What is inhalant abuse?
What types of things do people use when they are huffing?
What are the risks of inhalant abuse?
Inhalant abuse or huffing is a commonly practiced way to get high. The prevalence varies from place to place, but inhalants can often be the first drugs of abuse. They are cheap and easy to get so it makes them ideal for beginners. What do we need to know about it? Tune in this week as we answer these questions and more.
Prevalence of and Factors Contributing to Glue Sniffing in the South Asian Association for Regional Cooperation (SAARC) Region: A Scoping Review and Meta-analysis: Substance Use & Misuse: Vol 55, No 5
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You’re listening to the All Things Substance podcast, the place for therapists to hear about substance abuse from a mental health perspective. I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor. It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice. So join me each week as we talk about All Things Substance.
Welcome back to the All Things Substance Podcast. This is episode 28.
We’re coming back after my short one week vacation. Taking a week’s vacation from the podcast means that I need to have an episode for the first day of vacation and for the first day back. Okay. I hope you had a chance to enjoy the interviews that I was able to do with Brian H who’s the host of the All-in An Addicted Gamblers Podcast and with Dr. Dave of Shrink Rap Radio,
I did do one thing over break for the podcast when I had the privilege of doing an interview with a woman named Jean McCarthy. She has a podcast called the Bubble Hour. She’s been alcohol-free for over 10 years and has done close to 400 episodes talking about her recovery, but also interviewing other people about their recovery. If you want to hear stories of recovery, head on over to her podcast called the Bubble Hour. That interview will be coming out in may. I’ll be sure to post it when it goes live.
This week, we’re going to be talking about inhalants. What I mean by inhalants are chemicals and substances that are being inhaled. Inhalants are things like gases and solvents that produce a really short but intense high. I should start by saying that inhalant use is a problem, but it’s not necessarily one that’s widespread. It’s going to be rare to find somebody who has inhalants as their drug of choice. Not saying it doesn’t happen because it really does, but it’s not as popular as a drug of choice for very long. As we talk, it will become clear why that is.
Inhalant drug use typically is found among and marginalized populations, such as street kids, indigenous or Aboriginal youth and Roma children. It can also occur in school and children and in marginalized adult populations,
In the United States, inhalant abuse isn’t a widespread problem than it might be in other countries. There are certain populations that are at risk for inhalant abuse and inhalant dependence. In the United States this tends to be between the ages of six and 17, although there are adult users and we’ll talk about that as well.
There are some countries where inhalant abuse is a very serious problem, especially among children who live on the streets. In countries, across Africa and Asia, there are cities where inhalant abuse among street kids is a very big problem. It tends to be about glue and there are different brands of glue that are most popular depending on the region where you are.
This could be in Kenya. The Philippines, India, and Egypt. There’s been some research done in other countries like Russia and Mexico. I’m certain that in other countries of the world, there are pockets of people who are using inhalants. I just wanted to give you a glimpse of how prevalent this is and give you context for while we’re talking about this.
The very first thing I think about when I think about inhalant abuse is a student that died when I was in high school. I was a freshman when this happened in the nineties and there was a student who was two years older than me. He died from huffing Scotchgard. For those not familiar Scotchgard is a substance used to protect cloth or carpet from stains and spills. You can buy scotch guard pretty much anywhere that they’re going to sell home cleaning products and whatnot.
I remember being shocked when I heard about the cause of death. I wasn’t even aware that inhalants were really a thing, even though I was deep in my use by then. About six months later, I recall two students from the next town over who died when they broke into a dental office and were huffing nitrous oxide.
I had heard of people using whippets before, but I wasn’t totally certain what that was. I knew it had to do with whip cream chargers. So these are the metal cylinders that are put in a whipped cream can to charge it so that it makes the substance foam up. Well whippets are nitrous oxide.
As we know, nitrous oxide has medical uses. They use it at the dentist office to help people deal with the anxiety of procedures. How they use it is controlled and regulated in terms of dosage and how it’s administered.
In the wake of those deaths of kids, my own age, I remember feeling like maybe people don’t know that inhalants are really dangerous. As I moved into college and was working with teenagers, it was always something that I was paying attention to and would ask the kids about. For the most part, kids would look at me with a confused look on their face, not knowing what it was or if they did, they would be incredulous about why I thought they would be huffing. Every once in a while though, I would find kids who would say, yeah, they tried it or they knew someone who did.
