Inhalant abuse and dependence among adolescents in the United States

The Need for Action: Addressing Inhalant Abuse and Whitener Addiction Among Adolescents

Inhalant abuse and whitener addiction are serious problems among adolescents that have significant consequences for physical and mental health, as well as for families, communities, and society as a whole. This review article discusses the causes and health consequences of inhalant abuse and whitener addiction among adolescents, as well as the challenges in addressing the problem. The paper also outlines strategies for addressing inhalant abuse and whitener addiction, including education and awareness campaigns; early intervention and treatment; collaboration between schools, healthcare providers, and community organizations; and support for families affected by inhalant abuse and addiction. The paper concludes with a call to action for policymakers, healthcare providers, and community members to prioritize and address inhalant abuse and whitener addiction among adolescents. By working together, we can help to prevent substance abuse and promote the health and well-being of our youth.

Adolescent substance use and high school noncompletion: exploring the nature of the relationship using a discordant twin design

BACKGROUND AND AIMS

Previous studies have demonstrated associations between substance use and reduced educational attainment; however, many were unable to account for potential confounding factors like genetics and the rearing environment. In the few studies that controlled for these factors, the substances assessed were limited to alcohol, cannabis, and tobacco. To address these limitations, we examined the relationship between adolescent use of seven kinds of substances, the number of additional substances used, and high school noncompletion within a large sample of Australian twins.

DESIGN

A series of two-level generalized mixed effects logistic regressions were conducted to examine associations between adolescent substance use and high school noncompletion.

SETTING

Australia.

PARTICIPANTS

A total of 9579 adult Australian twins from two cohorts of the Australian Twin Registry.

MEASUREMENTS

Assessments of high school completion, childhood major depression, conduct disorder symptoms, substance use initiation, demographics, and parental educational attainment using the Australian version of the Semi-Structured Assessment for the Genetics of Alcoholism.

FINDINGS

There were unique within-twin-pair effects of use of sedatives (odds ratio [OR] = 22.39 [95% confidence interval (CI) = 1.18-423.48]) and inhalants/solvents (OR = 10.46 [95% CI = 1.30-84.16]) on high school noncompletion. The number of substances used in adolescence was strongly associated with high school noncompletion across all discordant twin models (ORs from 1.50-2.32, Ps < 0.03).

CONCLUSIONS

In Australia, adolescent substance use appears to be associated with early school dropout, with the effects of any given substance largely because of the confounding factors of parental education, childhood conduct disorder symptoms, and use of other substances. Sedatives and inhalants/solvents have effects on high school noncompletion that cannot be explained by polysubstance use or familial factors.

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department

Today, the concomitant abuse of nitrous oxide (N₂O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N₂O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N₂O users visiting the ED. This was a retrospective observational cohort study. All N₂O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N₂O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N₂O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N₂O. Combined use of N₂O and illicit drugs can cause great harm to health.

Functional Vitamin B12 Deficiency in Association With Nitrous Oxide Inhalation

There is a rise in the use and abuse of nitrous oxide (N₂O) as a recreational drug. In spite of the laws enforced internationally, it remains readily available and is an inexpensive mode of recreational drug. Commonly known as the ‘laughing gas’, its use as a euphoric agent is on the rise. Subsequently, the side effects are also coming to light, associated with medical, financial and social implications. It is not detected in routine drug testing. The key differential in an acute setting is often confused with the query for Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy and malabsorption syndromes associated with vitamin B12 and folate deficiencies. This is a case report of a 21-year-old male who presented to the hospital with concerns for weakness and tingling sensations in his extremities accompanied by an inability to bear weight, which he suggested to seem to be worsening over a period of three weeks. His blood tests suggest mild deficiencies of vitamin B12 and folate levels, and MRI revealed subacute combined degeneration of the cervical cord from C2 to C6. The radiologist advised to rule out B12 deficiency and the use of nitrous oxide as a recreational drug. This led to the discussion with the patient, during which he admitted to the use of nitrous oxide. Prompt management with B12 injections intramuscularly every two to three days a week for 11 days followed by folate supplements and monthly B12 injections were advised. He was also reviewed by the physiotherapy teams, and the patient agreed to not use nitrous oxide in the future as a recreational drug.

Recreational Nitrous Oxide Abuse: Prevalence, Neurotoxicity, and Treatment

Nitrous oxide (N₂O), also known as "laughing gas," is a colorless, nonirritating gas. Clinically, it is widely used as an inhaled anesthetic, analgesic, and anxiolytic. In recent years, recreational abuse of N₂O has become increasingly common, especially among young adults and adolescents, but many of them lack awareness of the possible side effects associated with this drug. N₂O abuse can damage multiple systems, especially the nervous system, but the exact mechanism of N₂O toxicity remains controversial. At present, an increasing number of cases of nervous system damage caused by N₂O abuse have been reported both at home and abroad. Discontinuation of N₂O use and timely supplementation with vitamin B12 are essential for a good prognosis. Long-term abuse without timely treatment will eventually lead to irreversible neurological damage. In this article, we discuss the epidemiology of N₂O abuse, neurotoxicity mechanisms, clinical manifestations, relevant auxiliary examinations, treatments, and prognosis to improve social awareness of N₂O exposure risk, especially among users and clinicians.

