Inhalants 

Updated: May 05, 2017
Author: Nicholas J Connors, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS 

Overview

Background

Inhalants are volatile substances producing vapors that can be inhaled and absorbed by pulmonary mucosa to produce a mind-altering "buzz" or high. Inhalants are dangerous and their use represents an abuse problem in the United States and abroad. At greatest risk of harm from these drugs are adolescents in their early teenage years due to the unregulated sale of products containing inhalant chemicals and their ease of use. Most inhalants are central nervous system (CNS) depressants, but they also cause adverse medical effects on almost every organ system. Both short- and long-term toxic effects occur. Short-term effects include diplopia, memory impairment, slurred speech, seizure, or death from cardiac arrhythmias. Long-term chronic effects include permanent ataxias or peripheral neuropathies, blindness, cognitive impairment, dementia, and renal toxicity.

Recreational use of inhalants in the United States increased in the 1950s and is now widespread amongst adolescents. More than 3000 abusable products containing volatile chemicals are legal and readily obtained; these include solvents, adhesives, fuels, dry-cleaning agents, cigarette lighters, permanent markers, correction fluid, and aerosols with propellants used in whipped cream, deodorants, paints, electronic cleaning sprays, and cooking sprays. These products are readily available, easy to purchase, legal to possess, easy to conceal, and found in many households or garages. The CNS effects are rapid in onset and brief, lessening the chances of being detected by authorities or guardians. Few states have laws prohibiting inhalant abuse and criminal prosecution is rare.

The most commonly abused inhalants are aromatic hydrocarbons, aliphatic hydrocarbons, alkyl halides, and nitrites.

  • Aromatic hydrocarbons, such as toluene and xylene, are the most commonly used inhalants of abuse likely because they cause an intense euphoric rush when inhaled. They are found in markers, adhesive cements, model glues, paint thinners, and spray paints, with the highest concentration found in gold and silver spray paint.

  • Aliphatic hydrocarbons are volatile fuels such as propane, butane (cigarette lighter fluid), and gasoline.

  • Alkyl halides, 1,1,1-trichloroethane or trichloroethylene, are found in cleaning fluids, typewriter correction fluid, and compressed air for cleaning electronics.

  • Nitrites, such as amyl nitrites, are found in room air fresheners, video head cleaner, and leather cleaner. These agents, commonly known as "poppers" or "snappers" are used to enhance sexual activity.

Terminology

Sniffing - Inhaling vapors from an open container

Huffing - Soaking a rag or sock with substance and placing it over the mouth and nose

Bagging - Spraying or pouring the substance into a paper or plastic bag and inhaling the vapors by placing the bag over the face or over the head

Dusting - Inhaling vapors directly from electronic equipment cleaning aerosols

Street names in inhalant abuse include air blast, aroma of men, bolt, bopper, bullet, discorama, dusting, glading, gluey, hardware, head cleaner, hippie crack, laughing gas, locker room, pearls, popper, quicksilver, rush, shoot the breeze, snapper, Texas shoe shine, thrust, tolly, and whiteout.

Pathophysiology

Inhalants are highly lipid soluble; they easily cross both alveolar membranes in the lungs and the blood-brain barrier to reach high concentrations in the brain. Inhalation avoids first-pass hepatic metabolism so the onset is fast. Symptom onset is noted within seconds, and peak plasma concentration occurs 15–30 minutes after inhalation. The inhaled concentration depends on the mode of administration. Sniffing offers the lowest concentration, followed by huffing, and bagging offers the highest concentration. With a few exceptions, elimination occurs primarily through the lungs, with many inhaled compounds eliminated unchanged by exhalation. Some of the inhalants, including alkyl nitrites, aromatics, and methylene chloride, undergo significant hepatic metabolism that can produce damaging free nitrites and toxic carbon monoxide as byproducts.