As I moved into my first job post grad school, it was at a treatment center for adolescent girls. Asking about use of inhalants was something that was standard during our intakes. What I found is that most of those girls had used inhalants. The use of inhalants for them had been earlier in terms of being younger and they’d moved on from that. Some girls admitted to using it when they weren’t able to find their drug of choice.
Inhalants are popular because they’re really cheap and pretty easy to get. In fact, treatment centers have rules that patients aren’t allowed to bring aerosol products like deodorant or hairspray, those sorts of things.
We also had to be cautious about having aerosol deodorizers in the guest bathrooms and that was something that we just always thought about. As you move throughout your day today, or even tomorrow, keep an eye on different things that you see that are aerosol based. Could be hairspray could be a bottle of Glade or some kind of Febreeze, could be Pledge. It could be any number of things. You’ll find them in public places. You’ll find them under the sink in your own home. It might be something that you haven’t really thought about before, but each one of those aerosol based products can be abused.
I remember a particular client and she was with us on two different occasions. One of them was during the first year I was there and then she came back about nine months later. One day during the school hours that they had, she looked upset. And I was talking to her and she said, “I used to know how to do math”. And I said, “what do you mean”?
She said, “I can’t do this. I don’t know why, but I can’t do this. I used to know how to do math and now I can’t think.” Well, the problem is, is that in between the first time and the second time she saw us, she had begun huffing, particularly huffing Glade, which is a popular air freshener. It had caused significant damage to her brain in a very short period of time.
So let’s back up a couple steps and talk about what inhalants are, the different kinds and how they’re used. So there are four main types of inhalants. Three of them act on the central nervous system as depressants whereas the fourth functions a little differently. The first type are volatile solvents. So these are liquids that evaporate at room temperature.
These could be things like paint thinners or paint removers, dry cleaning, fluids, degreasers, gasoline, glue, correction fluids, like for typewriters or felt tip markers. Just to name a few.
The second type are aerosols. These types of inhalants have proponents and the solvent. This could be a spray paint, deodorant, hairspray, vegetable oil spray for cooking and fabric protector sprays like Scotchgard.
The third type are gases. This could be a medical anesthetic or gas used in household or commercial products. Medical anesthetics could be chloroform, halothane and nitrous oxide, which is commonly called laughing gas. Nitrous oxide, or laughing gas is the most commonly abused substance in this subsection.
This product can be found in whipped cream dispensers and products that boost the octane level in racing cars. Other household or commercial products containing gases include butane lighters, propane tanks, and refrigerants. Those three types of inhalants, solvents, aerosols, and gases act directly on the central nervous system.
The fourth category are called nitrites. These act differently in that they are vasodilators. Nitrates act primarily to dilate blood vessels and are used primarily as sexual enhancers.
There are three main types of nitrites that I’ll tell you the name of, but in general, just knowing that word nitrite is enough. There are cyclohexyl nitrites , butyl, nitrites, and amyl nitrites . These are generally referred to as poppers or snappers. Amyl nitrite is used in some diagnostic procedures and has been prescribed to treat some patients for heart pain.
Nitrates are now prohibited by the Consumer Product Safety Commission, but you can still find small amounts in things like video head cleaner room odorizer , leather cleaner or liquid aroma. I knew about those other three, but I’ve never heard of liquid aroma.
Typically people who are using inhalants, aren’t super picky about what it is that they’re using if it’s available. They do tend to have a inhalant of choice, so to speak and might go out of their way to get that specific thing. But in a pinch, any other type will work.
Surveys have been done over the years to study adolescent substance use. The numbers are going to vary from year to year, but what they found is that about 60 to 75% of inhalant users were under the age of 18.
On average, they found that a lot of inhalant abuse is happening around eighth grade. In the United States, eighth grade is approximately 13 to 14 years old, depending on the part of the country you’re in, but it’s going to be somewhere in that range.
Inhalants are easy to get, so a lot of times they are the first drugs of abuse. The research shows us that use of inhalants started as young as six years old and tapered off around 17 years old. Research further found that inhalant abuse was happening in both urban and rural environments.
