Introduction to Inhalants

An inhalant is any gas that is administered by inhalation for the purpose of achieving euphoria. Psychoactive inhalants possess both euphoric (also called "narcotic effect") and anesthetic properties. The degree and duration of euphoria depends on each substance.

The potency is determined by solubility in lipid, which is termed gas lipid partition coefficient. Higher it is, more potent it is. The duration to kick-in and come-down is determined by solubility in blood. The lower the blood solubility, faster the kick-in and recovery. The data is not necessarily available for every chemical.

Although no inhalant is perfectly safe, some are more dangerous than others.

Ways of administration

It is inhaled directly in gaseous form or if it is a liquid, the vaporized component is inhaled. There is little control over vapor concentration in recreational use, however in anesthetic use, the liquid is evaporated using heated vaporizer and its concentration is tightly controlled with an equipment.

Effects of Inhalants

Inhalants possess anesthetic, analgesic and narcotic properties.

Nitrous oxide has negligible toxicity, fast on-set, but low-potency owing to low low solubility in blood as well as lipid. Its already in gaseous state at room temperature, therefore it is possible to reach almost 100% concentration.

Trichloroethylene vapor is highly soluble in both fat and blood. The potency is high but it is slow to kick in. The potency is about 600 times more potent than nitrous oxide(requires 0.17% concentration to produce the same effect as pure nitrous), however because of its relatively low volatility, achieving a high vapor concentration is difficult.

Dangers

They all possess asphyxiation hazard. Gases and extremely volatile liquids are on the high end of this as they're capable of producing gas in high enough concentration to displace oxygen. Liquids with lower volatility is self-limiting through the rate it can become vaporized.

Some inhalants possess toxicity to liver or kidneys and there are a few that should be absolutely avoided. Carbon disulfide and carbon tetrachloride are two such examples. These are however, not commonly found outside of industrial processes.

Fire, burns and explosion

Flammable inhalants carry the additional risk of secondary injury from accidental ignition of vapor. Such examples are butane, propane, gasoline and ether.

Cardiac sensitization

Halocarbons have the ability to interfere with heart rate. According to industry hygiene studies addressing accidental exposure, it is dependent on concentration more than duration of exposure based on animal testing and fuel volunteer testing. It would appear that taking in a lung full of gas and holding it in is much more dangerous than taking repeated doses at lower concentration, albeit at the cost of increased time to reach euphoria.

Forms of inhalants

There are a few forms.

Inorganic

There are several inorganic gases that possess psychoactive, anesthetic properties:

• Nitrous oxide
• Xenon

While the latter has seen applications in anesthesiology, due to its extremely high cost it is rarely used for this purpose in modern times.

Surprisingly, even pure nitrogen produces anesthetic euphoria in hyperbaric conditions. (That is, at a much higher pressure than the ordinary atmosphere.) However, these conditions can only be produced in compression chambers or under a significant depth of water. The increased solubility of nitrogen at elevated pressure causes intoxication which is widely known among divers as "nitrogen narcosis".

Organic nitrites

These include amyl nitrite, butyl nitrite and other volatile nitrile compounds. It is the nitrite portion of the chmical that creates a sense of "rush" and muscle relaxation and they behave different from other inhalants.

organic vapors

These represent the majority of abused inhalants except nitrous oxide.
These include fuels, solvents, refrigerants (Freons) and dusters.

It is absorbed into the body through diffusing into lipid membrane in the lungs. Many inhalants have an anesthetic effect as well as euphoric effect and the potency is measured in a unit called Minimum alveolar concentration or MAC, which defines the concentration needed to stop response to pain stimulus in 50% of subject.

Though widely used medically, the mechanism of action for gaseous anesthetic agents is unknown^1

Higher MAC represents lower potency. Nitrous oxide has one of the highest MAC at 103%, meaning that even in purest form, it is not able to produce full anesthesia. To avoid asphyxiation, the inhalant gas must contain enough oxygen to support life.

On the other other end of extreme, another inhalant called isoflurane can produce anesthesia with a concentration as low as 1.2%^2

To be used, the agent must be delivered in vapor form. Chemicals that are liquid at room temperature must have sufficiently high vapor pressure and must be vaporized. Many oil based solvents fall in the liquid category.

