|
2.19.99
Bibliography for Inhalants
Epidemiology
Edwards RW; Oetting ER. Inhalant use in the United States.
NIDA Res Monogr 1995;148:8-28.
No abstract
This entire issue dedicated to the epidemiology of
inhalant abuse in different parts of the world.
Neumark YD; Delva J; Anthony JC . The epidemiology of
adolescent inhalant drug involvement. Arch Pediatr Adolesc Med 1998 Aug;152(8):781-6.
ABSTRACT:
OBJECTIVE: To fill some of the gaps in our knowledge
of the epidemiology of inhalant drug use. We examine age, sex, and race
or ethnicity variations in the occurrence of inhalant use as well as time
trends and the purported transitory nature of inhalant use among adolescents
in the United States.
DESIGN: The data analyzed in this report were collected
as part of the National Household Survey on Drug Abuse from 1990 through
1995. This annual survey is designed to provide cross-sectional information
about the patterns of drug use among nationally representative samples
of US household residents aged 12 years and older.
PARTICIPANTS: The sample included 34826 adolescents aged
12 to 17 years who participated in the National Household Survey on Drug
Abuse from 1990 through 1995 (N=2177-8005 per survey year). RESULTS: The
use of inhalants, particularly aerosols and glue, increased during the
first half of the current decade. Initiation of inhalant use is not limited
to early adolescence and is not a transitory behavior among adolescents
in the United States. The use of inhalants is equally common among members
of both sexes, and non- Hispanic white youths are more likely to report
use than are members of other race or ethnic groups.
CONCLUSIONS: The increasing use of inhalants, their widespread
availability, and the risks involved with their use indicate a need for
more focused attention on this public health problem.
Esmail A; Warburton B; Bland JM; Anderson HR; Ramsey J
Regional variations in deaths from volatile solvent abuse in Great Britain.
Addiction 1997 Dec;92(12):1765-71.
ABSTRACT:
AIMS: To assess geographical variations in mortality
and the relationship of socio-economic correlates to deaths from volatile
substance abuse (VSA) in Great Britain.
DESIGN: Analysis of the National Register of deaths from
VSA by linking the addresses (postcode) of the deceased to census enumeration
districts and hence wards and counties.
SETTING AND PARTICIPANTS: All 775 deaths in Great Britain
listed in the national register between 1985-91. Population counts from
the 1991 census were used as denominators.
MEASUREMENT: The Poisson heterogeneity test was used
to test the null hypothesis that all standardized mortality ratios were
from the same population. The t-test was used to compare differences in
Townsend Deprivation scores between wards with and without VSA deaths.
Multiple regression was used to assess the relationship between indices
of deprivation and deaths from VSA. FINDINGS: One-third of all VSA deathsccurred
in six regions of Great Britain which accounted for 17% of the at risk
population. There was considerable variation in age standardized mortality
ratios (ASMR) across regions. A ward level analysis indicated that wards
with a VSA death had significantly higher levels of deprivation. The Townsend
deprivation index showed mean deprivation scores of 2.8 and 0.2, respectively,
for wards with and without a registered death (p < 0.0001). Multiple
regression at county/region level found that 45% of the variation in ASMR
was explained by the components of the Townsend deprivation index. CONCLUSIONS:
Factors associated with deprivation are important in VSA deaths and this
should be taken into account in planning public health measures to prevent
mortality.
Overview
Sharp C, Rosenberg, N. Inhalants. In Substance Abuse:
A Comprehensive Textbook. Eds. Lowinson J, Ruiz P, Langrod J, Millman R.
Williams and Wilkins. Baltimore. 3rd edition. 1997, pp. 246-64.
No abstract.
An excellent summary of the subject. Note, though,
that nitrous oxide is not discussed.
Dinwiddie SH. Abuse of inhalants: a review. Addiction
1994 Aug;89(8):925-939
ABSTRACT:
Inhalants, a chemically heterogeneous group of psychoactive
substances found in adhesives, lighter fluids, spray paints, cleaning fluids
and typewriter correction fluid, may be used by up to 10% of young people.
This article reviews the health effects, epidemiology, risk of other substance
use and addiction and psychiatric co-morbidity associated with the practice
of inhalant use.
Gillman MA . Nitrous oxide abuse in perspective. Clin
Neuropharmacol 1992 Aug;15(4):297-306.
ABSTRACT:
I present evidence that certain health professionals
have a higher liability to drug abuse than does the general population.