Harms associated with inhalant misuse in adolescent females - a review of the pre-clinical and clinical evidence

BACKGROUND

Inhalant misuse, or the misuse of products containing toluene is common in adolescents, and is associated with diverse physiological and psychological harms. Females comprise over half those who misuse inhalants in adolescence, however, the majority of the evidence has been derived from male-only or mixed-sex studies without exploration of sex differences. Female adolescence is a critical maturational period with potential for growth, reproductive, cognitive and psychological harms that may lead to long-term health consequences. We therefore summarise evidence of female-specific harms arising from inhalant misuse.

METHODS

We synthesised pre-clinical and clinical studies of inhalant misuse which were conducted in females, or where sex-differences were reported, into a narrative literature review.

RESULTS

Females experience growth impairments and metabolic dysfunction arising from inhalant misuse, but data on sex-differences are inconclusive. Inhalant misuse in early adolescence may impact menarche and subsequent reproductive capacity, but studies have predominantly focused on the effects of inhalants on offspring rather than on the exposed female. There is limited evidence of sex-differences in relation to cognitive outcomes following exposure to inhalants in pre-clinical models. Females are at an increased risk of psychological harms associated with inhalant misuse, particularly depression and suicidal behaviour.

CONCLUSIONS

The type and magnitude of harms associated with inhalant misuse are sex-specific, but data are limited. We recommend that both pre-clinical and clinical studies of inhalant misuse include both males and females, and should specifically test for and report sex-differences. This can be used to build an evidence base for screening and interventions tailored to females.

1,1-Difluoroethane Detection Time in Blood after Inhalation Abuse Estimated by Monte Carlo PBPK Modeling

(1) Background: Inhalant abuse and misuse are still widespread problems. 1,1-Difluoroethane abuse is reported to be potentially fatal and to cause acute and chronic adverse health effects. Lab testing for difluoroethane is seldom done, partly because the maximum detection time (MDT) is unknown. We sought to reliably estimate the MDT of difluoroethane in blood after inhalation abuse; (2) Methods: MDT were estimated for the adult male American population using a physiologically based pharmacokinetic (PBPK) model and abuse patterns detailed by two individuals. Based on sensitivity analyses, variability in huffing pattern and body mass index was introduced in the model by Monte Carlo simulation; (3) Results: With a detection limit of 0.14 mg/L, the median MDT was estimated to be 10.5 h (5th-95th percentile 7.8-12.8 h) after the 2-h abuse scenario and 13.5 h (10.5-15.8 h) after the 6-h scenario. The ranges reflect variability in body mass index and hence amount of body fat; (4) Conclusions: Our simulations suggest that the MDT of difluoroethane in blood after abuse ranges from 7.8 to 15.8 h. Although shorter compared to many other drugs, these MDT are sufficient to allow for testing several hours after suspected intoxication in a patient.

Recreational nitrous oxide abuse related subacute combined degeneration of the spinal cord in adolescents - A case series and literature review

BACKGROUND

Nitrous oxide (N₂O) is a commonly used inhaled anesthetic in outpatient dental procedures. However, the increasing recreational use of N₂O may result in vitamin B₁₂ deficiency-related neurologic and psychiatric symptoms. The aim of this study was to demonstrate the clinical features of chronic N₂O abuse in pediatric patients.

METHODS

Patients under 20 years of age who were diagnosed with N₂O-induced subacute combined degeneration of the spinal cord from 2012 to 2018 were enrolled in this study. Clinical presentations, laboratory, imaging, ancillary studies, treatments and outcomes were analyzed.

RESULTS

Nine patients were included, all of whom presented with symptoms of myeloneuropathy including limb numbness, limb weakness or unsteady gait. Six patients had low or low-normal vitamin B₁₂ (cyanocobalamin) levels. Eight patients had evidence of subacute combined degeneration of the spinal cord via neuroimaging studies. All of the patients received vitamin B₁₂ supplementation as treatment. All had full recovery of muscle power within 2 months. Five patients had persistent sensory deficits.

CONCLUSION

Chronic N₂O abuse can cause permanent neurological damage if not treated promptly. Clinical staff should be aware of the various presentations of neurotoxicity related to N₂O abuse.

[Clinical features of long segmental myelopathy caused by nitrous oxide]

OBJECTIVE

To analyze the clinical and imaging characteristics of the neurological damage caused by nitrous oxide (N₂O).

METHODS

In the study, 10 patients in the Department of Neurology of China-Japan Friendship Hospital from October 2015 to February 2018 were retrospectively analyzed for the demographic data, the history of inhaled N₂O, clinical features, blood examination, electrophysiological examination, spinal magnetic resonance imaging and therapeutic efficacy profiles.