Here is a comprehensive, but not complete list of inhalants. Many products use one of these chemicals.

Liquid:
CFC-11, CFC-113, HCFC-141b
cyclohexane
Methyl ethyl ketone
diethyl ether
heptane
hexanes (toxic)
Toluene (somewhat toxic)
carbon tetrachloride (highly toxic)
carbon disulfide (highly toxic)
trichloethylene
chloroform

gases:
propane
butane
cyclopropane
difluroethane R-152a (Gas duster)
tetrafluoroethane R-134a (gas duster and refrigerant)
dichlorodifluoromethane R-12 (refrigerant)
R-22 (refrigerant)

1
British Journal of Anaesthesia, 1997
http://bja.oxfordjournals.org/cgi/reprint/78/3/290.pdf

2.
http://www.adsahome.org/PDFs/Nitrous.pdf

They're normally organic vapors from solvents and fuels.

Potency varies between different chemicals and their volatility. Substances with very high vapor pressure or gas at room temperature achieves higher concentration much easier.

Once it is vaporized, its solubility affects the potency. Attached file shows that CFC-11, a highly volatile liquid refrigerant produces anesthetic effect in 10 minutes with as little as 3.5% concentration while HCFC-22(used in home A/Cs) requires about 14%. Automotive and refrigerator refrigerants HFC-134a is even less potent requiring 20.5% concentration to reach anesthetic effect in 4 hours.

The concentration is measured in percentage of gas relative to total inhaled volume (the remainder, usually being air)

Butane is the most commonly misused volatile substance in the UK. It is an organic compound found in natural gas and produced from petroleum. Highly flammable, it is a colourless, odourless, easily liquefied gas.

Butane gas is sold bottled as a fuel for cooking and camping. When blended with propane and other hydrocarbons, it is referred to commercially as LPG. It is also used as a petrol component, as fuel for cigarette lighters and as a propellant in aerosol sprays such as deodorants.

Propellant gasesused as inhalants include Freon and compressed hydro fluorocarbons, which are used in various household and office products that come in aerosol spray cans, such as air freshener, computer keyboard cleaner spray (gas dusters, sometimes erroneously called "canned air"), non-stick cooking spray, aerosol insecticides, and aerosol hairspray.

The most common propellants are mixtures of volatile hydrocarbons, typically propane, n-butane and isobutane. All these have the disadvantage of being highly flammable.

Death from inhalants is generally caused by a very high concentration of fumes. Further concern is the additional toxicity resulting from either the physical properties of the compound itself, or additional ingredients present in a product.

How do solvents and volatile substances work?

When the fumes/chemicals from products are breathed in on purpose, they are absorbed through the lungs into the bloodstream. The chemicals in solvents are fat soluble and so pass rapidly to the brain and other body organs, making the effects kick in very quickly.

The effects from sniffing can vary from person to person. This depends upon their size, age, health, product sniffed, whether the person is used to sniffing and the environment they are sniffing in - for example, whether the person is on their own, with others, at a party, etc. The effect on the ‘sniffers’ emotions can also depend on the mood of the individual before sniffing. For example, if the ‘sniffer’ is happy beforehand then the ‘high’ will be greater.

Due to the rapid entry of the fumes/chemical into the bloodstream through the lungs, the effect will kick in within 20-30 seconds and last for the next 30-40 minutes.

However, the ‘high’ usually last only a few minutes. The duration of the experience depends on the product sniffed, for example, glue has a longer duration than butane.

The person sniffing solvents will often experience an initial feeling of euphoria, well-being and relaxation, as well as possible confusion and unsteadiness. The symptoms and effects from sniffing solvents are very similar to alcohol intoxication, although the speed of onset is much more rapid and can include the following:

• Drowsiness: the initial excitement is often followed by drowsiness
• Sickness
• Dizziness
• Slurred speech
• Loss of co-ordination
• Buzz - buzzing in the ears
• Light-headed - floaty feeling
• Chronic headaches
• Numbness and tingling in hands and feet
• Breathing difficulties
• Hallucinations
• Visual distortions - flashes of lights before the eyes
• Violent/aggressive behaviour
• Mood swings
• Loss of inhibitions
• Paranoia and anxiety
• Blackouts

(Some of the above effects are as described by current and ‘ex-sniffers’ during consultations.)

