Signs of Inhalant Abuse

Inhalants enter the body through the nose or mouth. The human respiratory system works to bring oxygen into the body quickly. The lungs have a huge surface area and a rich capillary supply that rapidly and efficiently absorbs oxygen. When gaseous and volatile drugs are inhaled, they take advantage of this path, traveling through the lungs to the blood and reaching the brain in seconds.

The immediate effects of inhalant abuse are similar to the classic early stages of anesthesia. The sniffer is initially stimulated, excited, disinhibited, and prone to impulsive or reckless behavior. He may also feel lightheaded and, with successive inhalations, less inhibited and less in control. The speech of the user becomes slurred and gait becomes staggered, with similarities to intoxication by alcohol. Euphoria, often accompanied by hallucinations, also may occur. This is followed by disorientation, muscle weakness, drowsiness, and sleep, most commonly after repeated cycles of inhaling the chemical.

The brain is a complex organ responsible for the coordination and regulation of all of the activities in life. Individual cells of the brain are called neurons. Neurons communicate with one another and with the rest of the body to allow us to think, feel, and perform physical actions. Inhalants and other drugs of abuse alter this basic and necessary communication between neurons to produce their effects, such as euphoria, hallucinations, and sedation. There are approximately 100 billion neurons in the human brain. Neurons have wire-like processes called axons, which transmit information away from the cell, and processes called dendrites, which receive information from other cells. A single neuron’s axon can transmit information to other cells over long distances (even four feet), while other neurons may transmit information short distances to neighboring cells. Axon endings make contacts on the cell bodies or dendrites of other neurons. The cell body is the part of the cell containing the nucleus. Neurons can have highly branched dendrites, on which axons from other cells can terminate, forming a synapse, where information can be communicated from one cell to the other. All psychoactive drugs exert their actions on individual neurons in the brain, more specifically, drugs act on the contact points, or synapses, between cells. The synapse is the site of many important brain proteins, including ion channels that are responsible for the rapid transmission of information between neurons. Inhalants are central nervous system (CNS) depressants. This means they slow down brain activity, which produces a calming and drowsy effect on the body. Other CNS depressants include narcotics, benzodiazepines, and barbiturates. The most widely abused CNS depressant is alcohol. All of these drugs have the potential to become both physically and psychologically addicting, and the mechanisms for the depressant effects of these drugs have been shown to overlap.

Dangers of Inhalant Abuse

ORGAN DAMAGE:

The abuse of inhalants can cause irreversible damage to the body. Organ damage and other disorders can result from chronic and long-term use of these drugs. Not all inhalants act alike. The abuse of different chemicals can cause damage to many different organs. In some cases, the damages have not been fully identified. This is a particular problem in inhalant abusers who abuse multiple drugs or who lack adequate nutrition and proper medical care.

The nervous system is particularly susceptible to chemical abuse. Damage to the peripheral nervous system can cause numbness, weakness, and muscle paralysis. Many inhalants have been shown to damage the myelin sheath, the protective coat around nerve cells. This causes symptoms like those seen in individuals with multiple sclerosis, including unusual fatigue, vision problems, loss of muscle coordination, slurred speech, and tremors. Direct damage to the brain also occurs with inhalant abuse. Research has shown atrophy, or shrinkage, of the brain’s white matter with inhalant abuse. Brain damage results in impaired cognition, learning difficulties, changes in behavior and personality, problems with coordination and movement, lost or impaired sight, and hearing and memory loss. Nitrous oxide use has been associated with damage to the nervous system and in particular the spinal cord. Nitrous oxide deactivates vitamin B12, which is vital for making the sheath that protects the spinal cord. The lack of vitamin B12 can result in spinal cord degeneration. Other reports have noted symptoms of numbness and weakness in the hands and legs, ataxia (the loss of ability to coordinate muscle movement), impotence, paralysis of the bladder and bowel function, personality changes, and impaired memory and intellect. Lung inflammation, pneumonia, and other infections are frequently observed in chronic solvent abusers. Inhalant abuse can cause chemical pneumonitis, in which the lungs swell and fluid builds up in them. This can cause breathing difficulties, scarring of the lung tissue, and in some cases, death.

Inhalant abuse is also linked with the development of Goodpasture’s syndrome, a disorder causing hemorrhaging of the membranes lining the lungs and the kidneys. If undiagnosed and untreated, Goodpasture’s syndrome can be fatal. The heart is also a target of inhalant toxicity. Abnormal heart rhythms are associated with inhalant abuse, which can result in sudden death. Liver function is often abnormal in chronic inhalant abusers. After abstinence, function usually returns to normal, but if the individual returns to inhalant use, the problems will return. When inhalant use is coupled with alcohol abuse, which also causes liver toxicity, additive effects may occur. Inhalant abuse can result in kidney stones, severe kidney damage, and acute renal failure. Electrolyte imbalances can occur in the kidneys and individuals may have difficulties urinating. In severely affected patients, this results in mental confusion, muscle weakness, nausea, and vomiting. Goodpasture’s syndrome and glomerulonephritis, a chronic form of kidney disease, may also occur.