The mechanism of inhalant's effects is not fully understood. Pharmacologic properties of all inhalants vary, contributing to different gas potentials, solubility in the blood, and elimination, which leads to slight differences in their actions, intoxicating effects, and abuse potential. Some authors propose the action of some is similar to the action of ethanol. They suggest the action is to stimulate the gamma-aminobutyric acid (GABA) and the glycine a1 receptors, as well as inhibit the N -methyl-D -aspartate (NMDA) receptor, leading to inhibition in the CNS. Riegel et al proposed that toluene activates dopamine release in key brain regions.[1] Other proposed mechanisms include induced changes in neuronal cell membranes. Nitrites, used primarily as sexual enhancers due to their smooth muscle relaxation properties, also dilate blood vessels. More research is needed to better define the mechanisms of action of all inhalants.

Epidemiology

Frequency

United States

Inhalant abuse is common among adolescents. According to the 2014 National Survey on Drug Use and Health (NSDUH), 546,000 people aged 12 years or older were current users of inhalants. Use was most common in those ages 12 to 17 years. An estimated 149,000 adolescents were active inhalant users, while 316,000 were users aged 25 years or older, though the percentage of this group that absued inhalants was much lower than the adolescents.[39] Additionally, there were more than 10,000 ED visits related to inhalant abuse in the United States in 2011.[40] The most recent report by Monitoring the Future Study (MTF), a survey funded by the National Institute of Drug Abuse (NIDA) that monitors drug abuse in adolescents from grades 8 through 12, reports 5.7% of 12th graders had ever used inhalants and that current inhalant abuse remains highest among 8th graders. Inhalant abuse has decreased over the last two decades. Prevalence of 30-day use was 6.1%, 4.2% and 2.0% in 1995, 2005, and 2015, respectively.[36]

Inhalant abuse is less common (though not rare) in adults. Those especially at risk are doctors, nurses, factory workers, dentists, shoemakers, hair stylists, painters, and dry-cleaning workers; all with ready access to chemicals or anesthetics. Besides the chemical high offered by these drugs, some adults seek an additional aphrodisiac effect reported to occur with some of these chemicals. Nitrite inhalant use, for example, is prevalent amongst homosexual males. In one survey, 69% of homosexual males sampled had experience with nitrite inhalants.

These drugs have no social or geographic boundaries, but children abusing inhalants tend to be of lower socioeconomic class, poor performers in school with high rates of absenteeism, and from difficult home situations.

International

Across the globe, inhalant abuse is rampant among children in both industrial nations and developing countries. Countries with particularly high abuse rates include Great Britain, Singapore, and Brazil.

Mortality/Morbidity

Inhalant abuse is associated with significant morbidity and mortality. The debilitating and potentially lethal effects of inhalants can occur even with the first use. Although inhalant deaths are likely underreported in the United States, the 2005 report of the National Inhalant Prevention Coalition (NIPC) reports 100–125 deaths annually as a result of inhalant abuse.[2] Another study by Alper et al found that toluene was associated with an increased QT interval in abusers with a history of unexplained syncope.[3] Additional medical conditions associated with inhalant abuse include acute, severe acute cardiomyopathy and renal failure (toluene),[4]  severe angioedema (dusters),[6] and acute or chronic myocardial ischemia (butane).[7]

Asphyxiation can result from the displacement of oxygen in the lungs by prolonged or repeated inhalations. Suffocation can occur if a plastic bag is placed over the head when inhaling the fumes and the user becomes unconscious. Death can also occur because of complications of the intoxication such as choking on aspirated gastric contents, fire-related injuries from inhalant combustion, or fatal injuries suffered as a result of high-risk behaviors.