Using Inhalants

Ways of administration

Combinations with Inhalants

Different Uses for Inhalants

The dangers of Inhalants

Forms of Inhalants

Legal status of Inhalants

United Nations

USA

EU

History of Inhalants

A brief history of VSA

The practice of solvent abuse is by no means a modern phenomenon. The deliberate inhalation of substances, which can produce an intoxicated state, dates back at least as far as the ancient Greek and other civilisations, where it was an adjunct to religious practice. Vapour inhalation has a long history, dating back to the rituals at the Oracle of Delphi, where priestesses induced trance by inhaling the vapours from crevices in rocks. There is a distinct thread of mysticism, prophecy, and worship, using vapour inhalation in all cultures, and incense and other aromatic materials are still used as part of worship in a number of religions.

Volatile Substance Abuse as we know it involves the inhalation of vapours from a number of substances, which then enter the body via the large surface of the lungs, providing easy access to the body and the rapid onset of effects. Today the range of abusable products is extremely broad and incorporates most products containing solvents such as toluene, hexanes, heptanes, ethyl acetate, isopropyl acetate, acetone, methyl ethyl ketone, methylene chloride and trichloroethane. As a group these chemicals act as cerebral depressants and may carry other potential health risks. Commonly abused products include cleaning fluids, lighter fuels, nail polish remover, paint thinners and aerosol products. Butane gas lighter refills were the cause of the highest number of VSA deaths in the UK between 1971 and 2006, totalling 900 deaths. The problem of solvent abuse is now widespread and varied, not only in Britain and the USA, but also in Africa, Australia, Canada, Fiji, Finland, Japan, Central and South America and throughout Europe.

Historical background

Nitrous oxide, sometimes known as ‘laughing gas’ was commonly used for its intoxicating effects during the nineteenth century and was particularly popular amongst prominent figures such as Coleridge, Roget and Wedgwood. Its effects were described as good, delightful, intoxicating and relaxing, and it was considered the genteel way of getting drunk. There were public exhibitions in Britain and the USA, with the intention of illustrating the medical value of the gas as an anaesthetic. One example was of a man who sustained cuts and bruises while under the influence of nitrous oxide but felt no pain. Today nitrous oxide is used as a propellant, for example in whipped cream dispensers, and most cases of abuse today involve those who have access to commercial gadgets which produce whipped cream, or those associated with dentistry.

During periods of deprivation in Europe, Britain, and the USA in the nineteenth century, and in Germany during the Second World War, ether was commonly drunk as a substitute for alcohol. It was seen as a cheap and permissible form of alcohol during the temperance crusades throughout the British Isles in 1840, but was also used in midwifery around the same time. Hans Christian Andersen noted the effects of ether in his diary, commenting on the lifeless eyes of the ladies who used it.
In the nineteenth century, ether and chloroform were commonly in use as anaesthetics and became popular for recreational use along with nitrous oxide which was already popular at ‘sniffing parties’. English and American medical students commonly used ether for intoxication or 'ether frolics'.

Both chloroform and ether are volatile liquids, which give off a concentrated vapour. Experimentation with these and nitrous oxide goes back a long time and has not disappeared. There are isolated reports of chloroform inhalation, and instances of nitrous oxide sniffing have appeared in medical literature, most prevalently amongst those with easy access to the substances, such as laboratory and hospital staff.

The first cases of deliberate misuse of volatile chemicals occurred among young people in America in the 1950s, who inhaled the fumes from gasoline. There were reports of sporadic petrol sniffing in Australia, India and Great Britain from the 1950s. The clinical presentations of gasoline sniffing are similar to those of LSD, resulting in odd behaviour, hallucinations and unusual and unexpected temper tantrums.

The first reports of glue sniffing arose in the mid twentieth century, with arrests in Tuscan, Arizona and Pueblo, Colorado. There was a wave of publicity following an article on glue sniffing in a Denver newspaper, with warnings in the papers and on television. Ten months later, Denver had an enormous glue-sniffing problem. By 1965 glue sniffing occurred in every state of the USA. In the UK, VSA was still at a comfortable distance until reports of glue sniffing a few years later, and by the 1970s, the problem was becoming more prevalent.

volatile solvent abuse+inhalants

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References

www.epa.gov/opptintr/aegl/pubs/tsd9.pdf

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