RESULTS

The male-to-female ratio was 4:6 and it presented with an age-of-onset 17-26 years [the average age: (20.80±3.12) years]. The time from inhaled N₂O to onset was 1 month to 1 year [the average time: (6.95±4.19) months]. Paralysis in all the patients and numbness in 9 patients were the main clinical features, while positive Lhermitte's sign in 3 patients, urinary and defecation disturbance in 4 patients were also found. Blood examination indicated anemia in 2 patients, giant cell anemia in 1 case and small cell hypochromic anemia in 1 case. 3 cases had been treated with vitamin B12 in an external hospital, and the other 7 cases had abnormal increase in homocysteine levels. Electrophysiological examinations showed sensory and motor nerve involvement in 9 patients, and motor nerve involvement in 1 patient. The severity of lower extremity lesion was significantly heavier than that of upper extremity. Spinal magnetic resonance imagings showed that long segmental lesions were present in the cervical spinal cord of all the patients, 3 cases with long segmental lesions of the thoracic cord and 2 cases with spinal cord swelling. In 6 cases, the horizontal axis had an "inverted V-type" T2 high signal, 1 case was classified as "crescent", and 3 cases were "eight-shaped". The symptoms in these 10 cases were alleviated in varying degrees after stopping the inhalation of nitrous oxide, actively supplementing high doses of vitamin B12 and doing early rehabilitation exercises.

CONCLUSION

Myelopathy with nitrous oxide presents as paralysis and numbness in limb extremities. In imaging, cervical spinal cord damage is common, accompanied by thoracic spinal cord damage. The horizontal axis is more common in the "inverted V-type". Treatment with high doses of vitamin B12 is effective.

Exploring Nitrous Oxide as Treatment of Mood Disorders: Basic Concepts

Nitrous oxide (laughing gas) has shown early promise as a rapidly acting antidepressant in patients with treatment-resistant major depression and is currently investigated in several clinical trials. Because nitrous oxide is rarely administered outside operating rooms or dental practices, most psychiatrists are not familiar with how nitrous oxide is administered in a medical setting and what regulations guide its use. The goal of this brief review was to educate psychiatrists about the basic concepts of nitrous oxide administration and pharmacology. Furthermore, common misconceptions about nitrous oxide will be discussed.

The impact of conventional and nonconventional inhalants on children and adolescents

AIM

Inhalant abuse in the adolescent population is a growing concern for care givers, communities, physicians, and medical providers. The aim of this article is to provide a review of the literature about this new challenge. In addition, it raises awareness about recent health policy rulings.

METHODS

Review of the literature was done.

RESULTS

In this review article, the prevalence of different modes of inhalant use and abuse in children and young adults and their potential health implications will be examined: Cigarettes, ENDS (E Cigarettes), Hookah, Marijuana, and Huffing. Additionally, marketing and advertising tactics will be reviewed to understand how they target this population. A review of current health policy recommendations from the FDA, American Thoracic Society, and the American Academy of Pediatrics will also be discussed.

CONCLUSION

The rapid rise in e-cigarette and hookah use in school aged children should trigger a call to action in the medical and public health communities. Health policy recommendations need to be made to reduce the level of adolescent substance abuse.

Inhalant use in adolescents in northern Russia

PURPOSE

To determine the prevalence of inhalant use in Russian adolescents and to investigate associated psychosocial problems from a gender perspective.

METHODS

Data on inhalant use and comorbid psychopathology were collected by means of self-reports from 2892 (42.4% boys) sixth to tenth grade students in public schools in Arkhangelsk, Russia. Multivariate analysis of covariance was used to assess differences in the levels of internalizing and externalizing problems in boys and girls, who were non-users and users of inhalants.

RESULTS

The prevalence of inhalant use was 6.1% among boys and 3.4% among girls. Compared with non-users, inhalant users scored significantly higher on internalizing and externalizing problems, functional impairment and lower on academic motivation, with psychopathology increasing with age. While there were no gender differences for internalizing problems, increased levels of externalizing problems in inhalant users were gender-specific (significantly higher in boys).

CONCLUSIONS

Inhalant use is related to significantly higher levels of comorbid psychopathology in Russian adolescents. Comprehensive, evidence-based prevention and intervention policies are needed to address inhalant use and its harmful effects.

Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature

BACKGROUND/OBJECTIVES

Nitrous oxide (N2 O) is known to have abuse potential, although debate regarding the toxic effects of such abuse continues. Our objective was to review the case literature and present the neurologic, psychiatric and medical consequences of N2 O abuse.

METHODS

A systematic literature review was completed for case reports using keywords "nitrous oxide" with "abuse/abusing" or "misuse/misusing" or "overuse/overusing" or "addiction." Non-English-language cases and cases not involving direct toxic effects of N2 O were excluded as were commentaries or personal essays. Clinical presentation, frequency of N2 O abuse, laboratory studies, imaging, ancillary tests, treatments and outcomes were collected from case reports.