A common cause of mortality in inhalant abusers is sudden sniffing death syndrome (SSDS). Although the exact mechanism is unknown, the inhalant is believed to sensitize the myocardium to circulating catecholamines. This causes an exaggerated response to epinephrine released during a sudden alarm or increased physical activity that leads to a fatal arrhythmia. Death usually occurs while the user is running, attempting to flee, experiencing a particularly frightful hallucination, or during sexual activity. The co-ingestion of a sympathomimetic agent, such as cocaine or even therapeutic methylphenidate (Ritalin), may increase the risk of the fatal arrhythmia. Sudden sniffing death is particularly associated with the abuse of toluene, butyl nitrate, butane, propane, and chemicals in aerosols.

Race

Inhalant abuse rates are higher in Whites, although use is also high among Hispanic and Native American children.

Sex

In the past, abuse was more prevalent in males, but over the past two decades, abuse has increased in females and the prevalence is now nearly equal in the youth population. Inhalant abuse still tends to be higher in adult males.

Age

The typical abusers of inhalants are aged 10–15 years, although use in children as young as 7 and 8 years has been reported. The average age of initial use of these chemicals was around 10 years in one study, which preceded the average initiation into cigarettes by 1.5 years and narcotics by almost 4 years. Experimentation typically occurs in late childhood and is short lived. Chronic abuse is usually seen in older adolescents, although it has also been reported as late as the fifth and sixth decades of life.

Inhalant use leads to an earlier initiation of other drug use, including cigarettes and alcohol, and is associated with a higher lifetime prevalence of substance use disorders.

 

Presentation

History

Many children abuse inhalants regularly; however, only those who develop complications are likely to present to the emergency department (ED) or primary care physician. The clinician, especially the primary care physician, must therefore maintain a high index of suspicion for inhalant abuse in any patient presenting with unexplained and often vague complaints.

In the ED setting, the acutely intoxicated patient most frequently arrives by ambulance, with the police, or with friends and family. In obtaining the history, ask prehospital personnel about empty chemical or spray containers found at the scene. Ask about rags, cloths, or strange smells about the patient. Also inquire about the possibility of co-ingestion, suggested by pill bottles found at the scene.

As inhalant abuse is typically a group activity, elicit a history from friends or family who were present. Discuss with parents changes in behavior or school performance, new groups of friends, or new types of social activities that might suggest use of these drugs. Strongly suspect inhalant abuse in the setting of sudden collapse during adolescent group activities. Occult trauma is common in these patients, as lost inhibition leads to dangerous activities during intoxication.

The clinical history can be broken down into acute intoxication, chronic inhalation use, and withdrawal syndrome.

  • Acute intoxication - most symptoms resolve within 2 hours

    • In acute intoxication, neurologic, cardiac, and pulmonary symptoms predominate.

    • Acute neurologic symptoms resemble alcohol intoxication and include euphoria, slurred speech, ataxia, dizziness, diplopia, confusion, and CNS depression. Potential acute effects include headache, vertigo, auditory and visual hallucinations, seizures, stupor, and coma

    • Acute cardiac effects include heart palpitations, tachycardia, and arrhythmia.

    • Pulmonary symptoms are due to direct lung damage producing pneumonitis. In the history, inquire about dyspnea, wheezing, and coughing. Cyanosis of the extremities can develop secondary to methemoglobinemia associated with alkyl nitrite abuse and can produce skin discoloration and cyanosis.

  • Chronic abuse

    • In chronic inhalant abuse, irreversible CNS complications can occur, including cerebral cortex atrophy, cerebellar degeneration, peripheral neuropathy, and neuropsychosis, leading to cognitive function decline, dementia, gait disturbances, and loss of coordination. Neurologic signs and symptoms to elicit include peripheral neuropathies (typically stocking-glove distribution), seizures, paresthesias, ataxia, weakness, confusion, memory loss, and delusions.

    • Long-term exposure can also lead to cranial nerve damage, causing optic neuropathy and blindness, tinnitus, and sensorineural hearing loss.

    • Chronic renal injury from inhalant use includes type I renal tubular acidosis, urinary calculi, and glomerulonephritis and typically produces flank pain, clouding of the urine, and decreased urine production with azotemia.

