July 23, 2010

Huffing Your Life Away

Identifying those at risk of inhalant abuse

By Bob Scott

At 10 p.m. on March 1, 2005, Officer Jeff Williams left his Cleveland home to start his shift. One hour later, his wife, Kathy, a nurse by profession, went downstairs and kissed their 14-year-old son, Kyle, goodnight. The following morning, Kathy attempted to wake up Kyle before she left for work.

Known for pretending to be in a deep sleep, Kyle didn’t move, sitting up in bed with his legs crossed and his head slumped forward. Kathy went into the room and shook his arm and Kyle fell over. He was pale and had the straw from a can of Dust Off, a common aerosol computer cleaner, hanging from his mouth and the can itself in the bed.

According to the coroner’s report, Kyle had died between midnight and 1 a.m. – the Dust Off chemicals were the only drugs present in his system.

Recent studies by the National Inhalant Prevention Coalition estimate that one in five students in the United States has used an inhalant to get high by the time they reach the eighth grade – in a trend referred to as “huffing.”

While many parents are becoming aware that inhalants represent a cheap, legal, and easily accessible alternative to marijuana and alcohol among middle school students, few are aware of the deadly potency of inhalant poisons. Much like playing a game of Russian roulette, “huffers” take their lives in their hands each time they abuse an inhalant.

While education measures are in place to alert parents about this growing crisis in their homes, the same cannot be said for respiratory care professionals working in emergency rooms who may be seeing inhalant abusers slipping right under their noses.

Fighting for Air

Abusers usually select their inhalants from a range of over 1,000 common household products, including: volatile solvents, such as paint thinner, felt-tip markers, nail polish, and rubber cement; aerosol sprays, which contain propellants and solvents such as toluene, including hair products, cooking products, and especially silver- and gold-colored spray paint; and gases found in butane lighters, whipped cream dispensers, and even refrigerator and air conditioning units.

Users may pour the chemical on a rag and sniff it, they may spray the inside of a bag and huff the fumes in, or they may simply inhale straight from the container. Huffing inhalants often creates a high within minutes – as quickly as the chemicals are absorbed into the bloodstream – and usually lasts for less than an hour.

Due to this short-term high, inhalant abusers will huff repeatedly over a course of hours to prolong its effects, which can include euphoria, drowsiness, inhibition, hallucination, and delusion. However, it is the immediate negative effects that can provide the red flag for healthcare personnel.

“While there are no long-term studies on the effect of inhalants on the respiratory system, we are quite familiar with the short-term effects, the most dramatic of which could be death,” says Umur Hatipoglu, MD, from the Respiratory Institute at the Cleveland Clinic in Ohio. “First of all, many of these inhalant gases are actually heavier than oxygen so they settle into the lung, and while they physically displace oxygen from the lung, they don’t displace carbon dioxide.”

He continues: “The carbon dioxide actually continues escaping, and the inhalant abuser may not be aware that there are low levels of oxygen because what stimulates the respiratory system for the most part is an elevation of carbon dioxide, not low oxygen. By the time their oxygen level falls, they are actually in deep waters, and could easily die of hypoxia by developing cardiac arrhythmias, going into a coma, and/or having seizures.”

What has truly captured nationwide parental attention is that huffing is an equal opportunity killer – regardless of whether the user is a first-timer, a social huffer, or one who has been huffing inhalants for years, the risk of death is the same. “Sudden Sniffing Death,” as the media calls it, results from inhalants putting immense strain on the respiratory system, forcing the heart to beat rapidly and erratically until the user goes into cardiac or respiratory arrest.

“Other dangers associated with inhalants are, obviously, that these chemicals can irritate the air tubes and abusers can experience bronchospasms,” says Hatipoglu. “The air tubes can constrict, particularly in people who are prone to it, such as patients with asthma, who may die potentially as a result of asphyxiation.”

He adds, “While chronic damage to the lungs from inhalant abuse has not been very well documented just yet, we will eventually find out about the chronic effects since we know that a large proportion of people who abuse inhalants have respiratory disorders, such as asthma, bronchitis, and sinusitis. It is simply a matter of time”

The Addict at a Glance

While this type of drug abuse seems to be reaching epidemic levels, spurred by recent Substance Abuse and Mental Health Services Administration surveys and major television network coverage, inhalant abuse is hardly a new development.