Another thing that was interesting is they found the adult users of inhalants hadn’t necessarily used them as kids. And the people who are using it when they were kids, didn’t carry that into adulthood. It seems that for kids who were using that was a period of time in their life and they either weren’t using or moved on to using other things. Research suggested was that for the adult population, inhalant use not experimentation was something that began and adulthood and became severe in adulthood. Part of this might be due to the adult’s ability to have money to purchase things, to have a vehicle, to get them, to be able to buy them without questions about what they’re using it for. Whereas if a kid goes into a store and buys 20 cans of air duster, there’s going to be some questions.
My experience in working with people who have chemical dependency issues or are using substances is that air duster is going to be the most popular type of inhalant abuse. Inhalants can be used in a few different ways. Could be sniffing or snorting from a container, spraying aerosol directly into your mouth, using a bag where you’re spraying the substance into a plastic baggie, or in some cases into a balloon and then inhaling it that way. Huffing from an inhalant soaked rag, or some kind of cloth either through your nose or putting the cloth into your mouth.
These chemicals are absorbed really quickly into your bloodstream; within seconds you’re going to feel an effect. The effect only lasts for a few minutes and produces alcohol like effects for the most part. Slurred speech, inability to coordinate movement, euphoria, dizziness, lightheadedness, , sometimes hallucinations. but generally it’s the other effects, not the hallucinations that people are after in this particular case.
Like I said, it only lasts a few minutes and so repeated use is typically the order of the day. When the high starts to drop is when someone will typically use again. They’re not waiting until they have zero feeling whatsoever. It’s a matter of spiking the high. Each inhalation is going to increase the risk and the danger for a number of different outcomes.
The use of inhalants affects the central nervous system as a depressant. It also has an impact on the dopamine system as do nearly all substances of abuse. As well as interacting with other parts of the brain, like the extended amygdala.
Something that is interesting and somewhat different from other drugs of abuse is that typically people who are using pick a substance based on its pharmacological aspects. So the type of high. With people who are using inhalants, they do want that type of high, but it is based on the route of administration. So they’re going after substances based on how it’s used, as opposed to how it affects them. This typically has to do with accessibility.
So in terms of noticing, if someone’s been using inhalants, there are going to be a few ways. There could be chemical odors on clothes or on somebody’s breath. Could be paint stains on their hands or fingers or clothes. A lot of times there’s ulcers around the nose and mouth and inside the mouth. Other symptoms are similar to other drugs of abuse and so that might make it a little more difficult. Such as, decrease in appetite, weight loss, decline in school performance change in hobbies and friends, poor hygiene and grooming habits, slurred speech, those kinds of things.
Testing for inhalant use is really pretty hard. Inhalants aren’t going to stay in your system for very long and inhalants are not detected by typical urine drug screens. Clinical testing could show use through elevated liver enzymes and blood and other tissues could be tested through gas chromatography. A specific urine test could find the presence of benzene, tulane and other substances if they’re used over a long period of time. But this is a little bit like finding a needle in a haystack. Typically how we know someone has been using substances is by their possession of empty cans, cartridges or through their admission of it.
So let’s talk about the risk and danger associated with inhalants. Clearly the main one is death. A person can absolutely die from using an inhalant, even one time. Using it successfully doesn’t mean that the next time is going to be okay. Doesn’t even mean that the next hit or the next inhalation is going to be okay.
A person could be huffing for days and all of a sudden end up with what’s called sudden sniffing death, go into cardiac arrest, have a seizure, those kinds of things. It’s really volatile and the risk is largely downplayed by the using community. People who are using inhalants have experience with it and feel like if something bad was going to happen, it would have happened already.
An overdose on inhalants isn’t just when somebody dies, it can also be nausea and vomiting, irregular heartbeat, chest pains, hallucinations, blackouts, seizures, or coma.
Huffing is always dangerous, but there are some things that can make it more dangerous. Such as: doing so in an enclosed indoor environment, doing physical activity after huffing, using inhalants with other medicines or other types of drugs, and if someone has other health conditions, in addition to the inhalant abuse, okay.
You recall my young client who felt like she had lost her ability to do math, she’s not wrong. One of the things that inhalant use can cause is permanent brain damage and it doesn’t take very long. We have brain scans of chronic inhalant abusers showing the decrease in brain size and gray matter.