    • Toxic hepatitis and liver failure has also been seen in chronic users of chlorinated hydrocarbons caused by damage from toxic metabolites. The history may reveal symptoms of right upper quadrant abdominal pain, nausea, vomiting, low-grade fever, fatigue, or jaundice.

    • Rhabdomyolysis and severe muscle weakness, similar to Guillain-Barré syndrome, has also been reported.

  • Withdrawal symptoms

    • These symptoms include tremors, irritability, anxiety, insomnia, delirium, tingling sensations, seizures, and muscle cramps. If tolerance has developed, complaints of chills, headache, muscle cramps, and vague abdominal pain should be elicited.

    • These patients present with sleep disturbance, tremor, nausea, irritability, and abdominal pain. Withdrawal symptoms are worse during the period 2-5 days after inhalant cessation. Patients may present with symptoms similar to delirium tremens.

    • Given the proposed mechanism of action of toluene, a commonly abused inhalant, is on the GABA receptors in the brain, it is also possible that chronic users may develop a withdrawal syndrome upon cessation of use.[8] This has been reported in case reports with improvement upon treatment in a similar manner as alcohol withdrawal and is something to consider in an admitted patient with symptoms concerning for withdrawal.

If the inhalant abuse patient is pregnant, special considerations need to be taken. Although well-controlled prospective data have not been collected, current information suggests adverse effects of maternal inhalant abuse on the fetus. Because of high lipophilicity, these solvents readily cross the placenta and cause fetal anomalies, including microcephaly, narrow bifrontal diameter, hypoplastic midface, and blunt fingertips. This syndrome closely resembles the physical findings of fetal alcohol syndrome. Increased rates of spontaneous abortion and fetal malformations have been reported, as have growth retardation and deficits in both speech and cognitive skills.

Physical

Skin

Cutaneous manifestations of inhalant use may include the following:

  • Paint or stains on the face, hands, or clothing
This young man was huffing green spray paint. Note This young man was huffing green spray paint. Note the presence of the paint on his hands and face.
This picture shows a close-up of the face of a you This picture shows a close-up of the face of a young man who had been huffing green spray paint.

See the list below:

  • "Huffer rash" - Erythematous "frost bite" eruption on the face and oral mucosa caused by severe drying and cracking of the skin and resultant bacterial infection

  • Thermal or chemical burns on the face or hands

  • Conjunctival injection

  • Jaundice (with chronic hepatic injury)

  • Cyanosis (with methemoglobinemia)

Respiratory

Respiratory symptoms of inhalant use may include the following:

  • Chemical odor in the breath

  • Wheezing, rhonchi, or rales

  • Oral or airway burns

  • Rhinitis

  • Respiratory distress with aspiration of gastric contents

Neurologic/psychiatric

Some neurologic/psychiatric manifestations of inhalant use may include the following:

  • Slurred speech

  • Diplopia

  • Blurred vision

  • Nystagmus

  • Euphoria

  • Psychomotor retardation

  • Disorientation

  • Sense of invulnerability

  • Distortion of space and time

  • Auditory or visual hallucinations with paranoid ideations

  • Photophobia

  • Weakness

  • Impaired memory

  • Peripheral neuropathy (typically stocking-glove distribution)

  • Seizures

  • Agitated coma (unconsciousness with tremors, restlessness, and hyperreflexia)

Cardiac

Heart symptoms of inhalant use may include the following:

  • Arrhythmias, including premature ventricular contractions (PVCs) or supraventricular tachycardia (SVT)

  • Tachycardia or bradycardia

  • Hypotension

Gastrointestinal tract

Gastrointestinal symptoms of inhalant use may include the following:

  • Nausea and vomiting

  • Diarrhea

  • Abdominal pain (suspect hepatic injury if the pain is in the right upper quadrant, especially in a chronic abuser)

  • Flank pain (suspect renal injury in chronic abusers)

Causes

The cause of inhalational injury is the use of inhalation agents. As described earlier, this use is affected by many factors such as age and socioeconomic status (see Frequency and Mortality/Morbidity).