RESULTS

Our review returned 335 Pubmed, 204 Web of Science, 73 PsycINFO, 6 CINAHL, 55 EMBASE and 0 Grey Literature results, and after exclusion and removal of duplicates, 91 individual cases across 77 publications were included. There were also 11 publications reporting 29 cases of death related to N2 O abuse. The majority of cases (N = 72) reported neurologic sequelae including myeloneuropathy and subacute combined degeneration, commonly (N = 39) with neuroimaging changes. Psychiatric (N = 11) effects included psychosis while other medical effects (N = 8) included pneumomediastinum and frostbite. Across all cases N2 O abuse was correlated with low or low-normal Vitamin B12 (cyanocobalamin) levels (N = 52) and occasionally elevated homocysteine and methylmalonic acid.

CONCLUSIONS/SCIENTIFIC SIGNIFICANCE

N2 O abuse represents a significant problem because of the difficulty involved with identification and the toxicity related to chronic abuse including possible death. Health professionals should be aware of the toxic effects of N2 O and be able to identify potential N2 O abuse. (Am J Addict 2016;25:358-369).

Laboratory approach for diagnosis of toluene-based inhalant abuse in a clinical setting

The steady increase of inhalant abuse is a great challenge for analytical toxicologists. This review describes an overview of inhalant abuse including the extent of the problem, types of products abused, modes of administration, pharmacology and effects of inhalants, the role of laboratory, interpretation of laboratory results and clinical considerations. Regular laboratory screening for inhalant abuse as well as other substance abuse and health risk behaviors must be a part of standard clinical care.

Patterns of substance use, delinquency, and risk factors among adolescent inhalant users

BACKGROUND

Despite insidious effects, use of inhalant substances by adolescents remains an understudied phenomenon.

OBJECTIVE

This research was designed to identify patterns of past year substance use and delinquency among adolescent inhalant users.

METHOD

The study used a sample of adolescent inhalant users (ages ranged from 12-17 years, n = 7,476) taken from a pooled sample of the 2002 through 2012 National Survey of Drug Use and Health (NSDUH). Three-step latent class analyses were conducted with past year substance use and delinquency behaviors as class indicators. Demographic and social covariates were included in the analyses.

RESULTS

Analyses yielded a six-class solution comprised of classes of users characterized by low substance use/low delinquency, high substance use/low delinquency, low substance use/fighting, cigarettes/alcohol/marijuana, high substance use/high delinquency, and cigarettes/alcohol/ marijuana/opioids/moderate delinquency.

CONCLUSIONS

Findings provide insight into the taxonomy of adolescent inhalant user heterogeneity, and may inform future efforts at detection and prevention of inhalant use by suggesting warning signs of co-occurring externalizing behaviors and possible indications of underlying internalized issues.

Chronic intermittent toluene inhalation initiated during adolescence in rats does not alter voluntary consumption of ethanol in adulthood

Voluntary inhalation of organic solvents, such as toluene, is particularly prevalent in adolescent populations and is considered to be a contributing factor to substance use and dependence later in life. While inhalants are often the initial "drug" experienced during this period, alcohol is another substance readily abused by adolescent populations. Although both substances are thought to have similar actions within the brain, our understanding of the implications of adolescent inhalant abuse upon subsequent exposure to alcohol remains to be investigated. Thus, this study aimed to assess locomotor responses to acute ethanol and voluntary ethanol consumption following a period of toluene inhalation throughout adolescence/early adulthood. Adolescent male Wistar rats (postnatal day [PN] 27) inhaled air or toluene (3000 ppm) for 1 h/day, 3 days/week for 4 (PN 27-52) or 8 weeks (PN 27-80) to mimic the patterns observed in human inhalant abusers. Following the exposure period, cross-sensitization to acute ethanol challenge (0.5 g/kg, intra-peritoneally [i.p.]), and voluntary consumption of 20% ethanol in a chronic intermittent 2-bottle choice paradigm, were assessed. Hepatic ethanol and acetaldehyde metabolism and liver histopathology were also investigated. Chronic intermittent toluene (CIT) exposure throughout adolescence for up to 8 weeks did not alter the behavioral response to acute ethanol or voluntary consumption of ethanol in adulthood, although an age-dependent effect on ethanol consumption was observed (p<0.05). Both liver function and pathology did not differ between treatment groups. Thus, in the paradigm employed, CIT exposure throughout adolescence and early adulthood did not predispose rats to subsequent locomotor sensitivity or voluntary consumption of ethanol in adulthood.

Risk for inhalant initiation among middle school students: understanding individual, family, and peer risk and protective factors

OBJECTIVE

Because initiation of inhalants at an early age is associated with a range of health and behavioral problems, including an increased likelihood of inhalant dependence (based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), we conducted discrete time survival analyses to determine the role of time-invariant and time-variant (over five waves) risk and protective factors as well as grade in inhalant initiation among middle school students.