“Rather than becoming more widespread, inhalant abuse is simply becoming more well known, both in healthcare and in the home,” says Shari Corbitt, PsyD, executive director of Promises Treatment Centers in Malibu, Calif. “Inhalant abuse has been a prevalent behavior – and a serious problem – for two to three decades because the chemicals have always been so cheap and readily available.”

Regardless of the time lapse, the news about inhalant abuse is spreading. Manufacturers of volatile solvents and compressed air canisters have made initiatives to place warning labels on their products, warning both parents and would-be abusers that huffing “may be harmful or fatal,” while others have gone so far as to add a bitterant to the chemicals so that it tastes unpleasant in order to discourage abuse.

However, is the message reaching healthcare professionals working on the front lines?

“As far as the respiratory community goes, I would have to say that there has been little to no move to educate professionals in identifying signs of inhalant abuse,” says Hatipoglu. “I know that there are efforts on the part of the Substance Abuse and Mental Health Services Administration, which provides guidance to families and patients, but as far as the respiratory community goes, I think there is an unmet need there.”

While parents play a pivotal role in identifying changes in the physical condition and behavior of their children, educating respiratory professionals and healthcare personnel about the common signs and symptoms related to inhalant abuse provides another opportunity for diagnosis and intervention.

“There are two areas healthcare professionals can look at when diagnosing adolescents engaged in huffing – acute and chronic usage,” says Hatipoglu. “Acutely, these patients are going to manifest with behavioral problems. They will basically act as if they are inebriated – their speech may be slurred and their eyes may be glassy and red. It is, by and large, not very different than the other illegal agents that patients tend to abuse.”

He continues: “More specifically, huffing, sniffing, and bagging basically expose the mouth and nose area to extreme toxic chemicals, so you may see a rash there or evidence of nosebleeds. There is also what we would call ‘huffer’s eczema,’ which is an area of atrophy around the mouth and throat.”

While an abuser’s use of inhalants may be diagnosed during a medical interview, for instance, after they are brought to a hospital emergency room following an  injury in an accident related to inhalant use, a definitive diagnosis can be more slippery than many professionals believe. Although inhalants can be detected in blood or urine samples, laboratory tests cannot always confirm the diagnosis   since the inhalants do not remain in the system very long.

Healthcare personnel can also look for some of the more common behavioral markers of a patient abusing inhalants.

“Healthcare professionals should make note of extremely erratic behavior, secretive behavior, a significant drop-off in school performance, change in friends – essentially, all of the other changes that you would expect with any other drug usage,” says Corbitt. “But one of the things unique to patients who are huffing is their very erratic behavior. There can also be fits of rage, even with very young adolescents.”

Point of No Return

“The biggest problem with huffing – whatever the chemical may be – is that there’s no coming back,” says Corbitt. “When a person smokes too much pot or drinks too much alcohol, unless they are at the gates of death from their drug of choice, there is typically a great deal of recovery that can occur.”

“However, when someone has participated in huffing inhalants for a good deal of time, the damage to the brain is, at this point in time, thought to be irreversible. It’s terribly insidious,” says Corbitt. “Teenagers will tell you about their friend who huffs, ‘We’re afraid of him – he’s not quite right.’ These teenagers are able to identify that their friends who huff frequently get severely damaged from a brain perspective.”

While there are drug rehabilitation options for inhalant abusers, including inpatient treatment, individual or group therapy, a variety of medications to ease patient withdrawal, for chronic huffers the worst of the damage has already been done, not only to several of their internal organs, but also to their cognitive range of abilities.

“When we work with adults, we take their adolescent and young adult history,” says Crobitt. “In our line of work, we get to hear a lot about what our clients did as youths and as young adults and I have to be honest with you, we don’t hear a lot about huffing. I think that’s partly because people who participate in huffing frequently don’t wind up in treatment centers – they wind up in mental hospitals, because they get so deeply psychiatrically impaired. However, if intervention occurs soon enough, a treatment center can be an appropriate choice.”
 

 

- http://www.therapytimes.com/content=1002J84C487EAC86408040441

- http://www.promises.com/

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