 

DDx

 

Workup

Laboratory Studies

As with every patient, the laboratory workup depends upon the severity of the illness. For anything more severe than mild intoxication, the following tests are generally recommended:

  • Pulse oximetry: Pulse oximetry assesses the degree of oxygenation and general state of pulmonary effort and function.

  • Serum chemistry: Analyses should include a standard renal panel including sodium, potassium, chloride, bicarbonate, BUN, and creatinine. Some of the inhalants, toluene in particular, cause a syndrome of distal renal tubular acidosis, with a resultant elevated anion gap, hyperchloremia, hypokalemia, and hypophosphatemia. Azotemia is also common with chronic exposure but resolves with abstinence. Hypoglycemia may be noted.

  • Arterial blood gases (ABGs): This study can be helpful in cases of inhalant intoxication. Significant acidosis, hypoxemia, or hypercarbia may suggest the need for patient intubation.

  • Complete blood count (CBC): CBC is useful as a routine screening laboratory test. Chronic users may exhibit bone marrow suppression, thrombocytopenia, and aplastic anemia.

  • Urinalysis: Elevated urobilinogen suggests hepatic involvement. Hyaline casts, elevated white blood cell counts, elevated red blood cell counts, or abnormal glucose and protein levels may suggest renal injury.

  • Creatine phosphokinase (CPK): Useful in patients with muscle tenderness or myoglobinuria to evaluate the presence of rhabdomyolysis.

  • Serum or urine toxicology: Toxicology screens may be helpful if the specific chemical involved is unknown. Specific toxicologic tests of inhalant agents are not readily available in all laboratories and may take several days to weeks to get results, so they are not helpful in the immediate diagnosis. Thiesen et al showed that toluene can be detected as urinary hippuric acid (UHA) but required correlation to blood toluene levels.[9] Chakroun et al demonstrated similar results and also detected o -Cresol and 2,5 hexandione in the urine. Consult with the laboratory regarding their ability to test for specific agents.

  • Pregnancy testing should be done in all solvent-abusing females because of the risk of embryopathy caused by these agents.

Imaging Studies

Imaging studies can be useful adjuncts to the history, physical, and laboratory evaluation. Suggested studies include chest radiographs and head CT scan.

  • Chest radiograph: This study helps identify the etiology of respiratory difficulties associated with inhalant abuse. These include pneumothorax, aspiration pneumonia, or chemical pneumonitis with patchy or diffuse infiltrates. Chronic abusers with subsequent cardiomegaly might exhibit enlarged heart size and pulmonary edema.

  • Head CT scan: If occult trauma is suspected in the inhalant abuse patient, be liberal with CT scanning to rule out intracranial hemorrhage and occult fractures. Chronic abusers may show signs of cerebral or cerebellar atrophy.

  • MRI: Abuse of nitrites can cresult in dorsal and lateral spinal column disorders due to effects on B12 metabolism.

Other Tests

ECG/cardiac monitoring: Many inhalants are proarrhythmic; therefore, acutely intoxicated patients should have continuous ECG monitoring. ECG often shows tachycardia, bradycardia, arrhythmias, or even cardiac ischemia with solvent abuse.

Procedures

See the list below:

  • Follow advanced cardiac life support (ACLS) guidelines.

  • Consider oral or tracheal intubation in any patient with significantly decreased level of consciousness, inability to protect the airway, or severe oropharyngeal thermal injury secondary to inhalation.

  • Obtain peripheral or central intravenous (IV) access in all patients with suspected significant intoxication.

  • Cardioversion may be necessary if ventricular arrhythmias are present.

 

Treatment

Medical Care

Appropriate medical care for the inhalant-abusing patient is dictated by the severity of injury and the setting of care. The following medical care is recommended for patients with acute intoxication.