METHOD

The current study uses data from 3,215 students who were initially surveyed as sixth graders in 2008-2009 and were resurveyed in seventh and eighth grades. Students were part of a larger substance use prevention trial conducted in greater Los Angeles. The sample is racially/ethnically diverse (54% Hispanic/Latino, 16% Asian, 14% White, 3% African American) and 51% male.

RESULTS

Seventeen percent of youths initiated inhalants during middle school. Higher drug refusal self-efficacy, familism (i.e., values related to family), and parental respect were associated with decreased odds of inhalant initiation. Having a significant adult or older sibling who used substances was associated with increased risk of initiation, but adult influence declined linearly and by the end of seventh grade was no longer a risk factor. Self-rated popularity was associated with inhalant initiation in seventh grade only, and perceived substance use by peers was associated with inhalant initiation in sixth grade only.

CONCLUSIONS

The influence of adults, siblings, and peers on inhalant use may be strongest in sixth and seventh grade. Interventions to prevent inhalant initiation should target sixth and seventh graders, address influence by family and peers, and provide skills training to improve drug refusal self-efficacy.

Specific impairments in instrumental learning following chronic intermittent toluene inhalation in adolescent rats

RATIONALE

Inhalant abuse is prevalent in adolescent populations, with chronic use resulting in neurobiological and cognitive abnormalities in adulthood. However, the nature and persistence of cognitive dysfunction, particularly following adolescent inhalant abuse, remain equivocal.

OBJECTIVE

The present study assessed specific cognitive processes beginning in late adolescence and adulthood following adolescent inhalation of toluene, a main component of many compounds readily abused.

METHODS

Adolescent male Wistar rats (postnatal day (PN) 27) were exposed to chronic intermittent inhaled toluene (10,000 ppm) for 1 h/day, 3 days/week for 4 weeks (PN 27-52) to mimic the patterns observed in human adolescent inhalant abusers. Following toluene exposure, motor and cognitive function was assessed.

RESULTS

Adolescent toluene exposure did not alter motor learning in the Rotarod task (PN 58) or acquisition, reversal, or retention of spatial learning in the Morris water maze (PN 55-64). In contrast, it delayed acquisition of instrumental responding for sucrose (5 % w/v) and impaired operant reversal learning and cue-induced reinstatement of sucrose seeking in adulthood (PN 57-100).

CONCLUSION

This study demonstrates that exposure to toluene at an abuse concentration during adolescence results in specific impairments in aspects of instrumental learning, without altering motor function and spatial learning in late adolescence/early adulthood. Our data imply that persistent alterations in reward processing may occur following adolescent inhalant misuse.

Anxiety symptoms in crack cocaine and inhalant users admitted to a psychiatric hospital in southern Brazil

OBJECTIVE

The occurrence of psychiatric comorbidity among individuals with crack or inhalant dependence is frequently observed. The objective of this study was to investigate anxiety symptoms among crack cocaine and inhalant users in southern Brazil.

METHODS

The study investigated two groups of volunteers of equal size (n=50): one group consisted of crack cocaine users, and the other group consisted of inhalant users. Research volunteers completed the Portuguese versions of the State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Self-Report Questionnaire (SRQ).

RESULTS

Both crack and inhalant users experience significant symptoms of anxiety. Inhalant users presented significantly more anxiety symptoms than crack users according to the HAM-A questionnaire only. In contrast to the results of the HAM-A, the STAI failed to demonstrate a significant difference between the two groups of substance users. SRQ scores revealed that crack and inhalants users had significant degrees of morbidity.

CONCLUSION

A significant difference regarding anxiety symptomatology, especially state anxiety, was observed among inhalant and crack users. Anxiety and overall mental psychopathology were significantly correlated in this sample. The results indicate that screening initiatives to detect anxiety and additional psychiatric comorbidities among crack and inhalant users are feasible and relevant.

Volatile substance misuse : clinical considerations, neuropsychopharmacology and potential role of pharmacotherapy in management

Volatile substance misuse is among the most prevalent and toxic forms of psychoactive drug use, and often results in highly deleterious social, psychological and medical consequences. The prevalence of this pernicious form of substance misuse owes in part to the fact that volatile substances of misuse are ubiquitous in the natural environment. Commonly misused commercial products include glue, shoe polish, nail polish remover, butane lighter fluid, gasoline and computer duster spray. National samples of volatile substance misusers tend to exhibit high rates of psychiatric problems and antisocial behaviour. In addition, cognitive impairments and affective dysregulation are often observed among these individuals. Volatile substances exert their complex neuropharmacological effects on dopaminergic, glutamatergic, GABAergic and serotoninergic receptor systems, as well as on cell membranes and ion channels. Concomitantly, pharmacotherapies for volatile substance abuse might profitably target a number of mechanisms, including reward circuitry in the brain, symptoms of craving and withdrawal, neuropsychiatric and emotional impairments that promote volatile substance abuse, and cognitive enhancement to rectify deficits in executive function. This review details the modes of use, subjective effects, epidemiology, adverse consequences, neuropsychopharmacology and drug treatment of volatile substance misuse, and discusses the potential role of novel forms of pharmacological intervention for this oft-overlooked public health threat of epidemic proportions.