In view of this, data are presented in which the extremely limited contribution
of nitrous oxide to this problem is assessed. I demonstrate on the basis
of the limited published data now available that pure nitrous oxide addiction
is very rare among health professionals, being the rarest drug of abuse
among them. When used by the latter, it is most commonly part of a polydrug
abuse pattern, not being a major component of the addiction in these cases.
It is clear that nitrous oxide addiction is even less of a problem in the
general population. Furthermore, after almost 200 years of use, its very
minor addictive potential should by now have clarified itself. It would
appear that it is unlikely to become, has never been, nor is it the moment
of any real significance as a drug of abuse when compared with the many
currently available addictive drugs, which clearly pose a much more serious
prproblem.
This review also has section on the use of nitrous
oxide in addiction medicine.
Newell GR; Spitz MR; Wilson MB. Nitrite inhalants: historical
perspective. NIDA Res Monogr 1988;83:1-14.
ABSTRACT:
There are important reasons for considering nitrite inhalation
as a factor in the development of AIDS-related KS in young male homosexuals.
These are (1) the pharmacologic properties of amyl, butyl, and isobutyl
nitrites, which are toxic; (2) the mutagenic, teratogenic, and carcinogenic
products resulting from metabolism of N-nitroso compounds; (3) the potent
carcinogenicity of N-nitroso compounds in 39 different animal species;
and (4) the deleterious effects of volatile nitrites on human lymphocytes
both in vitro and in vivo. Specifically related to this epidemic, there
are additional reasons for pursuing the connection between nitrite inhalation
and development of KS. These include: (1) the timing of the production
and sales of volatile nitrites for use as recreational drugs and the subsequent
outbreak of the AIDS epidemic (7 to 10 years); (2) the extensive use of
nitrites among male homosexuals; (3) the virtual universal history of nitrite
use by young male homosexuals in whom KS has developed during the past
3 years; and (4) the age group in which KS is developing is consistent
with a cohort initially exposed 7 to 10 years ago.
Steffee CH; Davis GJ; Nicol KK A whiff of death: fatal
volatile solvent inhalation abuse. South Med J 1996 Sep;89(9):879-84.
ABSTRACT:
Inhalation abuse of volatile solvents, previously known
generically as "glue sniffing," is typically pursued by adolescents. A
wide range of legal, easily obtained products containing volatile substances
are available for abuse. We report two illustrative cases of fatal volatile
substance abuse: gasoline sniffing in a 20-year-old man and aerosol propellant
gas inhalation (aerosol air freshener) in a 16-year-old girl with underlying
reactive airway disease. Although the ratio of deaths to nonfatal inhalation
escapades is extremely low, volatile solvent abuse carries the risk of
sudden death due to cardiac arrest after a dysrhythmia or vasovagal event,
central nervous system respiratory depression, hypoxia and hypercapnia
due to the techniques of inhalation, and other mechanisms. Investigation
of the patient's substance abuse history, examination of the scene of death,
and special toxicologic analyses are critical to identifying volatile substance
inhalation abuse as the cause of death because anatomic autopsy findings
will typically be nonspecific. Above all, physicians must suspect the diagnosis
of volatile substance inhalation abuse, especially in any case of sudden
death involving an otherwise healthy young person.
A good brief review to give to medical students.
Neurobiology
Evans EB; Balster RL CNS depressant effects of volatile
organic solvents. Neurosci Biobehav Rev 1991 Summer;15(2):233-41.
ABSTRACT:
Volatile chemicals used widely as solvents can produce
acute effects on the nervous system and behavior after inhalation exposure,
and many are subject to abuse. This review considers the nature of the
acute effects of volatile organic solvents by comparing their actions to
those of classical CNS depressant drugs such as the barbiturates, benzodiazepines
and ethanol. Like CNS depressant drugs, selected inhalants have been shown
to have biphasic effects on motor activity, disrupt psychomotor performance,
have anticonvulsant effects, produce biphasic drug-like effects on rates
of schedule-controlled operant behavior, increase rates of punished responding,
enhance the effects of depressant drugs, serve as reinforcers in self-administration
studies and share discriminative stimulus effects with barbiturates and
ethanol. Toluene and 1,1,1-trichloroethane, as well as subanesthetic concentrations
of halothane, have been the most extensively studied; however, it is unclear
whether important differences may exist among solvents in their ability
to produce a depressant profile of acute effects. The possibility that
selected solvents can have acute effects similar to those of depressant
drugs may shed light on the nature of their acute behavioral toxicology
and on their abuse.