Inhalants put an incredible strain on the body and an incredible strain on different organs and brain functions. . Chronic use of inhalants can cause significant damage to the heart, lungs, liver and kidneys. Inhalant induced damage to different organs might be partially reversible when somebody stops using, but many of the syndromes caused by repeated or prolonged abuse are irreversible
You can imagine that use of inhalants while pregnant can cause significant harm in utero. Some studies suggest lowered birth weights, occasional skeletal abnormalities, delayed behavioral development, altered regulation of metabolism especially in males and changes in food intake and weight gain in males and females.
Some of these chemicals can cause issues with reproductive systems in the long term, increase risk for leukemia, cause injury to red blood cells, all sorts of things. So I think you get the point that inhalants are bad in general, across the board. If you’re curious about which substances cause which type of damage there’ll be links in the show notes for you to be able to look at.
It’s not that people don’t know that inhalants are dangerous, most of the people who are using them have some knowledge. Younger kids, of course, they’re not going to know as much, but adults, they know it’s dangerous, but the high or the withdrawal symptoms, bring them back.
People are using these chemicals like Freon or gasoline or other refrigerants that can cause frostbite and they’re finding ways to do it so that they don’t have some of those side effects, but the dangers of it aren’t just about someone’s health.
In 2018 in Minnesota, there was an article about a man who died from his use of air duster. Air duster is used to clean computer keyboards and computer parts typically, although I’m sure there are people who use it for other things.
The man and his wife had been together for 20 years and had a six year old son at the time he died. They had been separated because after his son was born, he had begun drinking. He got sober, but apparently started huffing in secret.
The man had been driving another town over to a local hardware store where cans were sold two for about $7. Receipts had shown that he was buying up to 10 cans every single day. At the time that he died he wasn’t able to hide it even when his son was around. His son had, unprompted, told his mom that his dad was drinking from the can with the red straw. He died at age 42 and the cause of death was listed as acute volatile inhalant toxicity. His huffing had caused a heart attack known as sudden sniffing death syndrome.
The news channel that reported on this asked for medical records from the local examiner.. While deaths from huffing aren’t super common, of the deaths they reported most of them were men in their thirties and forties. Many of the men were educated professionals who had struggled with alcohol use.
One of the men was a comedian in the Twin Cities of Minneapolis and St. Paul. Another was a man who had a degree in aerospace engineering. He had appeared as the Kinetic Man on America’s Got Talent. Another man was a dentist who had been huffing nitrous oxide, and then switched to air duster.
Air duster is cited in a number of different reports of accidents while driving under the influence. Difluoroethane, which is the chemical and air duster is not covered under DUI laws in most States. There are numerous articles all over the internet of people who were huffing, typically air duster while they were driving and ended up crashing. In some cases, just damaging property in others, killing themselves, and yet in others, killing other non intoxicated people.
I want to give you a couple case studies that I found. One is of a 43 year old, married female of average socioeconomic status. Who was part of a Hindu nuclear family that was by all accounts well adjusted and no past or current family history of psychiatric illness or substance use.
The woman was working in an office as an assistant secretary and had for the last 15 years. At the time of the case history being taken, she had been huffing typewriter fluid for three years.
She reported that the first time she inhaled it was by accident. And what she enjoyed was the relaxed feeling afterwards. She was inhaling mostly by mistake at first and only while at work.
As therapists, we’re going to wonder “three years she’s been using, what happened three years ago?” Well, three years prior her mother-in-law had moved in with them. This isn’t a bash on in-laws or specifically mother-in-law’s. I have a fabulous mother-in-law and I hope to be a fabulous mother-in-law in the future. We also know that families can be stressful. It can be complicated.
It’s not your parent. And so how your spouse is going to deal with their parent can be really difficult. How the spouse is going to deal with their parent being there is something that you don’t know until it starts happening. In this case, occasionally she would have heated arguments with her mother-in-law.
She found that when she was at work inhaling the typewriter fluid gave her a relaxed feeling and allowed her to forget about the argument for just a little while and to feel more calm. Before long, she began bringing bottles of typewriter fluid home with her. At one point she was going through three to four bottles a day. She noticed that without it she started to have cravings and was experiencing body aches, disrupted sleep, irritability, and trouble concentrating.