Inhalant dependence: data from a tertiary care center in South India

BACKGROUND

This study aims to understand the sociodemographic and clinical profile of inhalant abusers seeking treatment from a tertiary care psychiatric hospital in South India.

MATERIALS AND METHODS

The clinical charts of patients who utilized the psychiatric services of a tertiary care center in India for over 10 years were examined for the study.

RESULTS

The sample had an urban predominance, was mostly unemployed, and was all male. Most of them had an adolescent age of onset of inhalant use (mean - 16.23 years). All patients reported the use of volatile solvents as inhalants. One other substance dependence was identified in more than half of the sample. The psychiatric comorbidity included psychosis and depression. A comparison was made between patients who presented with inhalant dependence only (I) and inhalant-dependent individuals who also used other psychoactive substances apart from nicotine (IP). The inhalant-only group (I) had an earlier mean age at onset of substance use as compared to the IP group. All patients in the I group reported withdrawal symptoms compared to 77% of patients in the (IP) group (P=0.048). The IP group reported a significantly higher occurrence of aggression (54.5 vs. 19%, P=0.02), externalizing symptoms (77.3 vs. 42.9%, P=0.03), and attention-deficit hyperactivity disorder (ADHD) (50 vs. 14.3%, P=0.02).

CONCLUSION

Inhalant dependence is a serious health problem in adolescent subjects and is associated with high comorbidity of other substance dependence, psychiatric disorder, and externalizing spectrum disorder. There is a need for community-based prospective studies in this area from India.

A community prevention model to prevent children from inhaling and ingesting harmful legal products

Children's misuse of harmful legal products (HLPs), including inhaling or ingesting everyday household products, prescription drugs, and over-the-counter drugs, constitutes a serious health problem for American society. This article presents a community prevention model (CPM) focusing on this problem among pre and early adolescents. The model, consisting of a community mobilization strategy and environmental strategies targeting homes, schools, and retail outlets, is designed to increase community readiness and reduce the availability of HLPs, which is hypothesized to reduce HLPs use among children. The CPM is being tested in Alaskan rural communities as part of an inprogress eight-year National Institute on Drug Abuse randomized-controlled trial. This paper presents the CPM conceptual framework, describes the model, and highlights community participation, challenges, and lessons learned from implementation of the model over a 21-month period.

Inhalant use initiation among U.S. adolescents: evidence from the National Survey of Parents and Youth using discrete-time survival analysis

The purpose of this paper is to identify factors associated with initiation to inhalant use among adolescents aged 9 to 18. The data are from the National Survey of Parents and Youth, a longitudinal household survey. Baseline surveys for adolescents and parents were conducted between November 1999 and June 2001 and then annually for three subsequent rounds. The outcome measure is an indicator of a respondent's first use of inhalants. Discrete-time survival analysis was used to model the hazard of initiation. The hazard of inhalant initiation peaks at about 14 years of age (slightly younger than smoking and marijuana initiation). African Americans were less likely than Whites to initiate inhalant use, and higher family income was protective against inhalant initiation. The findings suggest that parenting is associated with initiation of inhalant use: parental drug use was a risk factor for inhalant initiation, and a measure of parental monitoring was protective. The study results also suggest a strong relationship between inhalant use and other problem behaviors and sensation seeking. These results highlight the need to intervene early for youth at risk of or just beginning to engage in risky behaviors including inhalant use.

Inhalant use and inhalant use disorders in the United States

More than 22 million Americans age 12 and older have used inhalants, and every year more than 750,000 use inhalants for the first time. Despite the substantial prevalence and serious toxicities of inhalant use, it has been termed "the forgotten epidemic." Inhalant abuse remains the least-studied form of substance abuse, although research on its epidemiology, neurobiology, treatment, and prevention has accelerated in recent years. This review examines current findings in these areas, identifies gaps in the research and clinical literatures pertaining to inhalant use, and discusses future directions for inhalant-related research and practice efforts.

Item response theory analysis of DSM-IV criteria for inhalant-use disorders in adolescents

OBJECTIVE

Inhalants are a serious public health concern and a dangerous form of substance use. An important unresolved issue in the inhalant literature concerns the validity of inhalant-use diagnoses and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, distinction between inhalant abuse and inhalant dependence. To address these limitations and provide the foundation for helping build stronger diagnostic and assessment tools related to inhalant problems, this study examined the dimensionality of the criteria set and the abuse-dependence distinction using item response theory (IRT) analysis.

METHOD

This study used data from a survey of the population of Missouri Division of Youth Services' residents of the residential treatment system. The current study focused on adolescents and young adults who reported a lifetime history of inhalant use (N = 279).