Prehospital care

The ABCs start by securing the patient's airway, breathing, and circulation. Follow standard ACLS protocols, keeping in mind that inhalant-abuse patients may experience hallucinations and become combative. Restraints should be applied carefully, if at all, and in accordance with local policy. Sufficient personnel should assist with moving the patient to the hospital to ensure the safety of both the patient and the EMS crew. If saturated with solvent, the patient's clothing should be removed to prevent worsening intoxication and to protect EMS personnel. Supply supplemental oxygen and obtain IV access if appropriate.

Emergency department care

ED care begins by protecting the patient's airway as dictated by level of consciousness and the ability of the patient to control their airway. Intubation may be required, so have appropriate equipment and personnel available. Place the patient on supplemental oxygen. Cautiously treat bronchospasm (if present) with aerosolized beta-agonists, bearing in mind that these agents may induce arrhythmias in the inhalant-sensitized heart. If severe bronchospasm is present, systemic steroids (in doses similar to those used with acute asthma exacerbations) can be helpful.

  • Obtain intravenous access and begin cardiac monitoring. Treat hypotension with supine patient positioning and intravenous fluid boluses. Use catecholamine pressors if necessary, but remember that these agents also cause cardiac sensitization and are proarrhythmic. Severe patient agitation should be treated with benzodiazepines or haloperidol (recognizing that haloperidol may decrease underlying seizure thresholds). Remember that sudden death in these patients often involves sudden or strenuous activity; therefore, minimize patient agitation as much as possible.

  • Measure electrolytes, including potassium, calcium, and phosphorus and replete as necessary because abnormal values can exacerbate cardiac dysrhythmias and muscle weakness.

  • GI decontamination is generally not recommended.

  • Specific laboratory tests and antidotes may be indicated for the following volatiles:

    • Methylene chloride: Check carboxyhemoglobin level, use 100% nonrebreather oxygen, and consider hyperbaric oxygen. These patients require prolonged monitoring and treatment (at least 12-24 h), because the carbon monoxide level resolves more slowly than in inhaled carbon monoxide poisoning.

    • Alkyl nitrites: Check serum methemoglobin levels. For levels more than 30%, or in symptomatic patients, administer methylene blue, 1-2 mg/kg IV over 5 minutes; repeat in 30-60 minutes as necessary. Total dose should not exceed 7 mg/kg to prevent generation of methemoglobin.

    • Carbon tetrachloride: Consider hepatic injury and necrosis. Experimental evidence supports use of N -acetyl-cysteine (NAC), charcoal hemoperfusion, and hyperbaric oxygen.

    • Gasoline: Chronic gasoline sniffing formerly was associated with lead poisoning; thus, lead testing might be warranted. Gasoline sold in the United States today is generally unleaded. Check blood lead level if appropriate and treat elevated levels accordingly with chelating agents.

    • Long-term abusers should be referred for psychiatric evaluation and treatment. Although there is no proven method of inhalant abuse treatment, a case study by Shen was successful in treating inhalant abuse with lamotrigine, an anticonvulsant that inhibits the excitatory amino acid glutamate.[10]

Consultations

Consulting a toxicologist or the regional poison control center (1-800-222-1222) for any acute inhalant intoxication is appropriate and encouraged.

A cardiologist should be consulted if ventricular arrhythmias are present and persistent.

 

Medication

Medication Summary

The goals of pharmacotherapy are to neutralize the effects of the toxic chemical, to reduce morbidity, and to prevent complications.

Vasopressors

Class Summary

These drugs augment both coronary and cerebral blood flow present during low flow states.

Epinephrine (Adrenalin)

Indicated in bolus form for asystole or pulseless arrest; indicated as continuous IV infusion for shock or significant hypotension after ensuring adequate intravascular volume.

Norepinephrine (Levophed)

Indicated for treatment of hypotension or shock after adequate volume replacement and if patient has stable rhythm. Norepinephrine has strong beta1- and alpha-adrenergic effects and moderate beta2 effects, which increase cardiac output and heart rate, decrease renal perfusion and pulmonary vascular resistance. It has variable effects on blood pressure.