Gyulai FE; Firestone LL; Mintun MA; Winter PM In vivo
imaging of human limbic responses to nitrous oxide inhalation. Anesth Analg
1996 Aug;83(2):291-98.
ABSTRACT:
Human behavioral studies have shown that nitrous oxide,
in subanesthetic concentrations, impairs psychomotor function, cognitive
performance, and learning and memory processes. However, the cerebral mechanisms
of such effects remain unknown. Positron emission tomography (PET) was
used to map the brain areas associated with nitrous oxide effects. Regional
cerebral blood flow (rCBF) was measured in eight volunteers, during room
air (control) or 20% nitrous oxide (nitrous oxide) inhalation using 15(O)-water,
to reflect regional neuronal activity. To control for the possibility that
20% nitrous oxide uncoupled cerebral blood flow and metabolism, in four
of the subjects, regional cerebral metabolic rate (rCMR) was also measured
using 18F- deoxyglucose during the two experimental conditions. Results
of rCBF and rCMR scans were compared between conditions using the statistical
parametric mapping method, and areas of nitrous oxide-related activation
or deactivation were identified at a significance level of 0.005. Percent
changes in rCBF scan pixels from these activated or deactivated areas were
then compared with those of stereotactically corresponding rCMR scan pixels
with t statistics (P < 0.05 was defined as a significant difference).
It was found that cerebral blood flow and metabolism were not uncoupled
by 20% nitrous oxide, since percent changes in rCBF and rCMR, detected
during nitrous oxide inhalation, did not differ significantly from each
other (P < 0.05). Nitrous oxide inhalation was associated with significant
activation in the anterior cingulate cortex, a limbic area known to mediate
psychomotor and cognitive processes.
Deactivation was found in the posterior cingulate, hippocampus,
parahippocampal gyrus, and visual association cortices in both hemispheres;
the former two regions are known to mediate learning and memory. These
areas identified by PET in vivo may provide the neuroanatomical basis for
the behavioral responses associated with subanesthetic nitrous oxide inhalation.
Gillman MA Nitrous oxide, an opioid addictive agent. Review
of the evidence. Am J Med 1986 Jul;81(1):97-102
ABSTRACT:
Pharmacologic evidence that nitrous oxide is addictive
through direct interaction with the endogenous opioid system includes the
possibility that it is a partial agonist and acts at the mu, kappa, and
sigma opioid receptors. The medical and psychiatric complications of its
abuse are discussed with special reference to the 32 cases of myeloneuropathy
so far reported; other dangers are also mentioned. Notwithstanding the
extremely low incidence of reported cases of nitrous oxide addiction compared
with all other addictive substances, greater controls should be placed
on its commercial availability to at least maintain its low level of abuse.
Treatment
Westermeyer J . The psychiatrist and solvent-inhalant
abuse: recognition, assessment, and treatment. Am J Psychiatry 1987 Jul;144(7):903-7.
ABSTRACT:
Solvent-inhalant abuse, existent for a century, has been
gradually increasing in several sectors of our society over the last few
decades. This form of substance abuse involves a variety of pharmacological
agents as well as several target groups at risk. A key strategy for effective
intervention is early recognition in clinical as well as other settings.
Psychiatrists should appreciate the clinical manifestations of these substances
because they often appear in psychiatric settings. Assessment and treatment
of the solvent-inhalant abuser must take into account the special pharmacological,
demographic, and ecological factors associated with this particular form
of substance abuse.
Classic Contributions
Beauvais F; Oetting ER . Toward a clear definition of
inhalant abuse. Int J Addict 1987 Aug;22(8):779-84
ABSTRACT:
The study of the nature and extent of the use of volatile,
psychoactive substances has been hampered by a confusing terminology. Widely
disparate substances such as glue, gasoline, anesthetic gases, and nitrites
have all been discussed under the single rubric of "inhalant abuse." A
classification scheme is proposed which differentiates users of substances
such as volatile hydrocarbons (gasoline, glue, etc.) from users of the
anesthetic gases and of the amyl and butyl nitrites. Since users of these
three types of volatile chemicals differ on predisposing factors, level
of dysfunction, and consequences of use, the former group should be classed
generically as "inhalant" users, while the latter should be diagnosed as
users of a specific drug.
Psychiatric Co-morbidity
Dinwiddie SH; Zorumski CF; Rubin EH Psychiatric correlates
of chronic solvent abuse. J Clin Psychiatry 1987 Aug;48(8):334-7.
