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

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6. An Environmental Protection Agency (EPA) regulation requiring use <strong>of</strong> CFCs to be phased out for environmental reasons; since one fabric waterpro<strong>of</strong>ing product was reformulated, deaths from abuse have reportedly declined. For some <strong>of</strong> these actions, there is anecdotal evidence that deaths and injuries from abuse <strong>of</strong> these products declined. However, it is unknown what impact these limited actions have had on the rate <strong>of</strong> abuse <strong>of</strong> inhalants in general since there are so many products with abuse potential on the market, and abusers readily can switch products. Furthermore, there appear to be no studies on the impact <strong>of</strong> these specific productoriented actions. Many <strong>of</strong> the products that are abused fall under the purview <strong>of</strong> the CPSC. It has been argued that the CPSC currently has the authority to ban or require reformulation or labeling <strong>of</strong> products found to present safety risks. However, the CPSC has articulated the legal opinion that its authorizing legislation pertains to product safety when used “as directed” and under “reasonably foreseeable handling or use.” The latter term is interpreted to exclude deliberate misuse <strong>of</strong> products for psychoactive purposes. Federal legislation probably could be enacted that would ban or set concentration limits on the use <strong>of</strong> specific abusable substances in products or classes <strong>of</strong> products. There are several major precedents, For example, use <strong>of</strong> CFCs as a class <strong>of</strong> chemicals has been banned under the Environmental Protection Act due to their impact on the environment. The Occupational Safety and Health Act provides authority under which personal exposure limits have been set for use <strong>of</strong> toxic substances in the workplace (including a number <strong>of</strong> products abused as inhalants). The Food, Drug, and Cosmetic Act forbids food from being sold that contains any detectable concentration <strong>of</strong> a substance found to be carcinogenic. The argument against product-oriented regulation to change products are that the costs <strong>of</strong> such an approach are much greater than the potential benefits. Firstly, only a tiny fraction <strong>of</strong> these products are abused, and the measured consequences <strong>of</strong> abuse appear to be small. Secondly, the costs <strong>of</strong> reformulating products and decreased product functionality in use may be substantial. Development <strong>of</strong> new products could become more expensive and slowed substantially. Finally, major resources would be required to enforce the regulations since there are so many substances 283
with abuse potential, and additional products and substances are being developed virtually every day. State Governments When State legislation is used to address inhalant abuse, law enforcement and business regulation have been the primary focuses <strong>of</strong> efforts. Out <strong>of</strong> 43 States that have enacted some kind <strong>of</strong> legislation pertaining to inhalant abuse, 41 have enacted provisions with a law enforcement approach, and 31 have enacted a business regulation approach. In contrast, only 10 States have enacted statutes that specifically contain prevention or treatment policies (see tables 2-6). No formal evaluations have been identified <strong>of</strong> the effectiveness <strong>of</strong> these State initiatives. However, Mr. Hugh Young, the Executive Director <strong>of</strong> SAFE, states that the business regulation policies are not enforced and that there have been no successful prosecutions under these laws. Statutes criminalizing abuse <strong>of</strong> inhalants (36 States) arguably have been enacted primarily to allow prosecutors and judges to divert inhalant abusers into treatment. Again, there are no data regarding the frequency with which this has been done. The national drug treatment studies report only between 2,500 and 5,000 admissions <strong>of</strong> inhalant abusers to treatment in 1990 (Brandeis University 1992; <strong>National</strong> Association <strong>of</strong> State Alcohol and Drug <strong>Abuse</strong> Directors 1991). Seven States enacted laws calling for abusable products to add irritants in order to discourage abuse <strong>of</strong> the products (table 4). In Texas and New York, these statutes charged State commissions or agencies with identifying and publishing lists <strong>of</strong> such “additives” that were approved as safe for this purpose. After substantial effort, the Texas and New York efforts to identify product additives were terminated because there was insufficient agreement on what would be safe and effective additives. For example, there is limited research showing that the only additive currently in use, oil <strong>of</strong> mustard, may be carcinogenic. The 10 States that have enacted prevention or treatment provisions into law (table 1) arguably have done so mainly to guarantee that inhalant abusers had access to some kind <strong>of</strong> treatment. However, there is no treatment approach that specifically is designed for and demonstrated to be effective at treatment <strong>of</strong> inhalant abuse. The only options are generic drug-free residential and outpatient programs that treat polydrug abuse using cognitive and behavioral therapy. Again, so few inhalant abusers 284
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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
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3. Alcohol and tobacco were not con
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Leal, H., and Pacheco, G. Estrategi
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Division of <stron
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mind the fact that a sizeable numbe
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Adults and Older Students I
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Method Participants. Participants w
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TABLE 6. Types of
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TABLE 9. Sources of</strong
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THE NEED FOR MORE RESEARCH ON INHAL
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funding. However, by encouraging th
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AUTHOR Isidore Silas Obot, Ph.D., M
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abuse and their biomedical, social,
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nitrites—is virtually unknown in
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TABLE 3. Frequency of</stro
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TABLE 5. Lifetime prevalence and cu
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working with children living in the
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of the youthful po
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Lucchini, R. “Niños Callejeros y
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least as far back as 1983. However,
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TABLE 1. Phase-out schedule for ozo
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inquisitorial, unlike the procedure
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UNITED KINGDOM VSA-RELATED MORTALIT
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FIGURE 5. United Kingdom VSA-relate
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TABLE 2. United Kingdom VSA-related
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TABLE 4. United Kingdom VSA-related
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NATIONAL VSA STATISTICS The only <s
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TABLE 6. National
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TABLE 7. Local surveys giving infor
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TABLE 7. Local surveys giving infor
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Page 243 and 244: problem would go away like other te
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Page 251 and 252: Market and Opinion Research Interna
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Page 257 and 258: that they chose solvents not only b
Page 259 and 260: Medical management and detoxificati
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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
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Page 271 and 272: TABLE 1. Recent use a of</s
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Page 277 and 278: REFERENCES Beauvais, F. Volatile so
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Page 281 and 282: predominated, but it seems clear th
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Page 287: eformulation of pr
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Page 297 and 298: TABLE 5. Specified products regulat
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Page 301 and 302: appear to enter treatment that prog
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Page 305 and 306: outcome evaluations. Ideally, such
Page 307 and 308: Mata, A.G., Jr., and Andrew, S.R. <
Page 309 and 310: Recommendations and Conclusions Zil
Page 311 and 312: AUTHORS Zili Sloboda, Sc.D. Nichola
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Page 315 and 316: 80 82 83 84 85 87 88 89 92 NEEDLE S
Page 317 and 318: 102 106 107 108 109 111 112 113 ANA
Page 319 and 320: 124 NEUROBIOLOGICAL APPROACHES TO B
Page 321 and 322: 138 139 140 141 142 143 IMAGING TEC
Page 323: NIH Publication No 95-3831 Printed
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