causes not known. A trend has been observed towards the misuse <strong>of</strong> the gaseous compounds in recent years (figure 7), particularly among the young (Esmail et al. 1992). Only five deaths have been directly attributed to the effects <strong>of</strong> alkyl nitrites. CAUSE OF DEATH It <strong>of</strong>ten is difficult to establish the precise mechanism <strong>of</strong> death related to VSA. Typically, a previously healthy teenager collapses while with friends, <strong>of</strong>ten at home. The paraphernalia <strong>of</strong> VSA, <strong>of</strong>ten the product and sometimes a plastic bag, is found by the body. Well-meaning friends or parents occasionally will tidy up the scene before an investigation. Usually at the post mortem examination, nothing remarkable is seen except perhaps acute congestion <strong>of</strong> the lungs, but the circumstances and the subsequent toxicology report lead to the conclusion that it was a sudden sniffing death. Knowing the arrythmogenic potential <strong>of</strong> the compounds, the pathologist reports that the death probably was due to a 218
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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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TABLE 7. National
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TABLE 9. National
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TABLE 9. National
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TABLE 10. National
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TABLE 10. National
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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 211 and 212: least as far back as 1983. However,
Page 213 and 214: TABLE 1. Phase-out schedule for ozo
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Page 217 and 218: UNITED KINGDOM VSA-RELATED MORTALIT
Page 219 and 220: FIGURE 5. United Kingdom VSA-relate
Page 221: TABLE 2. United Kingdom VSA-related
Page 229 and 230: NATIONAL VSA STATISTICS The only <s
Page 231 and 232: TABLE 6. National
Page 233 and 234: TABLE 7. Local surveys giving infor
Page 235 and 236: TABLE 7. Local surveys giving infor
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
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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
Page 261 and 262: challenges to a healthy readjustmen
Page 263 and 264: REFERENCES Beauvais, F. Social and
Page 265 and 266: Gathering Epidemiologic Information
Page 267 and 268: DIRECT POPULATION SURVEYS Cross-sec
Page 269 and 270: The findings in the two surveys wer
Page 271 and 272: 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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