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

contributions from many small groups working with volatile substance
abusers.
CLINICAL DIAGNOSIS
At the clinical level, Meredith and colleagues (1989) have discussed the
diagnosis <strong>of</strong> VSA and stress the importance <strong>of</strong> a laboratory examination
<strong>of</strong> blood for volatile compounds in cases <strong>of</strong> drunken behavior,
unexplained listlessness, anorexia, and moodiness in children. Reliable
analytical methods are available to detect all the compounds discussed in
this chapter in blood, except unchanged alkyl nitrites and gasoline
(Streete et al. 1992). It also is important from a toxicological standpoint
to ensure that, when reporting data on VSA, the chemical composition <strong>of</strong>
all products mentioned here is investigated. This usually means that a
chemical analysis is required (Ramsey and Flanagan 1982; Rosenberg
and Sharp 1992).
CONCLUSIONS
About 5 percent <strong>of</strong> all deaths in teenagers in England and Wales are now
caused by VSA. Faced with significant acute mortality, probably greater
than that resulting directly from heroin and cocaine in this age group, and
evidence that death <strong>of</strong>ten occurs when there is little or no previous history
<strong>of</strong> VSA, the view cannot be taken that an experimental sniff <strong>of</strong> butane
can be regarded as part <strong>of</strong> growing up. On the other hand, the sporadic
nature <strong>of</strong> the problem makes coordinating a local response particularly
difficult. In the absence <strong>of</strong> reliable data about the prevalence and detailed
nature <strong>of</strong> the problem, the relative hazard from abuse <strong>of</strong> different
products is difficult to assess. However, when 28 percent <strong>of</strong> all VSA
deaths are caused by one product, cigarette lighter refills, the view that
product-oriented policies are impractical and unenforceable must be
reconsidered.
Control <strong>of</strong> supply rarely has been successful in any area <strong>of</strong> drug abuse
prevention and is highly unlikely to be successful in the case <strong>of</strong> VSA
since abusable products surround us in our domestic and working lives.
However, there are many good reasons to limit the amount <strong>of</strong> volatile
organic compounds that are released into the environment, and there are
simple modifications that could render some products less attractive and
inconvenient to misuse. The long-term objective must be to persuade
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