RESULTS

The results from the IRT analysis showed no consistent hierarchical ordering of abuse and dependence criteria, providing strong evidence against the abuse-dependence distinction. The abuse criterion of legal problems associated with use represented the item with the highest level of inhalant severity. The dependence criterion that was related to giving up important social, occupational, or recreational activities provided the most accurate discrimination between individuals at different levels of severity.

CONCLUSIONS

Inhalant-use disorders are best represented using a dimensional versus a categorical approach. IRT analysis provides guidance for selecting criteria that can be useful for brief assessments of inhalant-use problems.

Volatile substance misuse among youth in Israel: results of a national school survey

Volatile substance misuse (VSM) among Israeli youth has been identified as widespread and growing. Using data from the 2009 National School Survey of 12-18 year olds (N = 7,166), this study describes VSM prevalence among Jews and Arabs, examining relationships between past-month VSM and sociodemographic, behavioral, psychological, and interpersonal characteristics. Past-month VSM, reported by 7.5% of respondents, was significantly associated with other risky behaviors including past-month illicit drug use (Adjusted odds ratios (AOR) = 5.41, 95% CI: 3.5-8.1), Internet gambling (AOR = 2.12, 95% CI: 1.5-3.1), smoking, binge drinking, and truancy. National drug policy must address VSM and develop strategies to reduce demand and supply. Potential study limitations are noted.

Inhalant abuse: A cause for concern

Inhalant abuse is of growing concern in adolescent and young adult population in the underdeveloped regions of the world. In the absence of availability of definitive tests in routine clinical settings, diagnosis is often difficult. Equally difficult is management and ensuring adherence to therapy. We report two successive cases of inhalant abuse seen at the outpatient department of the Department of Psychiatry, Mental Health Institute, SCB Medical College, Cuttack, Orissa, India. We report here two cases of inhalant abuse: one with an unusual mode of abuse and another with atypical clinical presentation.

Volatile substance misuse in the United States

Volatile substance misuse (VSM) is prevalent in the United States and associated with manifold deleterious outcomes. This review summarizes research on: (1) the prevalence of VSM in the United States and its trends since 1975, (2) population subgroups at an elevated risk for VSM, (3) key correlates of VSM, (4) psychosocial consequences of VSM, including emerging public health threats, and (5) etiological and contextual considerations of VSM use. Implications for future research and practice with volatile substance misusers in the United States are identified.

Increased risk for hepatitis C associated with solvent use among Canadian Aboriginal injection drug users

Background

Solvent abuse is a particularly serious issue affecting Aboriginal people. Here we examine the association between solvent use and socio-demographic variables, drug-related risk factors, and pathogen prevalence in Aboriginal injection drug users (IDU) in Manitoba, Canada.

Methods

Data originated from a cross-sectional survey of IDU from December 2003 to September 2004. Associations between solvent use and variables of interest were assessed by multiple logistic regression.

Results

A total of 266 Aboriginal IDU were included in the analysis of which 44 self-reported recent solvent use. Hepatitis C infection was 81% in solvent-users, compared to 55% in those reporting no solvent use. In multivariable models, solvent-users were younger and more likely to be infected with hepatitis C (AOR: 3.5; 95%CI: 1.3,14.7), to have shared needles in the last six months (AOR: 2.6; 95%CI:1.0,6.8), and to have injected talwin & Ritalin (AOR: 10.0; 95%CI: 3.8,26.3).

Interpretation

High hepatitis C prevalence, even after controlling for risky injection practices, suggests that solvent users may form closed networks of higher risk even amongst an already high-risk IDU population. Understanding the social-epidemiological context of initiation and maintenance of solvent use is necessary to address the inherent inequalities encountered by this subpopulation of substance users, and may inform prevention strategies for other marginalized populations.

Nitrous oxide inhalation among adolescents: prevalence, correlates, and co-occurrence with volatile solvent inhalation

Few studies have examined the prevalence of nitrous oxide (NO) inhalation or co-occurrence of NO and volatile solvent (VS) use in adolescents. Study aims were to (1) describe the independent and conjoint prevalence of NO and VS use in incarcerated youth, (2) compare adolescent users of both NO and VS inhalants (NO+VS) to users of NO-only, VS-only, and nonusers of NO and VS (NO/VNS nonusers) with regard to demographic, psychological, and behavioral characteristics, and (3) conduct logistic regression analyses identifying correlates of NO use. Residents (N = 723) of Missouri Division of Youth Services were assessed with standardized psychosocial measures. Participants averaged 15.5 (SD = 1.2) years of age, were ethnically diverse and predominantly male. Lifetime prevalence of NO use was 15.8%. NO+VS users evidenced greater impairments compared to NO+VS nonusers. VS-only users evidenced impairments that were similar in kind but at lower prevalences compared to those displayed by NO+VS users, whereas NO-only youth had profiles that were similar to those of NO/VS nonusers. Psychiatric disorders, polydrug use, and temperamental fearlessness were correlates of NO use. NO+VS users were at high risk for behavioral and emotional problems. Screening and interventions for NO and VS inhalant use should be implemented in juvenile justice facilities.