Exposure to nitrites appears to be associated with tumor incidence and infectious disease in animals. In humans, volatile nitrite use has been linked to Kaposi’s sarcoma, cancer that commonly occurs with AIDS. Researchers hypothesize that nitrite use may contribute to the development of this cancer. Research also indicates that nitrites damage and impair the immune system, decreasing its ability to counter disease.

Some inhalants show toxicity to blood and bone marrow. Benzene is a solvent that is very toxic to bone marrow. It can cause leukemia and severe anemia. Nitrous oxide does damage to bone marrow in chronic users. Another chemical in inhalants, methylene chloride, is converted to carbon monoxide in the body. Carbon monoxide can prevent the transport of oxygen in the blood and result in brain damage.

SEXUALLY TRANSMITTED DISEASES

Nitrites, which are mainly abused by older adolescents and adults, are typically used to enhance sexual function and pleasure. The use of these drugs has been shown to be associated with unsafe sexual practices. These practices put the users at a greater risk of contracting and spreading sexually transmitted diseases such as HIV and hepatitis.

INHALANT ABUSE AND PREGNANCY

Women who are pregnant and inhalant abusers are at a heightened risk of kidney damage. Inhalant abuse also puts the developing fetus at high risk for a condition known as “fetal solvent syndrome.” Case reports of newborns with fetal solvent syndrome have shown that prenatal exposure to inhalants (toluene and trichloroethylene) can result in lower birth weights, skeletal abnormalities, and delayed neurological and behavioral development. At this time, there is little known about the consequences of the abuse of specific chemicals and links to particular birth defects, but because of the potential for grave consequences of inhalant abuse, pregnant women are advised to avoid exposure to inhalants.

ADDICTION

Addiction to inhalants is a disease that interferes with and eventually overwhelms the abuser’s life. The abuser spirals into needing inhalants and becomes addicted to the drug. Despite the consequences, such as loss of a job, spouse, or health, the addict will continue to seek the drug out of this necessity.

DEPRESSION AND SUICIDE

The euphoria of the high a user experiences from inhalants is short-lived. The high ultimately ends and may be followed by an even more extreme low. Abuse of gasses and solvents can cause severe mood swings and bouts of depression. When an individual is already struggling to cope and unhappy, the “pessimistic fatalism” may take hold and convince the individual that his life is no longer worth living. Abusers of inhalants are at a higher risk of committing suicide than people who do not use inhalants.

DEATH

Sudden sniffing deaths have occurred in many first-time users of inhalants, highlighting the dangers of trying these drugs. Sniffing chemicals in solvents and aerosol inhalants can depress the central nervous system and cause the heart to beat slowly and irregularly. On top of this, users may have a rush of the hormone adrenaline, produced in response to fear, surprise, stress, or excitement. Hallucinations caused by the drug, or fear of being caught or confronted by a figure of authority, may result in a rush of adrenaline during inhalant use. Adrenaline can cause the heart to experience an even more irregular rhythm, called cardiac arrhythmia, to the point that the heart may stop beating. At this point, blood and oxygen will no longer reach the brain. There are no warning signs that cardiac arrhythmia will occur, and stopping inhalation once an arrhythmia begins in many cases does not cause the arrhythmia to stop. It may be dangerous to intervene with a sniffer during use because of the risk of producing stress or fear. Sudden sniffing deaths are responsible for more than half of the deaths due to inhalant abuse.

If a sniffer has used inhalants before without consequence, that does not mean she does not have a chance of experiencing a cardiac arrhythmia. Sudden sniffing deaths are mostly associated with aerosols, butane, toluene, and propane. Inhalant use can also cause deaths by suffocation and anoxia (complete lack of oxygen). In these cases, oxygen is displaced from the lungs by the inhaled chemical. Without any oxygen reaching the brain, breathing ceases. Suffocation is most often the result of breathing from a paper or plastic bag placed over the head or attached to the mouth and nose. Some inhalants coat the lungs and make breathing difficult, or lower the levels of oxygen in the blood (hypoxia). This danger is the reason for the label warnings on aerosols and solvents to use these products in well-ventilated areas. Even when using these products for their legitimate purposes, users are warned to prevent overexposure to solvent fumes. Vagal inhibition is another direct cause of death in inhalant users that results from inhalation of cold gasses from aerosol propellants. When these gasses are sprayed directly into the mouth, the larynx is stimulated by the cold substance and leads to a reflex inhibition of the heart. As a result, the heart will either slow down or may stop beating completely, causing death. In some cases, deaths have occurred by suffocation because the throat freezes due to contact with the cold substance, and the user cannot breathe and dies. In nonfatal cases, the low temperatures of the gasses can cause frostbite and severe tissue damage. Since volatile solvents depress the central nervous system, including the respiratory center of the brain, prolonged use can be hazardous. Respiratory depression can progress to respiratory arrest, in which the user stops breathing and dies. Death by choking is another possibility. Some users of inhalants have choked to death on their own vomit. Deaths from injuries are also common. Inhalants impair judgment and can cause the user to become careless or aggressive. As with other drugs of abuse, driving while under the influence is dangerous. A sniffer may think he is invincible, have unnatural self-confidence, or have hallucinations that he can fly, for example. Sniffers have died from attempting to jump from considerable heights, off buildings, and in front of trains, because of these delusions of grandeur. Another common accident occurs when someone lights a cigarette when friends are huffing flammable substances such as butane and gasoline. Many sniffers have been severely burned or killed in this type of accident.