What started happening is when the arguments began, she would step away for a minute and inhale the typewriter fluid and come back and be able to be regulated. Initially the family was happy that she wasn’t retaliating. Later were becoming frustrated with what they felt was a lack of household work and would often find her lying alone in her room. Over the last year of her use altercations with family members and coworkers began to be a more common occurrence.
Another case study was of a 21 year old male who was brought to the emergency room while unconscious. His friends reported that he’d been huffing for several months. it was difficult to get him awake and he only responded to deep pain.
As he became more awake, he was given a CT scan that was negative. He demanded to be released from the hospital and did so against medical advice. Three weeks later, the man appears again in full cardiac arrest. Extensive resuscitation efforts were made but he was not able to recover and died. His family reported that he had been huffing gun cleaner daily.
And lastly, a 13 year old female was brought to her primary care physician by her parent. The patient stated that her headaches began over the last year and recently she had been having headaches daily.
The headaches resulted in several absences from school. The patient’s mother also noted that sometimes her daughter seemed uncoordinated, confused and somewhat clumsy. She also noted that her daughter hadn’t been eating very much and that her academic performance had declined over the semester.
The physical examination found that she had cracked peri oral skin, with irritation and sores on her lips. The nail beds of her fingers appeared to be stained with ink. Otherwise the exam was normal.
During private questioning the patient admits to her doctor that she and a friend. Have been sniffing, glue and spray paint. As is typical, she says that it happened once or twice.
I bring these case studies to you as a way of helping us see what it would look like if somebody was huffing or abusing inhalants. For a lot of people, I think it can seem somewhat out there to be doing these things as we know that these chemicals are dangerous. They smell dangerous even.
Any one of us who’ve used air duster knows that after a little bit of time using it, your hands can get frostbite. I’ve seen frost form on the side of a can. Yet the high, the way that the drug works, keeps people coming back. The high from it is really intense and very short and so you keep using every few minutes. There are videos all over YouTube of people huffing, and explaining how to do it, and you can watch that and kids can watch that.
In doing my research. I wanted to understand how people were using whippets. So those are the whipped cream cartridges that we talked about earlier. They look like CO2 cartridges for paintball guns, that kind of thing. And so I was trying to figure out how someone would use one of those.
Well, some people will put it into a balloon and I found a Reddit thread where people were talking about how they used it. There are guides everywhere for how to use different kinds of inhalants “safely”. I didn’t see on these forums where people were talking about the dangers or the risks associated with it. It’s not unusual, but because of how immediately damaging inhalants can be I always find that shocking.
The thing about inhalants is that they are dangerous the first time, the 50th time, the hundredth time, anytime in between .Causing permanent brain damage and risk for death among other physical problems. For many of us, we’re not going to run into somebody who’s been using inhalants, but it is something to pay attention to.
If you notice somebody who has sores around their mouth, we might assume that they’re cold sores. Let’s say they have sores around their mouth. Let’s say they have bloody noses. Let’s say their fingers seem chapped or have dark stains on them. It’s just something that we want to watch and pay attention to.
I think about that doctor with that 13 year old. If that doctor hadn’t known to ask those questions, think about the number of tests that would have taken place to try to figure out why this 13 year old girl was having headaches. The doctor was really astute in this case and was able to see that there was ink on her nail beds and that that was unusual.
The fact that most users are children and adolescents is alarming because of the developing brain. I can’t even imagine what long-term effect inhalants would have on brain development.
Inhalant abuse isn’t going to be as common as the other drugs of abuse. It does have a place though, and it is something that I believe we need to know. Hopefully you feel like you’ve gotten the information you need to know that it’s an issue and an ability to potentially spot inhalant abuse in a client. If you’re interested in knowing more, there are links in the show notes to different case studies and reports.
Next week, we’re going to start a little sub series and this one’s going to be about hallucinogens. There are a number of different hallucinogens and psychedelic drugs. Some of them are referred to in pop culture and some of them are less well-known. The goal is to give you an overview and to help you know, about the different hallucinogenic drugs that are out there right now. We wouldn’t be able to talk about hallucinogens without also addressing the current research that’s being done on the use of psychedelic drugs for treating trauma, among other things.
I don’t pretend to be an expert on the use of hallucinogenic drugs in our field. So our discussion won’t be me saying, yes, this is good or no, it’s not, but more evaluating the information that’s out there and what the implications might be.
I hope you’ll join me for that discussion. Hope to see you next week
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