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FIGURE 8. United Kingdom VSA-related deaths: Cause <strong>of</strong> death by product. <strong>of</strong> prior VSA by the deceased, and the Coroner may not press the question for humanitarian reasons. The primary purpose <strong>of</strong> the inquest is to exclude crime rather than to establish the exact circumstances <strong>of</strong> death. In the remainder <strong>of</strong> deaths (i.e., 30 percent), there is no evidence <strong>of</strong> prior use, and some <strong>of</strong> these may be naive users who have succumbed due to inexperience. It must be difficult, particularly when using very volatile and short-acting compounds (like gases), to titrate the “high” against the dose. The risk <strong>of</strong> accidental overdose also is greater with the gaseous compounds. When liquid solvents and solvent-containing products are abused, the vapor inhaled always will contain air, but with gases it is easy to displace all air, thus adding anoxia to the hazard. For most other drugs <strong>of</strong> abuse, there is some indication <strong>of</strong> dose. Even street drugs such as cocaine and heroin tend to be sold in single dose units at the user level. In contrast, a teenager given a cigarette lighter refill has to either experiment or be taught by his or her peers to find out if one sniff or half a can is required to achieve the desired effect. One can imagine that this is a very risky process. METHODS OF MISUSE The method <strong>of</strong> misuse is related to the nature <strong>of</strong> the product (figure 9) Adhesives commonly are poured into a plastic bag, and the vapor is inhaled from the gathered neck <strong>of</strong> the bag. 221
FIGURE 9. United Kingdom VSA-related deaths: Method <strong>of</strong> misuse by product. Contact <strong>of</strong> the perioral region with adhesive contaminating the bag probably is responsible for “glue sniffers rash” (Meredith et al. 1989). Liquids commonly are inhaled directly from the original containers or poured into empty containers such as bleach bottles before use. It probably is observation <strong>of</strong> this practice by adults that gives rise to many rumors <strong>of</strong> bleach sniffing. However, this bizarre practice has been documented (Raferty 1980). Vapor from liquids also may be inhaled after pouring them onto a handkerchief or sleeve. Aerosols sometimes are inverted and sprayed directly into the mouth (figure 1), used to inflate plastic bags, or, more rarely, bubbled through water to scrub out the nonrespirable components. Deaths have occurred when children have done this in the bath; the semiconscious child falls forward and drowns. Cigarette lighter refills are misused by clenching the nozzle between the teeth, and pressing on the can to discharge the contents directly into the mouth, as discussed above. PLACES WHERE SUBSTANCES ARE ABUSED In 1991, 39 percent <strong>of</strong> VSA-related deaths occurred when sniffing took place at home; 11 percent at the home <strong>of</strong> a friend; 3 percent in an institution (e.g., school or residential home): 42 percent in a public place; and 2 percent at work. The location was not reported in 3 percent <strong>of</strong> cases (figure 10). It perhaps is surprising that over half <strong>of</strong> the deaths 222
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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
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Several programs have been develope
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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 207 and 208: of the youthful po
Page 209 and 210: Lucchini, R. “Niños Callejeros y
Page 211 and 212: least as far back as 1983. However,
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
Page 223 and 224: TABLE 4. United Kingdom VSA-related
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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
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
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
Page 273 and 274: are due to the fact that inhalants
Page 275 and 276: 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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