SOCIAL CONSEQUENCES

Because of their mood-altering properties, inhalants (and other drugs) are often used to avoid problems. The drug user may have maladaptive behavior when coping with adverse situations and emotional difficulties. An inhalant abuser will turn to drugs instead of learning to handle his emotions and make thoughtful and responsible decisions. This can become a mental and emotional crutch that hinders personal growth.

PHYSICAL AND LONG-TERM CONSEQUENCES OF INHALANT ABUSE:

 

  • Death—sudden sniffing deaths, suicide, cardiac arrest, suffocation, choking, respiratory arrest, injuries
  • Addiction
  • Brain damage and shrinkage
  • Spinal cord damage
  • Impaired learning and cognition
  • Memory loss
  • Personality and behavior changes
  • Problems with coordination and movement
  • Loss of vision or impaired vision
  • Impaired hearing
  • Peripheral nervous system damage
  • Muscle paralysis, weakness, numbness
  • Abnormal heart rhythms
  • Scarred lung tissue, impaired breathing, chemical pneumonitis
  • Goodpasture’s syndrome
  • Hand tremors
  • Weight loss
  • Liver toxicity and disease (Glomerulonephritis)
  • Kidney damage or failure, kidney stones, electrolyte imbalance
  • Sores or rash on face
  • Leukemia
  • Anemia
  • Damage to bone marrow
  • Impaired immune system
  • Developmental harm to newborns

 

Psychological dependence

The psychological dependence affects the behavior of the user. The individual has a particular mental state that is characterized by an imperious wish of using the drug in order to obtain the drug’s effects.

            Among the behavioral changes of the addict, we may include:

  • Drunk or dazed appearance
  • Lack of coordination/dizziness
  • Slurred speech
  • Apathetic behavior and depression
  • Aggressiveness and violent behavior
  • Inability to concentrate or inattentiveness
  • Anxiety
  • Loss of appetite, weight loss (long term)
  • Nausea
  • Excitability
  • Impaired vision
  • Fatigue
  • Memory loss

 

Physical dependence

Physical dependence occurs when inhalant addicts develop pathological organic needs of using the substance in order to avoid the disorders that may appear as soon as the individual stops administering the drug.

Physical dependence is often recognized by addict’s physical changes like:

  • Red eyes
  • Nosebleeds, red or runny nose
  • Sores around the mouth and nose
  • Pupils either constricted or dilated
  • Fast, deep, or labored breathing

 

Recognizing an Inhalant Addiction

Inhalant abuse may be recognized by both physical and behavioral signs. Some of these behaviors are mistaken for drunkenness, and many of the physical signs can be mistaken or go unnoticed. The most-often-recognized sign is the smell of chemicals on the breath. Signs of inhalant use include the following:

Physical signs:

  • Chemical odors on hair and clothing
  • Smell of chemicals on breath
  • Empty spray cans or bottles
  • Hidden glue bottles or aerosols
  • Hidden chemical-soaked rags
  • Paint stains on clothing or skin
  • Neglect of personal appearance/hygiene
  • Red eyes
  • Nosebleeds, red or runny nose
  • Sores around the mouth and nose
  • Pupils either constricted or dilated
  • Fast, deep, or labored breathing

Behavioral signs:

  • Drunk or dazed appearance
  • Lack of coordination/dizziness
  • Slurred speech
  • Apathetic behavior and depression
  • Aggressiveness and violent behavior
  • Inability to concentrate or inattentiveness
  • Anxiety
  • Loss of appetite, weight loss (long term)
  • Nausea
  • Excitability
  • Impaired vision
  • Fatigue
  • Memory loss

 

Signs of Overdose

The intoxication lasts only a few minutes. Abusers often try to prolong the high by continuing to inhale the drug repeatedly over the course of several hours. This is considered to be a very dangerous practice. With successive inhalations of the drug, abusers may suffer the loss of consciousness or even death. Sudden death can result from a single session of inhalant use by an otherwise healthy young person. It is particularly associated with the abuse of butane, propane, and chemicals in aerosols. Inhalant abuse can also cause death by suffocation from repeated inhalations, which lead to high concentrations of inhaled fumes displacing the available oxygen in the lungs, suffocation by blocking air from entering the lungs when inhaling fumes from a plastic bag placed over the head, and choking from swallowing vomit after inhaling substances.