Inhalant abuse: a case of hemoptysis associated with halogenated hydrocarbons abuse

An 18-year-old man presented to a community emergency department with increasing shortness of breath and fever. His condition was diagnosed, and he was treated as an inpatient for bilateral pneumonia associated with hypoxemia. When his condition became worse, he acknowledged to deliberate inhalation of keyboard cleaner and to having hemoptysis. Before his death on hospital day 11, known causes of alveolar hemorrhage were excluded. We postulated a cause-and-effect relationship, adding alveolar hemorrhage to the known complications of inhalant abuse.

The high prevalence of substance use disorders among recent MDMA users compared with other drug users: Implications for intervention

AIM

In light of the resurgence in MDMA use and its association with polysubstance use, we investigated the 12-month prevalence of substance use disorders (SUDs) among adult MDMA users to determine whether they are at risk of other drug-related problems that would call for targeted interventions.

METHODS

Data were drawn from the 2006 National Survey on Drug Use and Health. Past-year adult drug users were grouped into three mutually exclusive categories: 1) recent MDMA users, who had used the drug within the past year; 2) former MDMA users, who had a history of using this drug but had not done so within the past year; and 3) other drug users, who had never used MDMA. Logistic regression procedures were used to estimate the association between respondents' SUDs and MDMA use while adjusting for their socioeconomic status, mental health, age of first use, and history of polydrug use.

RESULTS

Approximately 14% of adults reported drug use in the past year, and 24% of those past-year drug users reported a history of MDMA use. Recent MDMA users exhibited the highest prevalence of disorders related to alcohol (41%), marijuana (30%), cocaine (10%), pain reliever/opioid (8%), and tranquilizer (3%) use. Adjusted logistic regression analyses revealed that, relative to other drug users, those who had recently used MDMA were twice as likely to meet criteria for marijuana and pain reliever/opioid use disorders. They were also about twice as likely as former MDMA users to meet criteria for marijuana, cocaine, and tranquilizer use disorders.

CONCLUSIONS

Seven out of ten recent MDMA users report experiencing an SUD in the past year. Adults who have recently used MDMA should be screened for possible SUDs to ensure early detection and treatment.

Inhalant withdrawal as a clinically significant feature of inhalant dependence disorder

Inhalant use is the intentional inhalation of vapors from commercial products or specific chemical agents for the purpose of achieving intoxication. Inhalants are among the most common and pernicious forms of substance use and the least studied of the major drugs. Diagnosis of inhalant dependence, according to the DSM-IV [Weintraub E, Gandhi D, Robinson C. Medical complications due to mothball abuse. South Med J 2000;93:427-9] excludes inhalant withdrawal symptoms, as expert opinion has suggested that an inhalant withdrawal syndrome is neither common nor clinically significant. This article draws from multiple sources of data to suggest that withdrawal symptoms can be part of inhalant dependence and are clinically significant. This hypothesis needs rigorous evaluation to ensure the diagnostic validity of inhalant use disorders.

A survey of inhalant use disorders among delinquent youth: prevalence, clinical features, and latent structure of DSM-IV diagnostic criteria

BACKGROUND

Inhalant use is among the most pernicious and poorly understood forms of adolescent substance use. Many youth in the juvenile justice system have used inhalants, but little is known about inhalant use disorders (IUDs) in antisocial youth populations. The purpose of this study was to examine the prevalence, clinical features, and latent structure of DSM-IV IUDs in a state population of antisocial youth.

METHODS

Cross-sectional survey conducted in 2003. Of 740 youth residing in Missouri State Division of Youth Services' (MDYS) residential treatment facilities at the time the study was conducted, 723 (97.7%) completed interviews. Eighty-seven percent were male, with a mean age of 15.5 (SD = 1.2). Nearly 4 in 10 youth (38.5%; n = 279) reported lifetime inhalant use. Youth ranged from very mildly to severely antisocial.

RESULTS

Of 279 inhalant users, 52 (18.6%) met DSM-IV inhalant abuse criteria and 79 (28.3%) met inhalant dependence criteria. Five of 10 IUD criteria were met by > 10% of the total sample. Latent class analyses demonstrated a substantial concordance between DSM-IV-defined IUDs and an empirically-derived classification based on responses to DSM-IV IUD diagnostic criteria.

CONCLUSION

IUDs and constituent criteria were prevalent among youth in the juvenile justice system. Two groups of problem inhalant users were identified, symptomatic users-DSM-IV inhalant abuse and highly symptomatic users-DSM-IV inhalant dependence, which differed primarily in severity of inhalant-related problems. Inhalant screening, prevention and treatment efforts in juvenile justice settings are rarely delivered, but critically needed.