ABSTRACT:
Eleven chronic solvent abusers admitted for inpatient
treatment were retrospectively identified and their records reviewed to
determine associated medical and psychiatric illness and other substance
abuse. Antisocial personality disorder and narcotics abuse were common
in the group, as were symptoms suggesting neurological or gastrointestinal
dysfunction. The patients' response to substance abuse treatment was poor.
The findings indicate that persons who abuse solvents over a long period
tend to have associated behavioral patterns that may contribute to poor
social adjustment and to poor response to the treatment of their substance-abuse
problems.
Ron MA Volatile substance abuse: a review of possible
long-term neurological, intellectual and psychiatric sequelae. Br J Psychiatry
1986 Mar;148:235-46.
ABSTRACT:
The possibility that chronic abuse of volatile substances
can cause permanent neurological, psychiatric, and intellectual sequelae
is critically reviewed. Toluene, present in the commonly used adhesives,
is most often implicated in 'glue sniffing'; this review focuses on its
potential long-term effects. Many criticisms - particularly poor matching
of control samples and inability to distinguish between acute and chronic
effects - can be levelled at the available studies, while no adequate follow-up
studies have been performed. In the light of present knowledge, the possibility
that permanent structural brain damage, with accompanying psychiatric manifestations,
results from solvent abuse remains inconclusive.
Yamanouchi N; Okada S; Kodama K; Sakamoto T; Sekine H;
Hirai S; Murakami A; Komatsu N; Sato T. Effects of MRI abnormalities on
WAIS-R performance in solvent abusers. Acta Neurol Scand 1997 Jul;96(1):34-9.
ABSTRACT:
OBJECTIVE: To clarify how chronic solvent abuse affects
cognitive function using magnetic resonance imaging as an index of brain
damage.
MATERIAL AND METHODS: A total of 25 chronic solvent abusers
underwent magnetic resonance imaging with quantitative neurometry and Wechsler
Adult Intelligence Scales revised. RESULTS: The abusers with white matter
change (n=10) showed significantly (P<0.05) lower performance IQ, especially
in Digit Symbol subtest (P<0.01). Also, the severity of pontine atrophy
was significantly correlated with PIQ (r=0.60, P<0.01).
CONCLUSIONS: These data indicate that solvent abuse causes
the decline in the test performance reflecting cognitive and fine motor
dysfunction and that white matter changes and pontine atrophy may have
some roles in this decline.
Public Policy and History
Balster RL . College on problems of drug dependence presidential
address 1996: inhalant abuse, a forgotten drug abuse problem. NIDA Res
Monogr. 1997;174:3-8.
No abstract.
Tenenbein M . Leaded gasoline abuse: the role of tetraethyl
lead. Hum Exp Toxicol 1997 Apr;16(4):217-22.
ABSTRACT:
Volatile substance abuse is practised worldwide however
reports of the abuse of leaded gasoline have been limited to northern Canada,
southwestern USA and the Australian Outback. Chronic, heavy abuse of leaded
gasoline results in an encephalopathy, cerebellar and corticospinal symptoms
and signs, dementia, mental status alterations, and persistent organic
psychosis. Much of this is due to the hydrocarbons of gasoline while the
tetraethyl lead contributes to the altered mental status and is responsible
for the persistent psychosis. Lead chelation therapy is not rational and
has not been shown to benefit these patients.
Medical Complications
Meadows R; Verghese A .Medical complications of glue sniffing.
South Med J 1996 May;89(5):455-62.
ABSTRACT:
Glue sniffing refers to the deliberate inhalation of
volatile solvents, commonly found in adhesives, for the purpose of intoxication.
The increasing prevalence of inhalant use suggests that many physicians
will encounter a glue-sniffing patient at some time during their practice.
Knowledge of the epidemiology, toxicology, and medical complications associated
with glue sniffing is essential in obtaining an accurate history of substance
abuse and in clinically managing these patients. This review of sources
is intended to aid clinicians in the recognition of glue-sniffing patients
and in the diagnosis of acute and chronic medical complications associated
with the abuse of glues, solvents, and related substances. Glue sniffing
has been linked to sudden death and chronic damage to the heart, lungs,
kidneys, liver, peripheral nerves, and brain. Inhalant abuse in general
is associated with mortality and morbidity, including social, educational,
and economic deprivation in adolescents and young adults.