 

Follow-up

Further Outpatient Care

Appropriate drug intervention programs and psychological counseling should be arranged prior to discharging the patient. Since withdrawal symptoms are relieved with inhalant re-exposure, addictive patterns may develop and should be addressed through counseling.[12]

Further Inpatient Care

Remember only those with significant inhalant-related complications are likely to reach the ED; these patients benefit from hospitalization for medical observation. In addition, psychiatric and social intervention is often necessary to prevent further abuse.

Although the acute intoxication may only last 15-45 minutes, drowsiness, disorientation, and stupor may persist for hours or even days, and chronic effects may last a lifetime.

ICU admission is certainly advised for any patient with hemodynamic instability, respiratory impairment, cardiac arrhythmias, or continued decreased level of consciousness. Close observation is necessary for worsening oxygenation and deterioration.

Acute withdrawal management may be managed with benzodiazepines.[11]

Transfer

If a patient requires prolonged cardiac monitoring or medical intensive care, but such facilities are not locally available, transfer to an appropriate tertiary hospital is indicated.

Deterrence/Prevention

Public education remains important, especially targeting at-risk groups. Individually, the risks and dangers of inhalant abuse should be explained to the patient. Dysfunctional family settings increase chances of return to inhalant use, and additional supervision may be required for these patients after discharge.

Complications

Complications of inhalant abuse include the following:

  • Cardiac - Sudden death, myocardial infarction, cardiac arrhythmias

  • Neurologic - Acute and/or permanent memory and cognitive impairment, blindness, psychosis, seizures, tetany, weakness, numbness, paresthesias

  • Pulmonary - Respiratory arrest, aspiration, chemical pneumonitis

  • Renal - Electrolyte disturbance, renal failure, hypocalcemia (particularly during fluid repletion)

  • Hepatic - Hepatic failure, hepatitis

  • Psychiatric – Inhalant abuse is associated with increased rates of suicidal ideation and suicidal attempts (minor and severe)[13]

  • Legal - Risk behaviors may lead to illegal activities or other forms of substance abuse

Prognosis

In general, the prognosis for inhalant abuse is good if the pattern of abuse is recognized early. Significant morbidity, especially neurologic, is the rule in prolonged chronic abuse. In a review of toluene abuse, long-term use produces white matter changes in the brain resulting in dementia.[8] The pulmonary, renal, cardiac, and gastrointestinal sequelae usually resolve with abstinence.

Patient Education

Patients and their parents need to be educated about inhalants and their devastating consequences. Education can occur through physician-patient discussion, referral to online resources, and third-party counseling on inhalant abuse. Adolescents have the legal right to receive confidential services for substance abuse, mental health, and reproductive health. Medical care providers can decide when parental involvement is appropriate and necessary.

To obtain further information, the following organizations may be contacted:

  • National Clearinghouse for Alcohol and Drug Information

  • PO Box 2345

  • Rockville, MD 20847-2345

  • Phone: (800) 729-6686

  • National Institute on Drug Abuse (NIDA)

  • 6001 Executive Boulevard, Room 5213

  • Bethesda, MD 20892-9561

  • Phone: (301) 442-1124

  • National Inhalant Prevention Coalition (NIPC)

  • 506 Barton Avenue

  • Chattanooga, TN 37405

  • Phone: (800) 269-4237 or (423) 265-4662

  • Fax: (423) 265-4889

  • e-mail: nipc@io.com

According to the National Inhalant Prevention Coalition (NIPC), treatment facilities for inhalant users are rare and difficult to find. A network of nationwide contacts exists through the NIPC, both for medical information and in locating treatment centers in the neighboring area.

For patient education resources, see the Substance Abuse Center, as well as Drug Dependence and Abuse and Substance Abuse.