Lolin Y. Chronic neurological toxicity associated with
exposure to volatile substances. Hum Toxicol 1989 Jul;8(4):293-300
ABSTRACT:
1. The main neurological disorders associated with chronic
VSA are peripheral neuropathy, cerebellar disease, chronic encephalopathy
and dementia. Apart from peripheral neuropathy, the clinical features are
non-specific, evidence for solvent-related toxicity is in most cases circumstantial
and there is no clear dose/response relationship.
2. Peripheral neuropathy is mainly associated with n-hexane
and methyl n- butyl ketone.
3. Cerebellar disease is usually associated with toluene
exposure; in the more severe cases there is often radiological evidence
of irreversible cerebellar atrophy.
4. Chronic encephalopathy and dementia are the most serious
consequence of solvent exposure, particularly to toluene in abusers and
to mixed solvents in industrial workers. Postmortem studies in some abusers
have shown generalized axonal degeneration, demyelination and brain atrophy.
5. Further studies on low level solvent exposure are
needed as little is known about the neurological consequences of mild VSA,
especially as regards individual susceptibility and possible interactions
between solvents and other toxins such as ethanol.
Soderberg LS. Immunomodulation by nitrite inhalants may
predispose abusers to AIDS and Kaposi's sarcoma. J Neuroimmunol 1998 Mar
15;83(1-2):157-61.
ABSTRACT:
Epidemiological studies indicating that nitrite inhalant
abuse is a co- factor in HIV infection and in Kaposi's sarcoma are supported
by recent experimental studies, described in this review. Inhalation exposure
to the nitrites produce a nonspecific cytotoxicity, depleting many cells
of the immune system. Apparently distinct from this cytotoxicity, inhalation
of the nitrites impairs a variety of immune mechanisms, affecting both
humoral and cell-mediated immunity. In addition, the inhalant-increased
macrophage production of the inflammatory cytokine tumor necrosis factor-alpha
(TNF-alpha), can directly stimulate HIV replication and can also stimulate
the growth of Kaposi's sarcoma cells. Thus, nitrite inhalants may impair
immune resistance to infection and actively promote viral replication and
tumor growth.
Special Populations
Jones HE; Balster RL. Inhalant abuse in pregnancy. Obstet
Gynecol Clin North Am 1998 Mar;25(1):153-67.
ABSTRACT:
Information from a variety of sources suggests the possibility
of adverse effects of maternal inhalant abuse, although a well-controlled,
prospective study in this area has not been conducted. One source of this
concern is the data from occupational exposure to some of the abused solvents,
specifically toluene and TCE, with numerous reports suggesting increased
spontaneous abortion and fetal malformations. There are also data suggesting
decreased fertility and an increased risk for spontaneous abortion in health
care workers exposed to nitrous oxide. The relevance of these studies to
problems of inhalant abuse is not clear. Although the chemicals involved
are the same, there are many differences in the exposure parameters, the
populations exposed, and the types of associated risk factors. Nonetheless,
there are more than 100 cases reported in the literature of children born
to solvent- abusing mothers. Many of these children were small at birth,
and some have craniofacial abnormalities not unlike that seen in children
with FAS. In the few studies reporting the findings of follow-up in these
children, some evidence has been obtained for retardation in growth and
development and for residual deficits in cognitive, speech, and motor skills.
Clearly, more research is needed to rule out the concomitant risk factors
and to identify specific chemicals and patterns of use associated with
adverse effects. Animal studies provide more direct evidence that prenatal
exposure to toluene or TCE can produce reduced birth weights, occasional
skeletal abnormalities, and delayed neurobehavioral development, even under
conditions designed to mimic inhalant abuse patterns. Additional research
is needed to identify other chemicals with adverse effects, critical periods
of exposure, effects of combinations of inhalants, or interactions with
drugs of abuse. The research literature seems sufficient to alert clinicians
to possible problems in patients who abuse inhalants while pregnant. Diagnosis
and good prenatal care for these women are important. The evidence for
neonatal withdrawal is limited at this time; however, infants born to women
who have recently used inhalants should be observed carefully for an alcohol-like
withdrawal syndrome. Although it is not possible to link a specific birth
defect or developmental problem in the child of an inhalant abuser to prenatal
exposure to a specific chemical, it is clear that inhalant abuse and its
associated lifestyle place children at increased risk. A wider appreciation
of this is needed among health care professionals and the general public.
An excellent, comprehensive review of the subject.
Henretig F . Inhalant abuse in children and adolescents.
Pediatr Ann. 1996 Jan;25(1):47-52.
No abstract available.
Bibliographies
Resource
Listing by Subject
PGY-V Home |