What are they

Inhalants are substances produced from organic chemicals. They are a depressant, which means they slow down brain functions and the activity of the central nervous system – affecting body mind and emotions.

There are hundreds of inhalant products used to achieve a state of intoxication. All have different effects and carry with them different risks and consequences. There is no safe level of inhalant use.

There are four categories commonly used to classify inhalant products:

• Solvents are liquid or semi-solid substances that vaporise at room temperature giving off fumes. Examples include petrol, glue and correction fluid.
• Aerosols usually contain solvents and propellant gas contained under pressure. Examples include spray paint and fly spray.
• Gases include medical anaesthetics such as ether, chloroform and nitrous oxide as well as household and industrial gases found in fuels and fire extinguishers.
• Nitrites are slightly different in that they do not suppress the central nervous system.  They dilate blood vessels and are also muscle relaxants. Examples include amyl, butyl and isobutyl nitrite (together known as alkyl nitrites or poppers)

The rest of this section will refer to the top three categories and use the term inhalants to encompass all products.

Children and teenagers are the most common groups who use inhalants recreationally. Users are defined within four categories:

• The experimenter: Usually children and teenagers fall into this category. Experimentation does not usually last long, and is motivated by curiosity and a desire to imitate peer behaviour.
• The social /situational user: These are generally children and teenagers who, after experimentation, continue to use inhalants in a recreationally, usually with a group of friends. It is common for social use to end by mid-adolescence as other interests develop. This can include a move towards alcohol and tobacco.
• The problematic user: This user relies on inhalants daily and allows them to take priority over other important activities. Users at this usually experience behaviour changes including hassles with friends or families, health problems, the inability to handle common situations, and changing feelings. Help should definitely be sought at this stage.
• The chronic user: A very small number of inhalant users make up this category. It occurs when they are using increasing doses to achieve the desired effects. It is common for chronic users to use inhalants alone. People at this stage have increased behavioural problems and become unstable, especially within social environments.

Slang

Glue, Gas, Sniff, Huff, Chroming, Poppers, Fuels, Aerosols, Solvents, Nitrites

Health effects

It is important to understand there is a large and varied range of products that can be abused. Intoxication levels and effects can differ depending on the method of use and the make up of chemical compounds present in different substances. The effects below are commonly experienced with a broad range of products. 

Short-term effects

Inhalants enter the blood stream directly from the lungs. The effects are felt immediately as the chemicals contained in inhalants rapidly reach the brain and other organs. Effects of inhalant use vary between persons and environments so it is difficult to predict the effects the inhalants will have. Combinations of inhalants and varying dosage may also affect an individual's reactions.

Short-term effects include:

• initial feelings of wellbeing and relaxation
• excitement
• loss of inhibitions
• drowsiness
• flu like symptoms
• reckless behaviour
• blurred vision
• unpleasant breath
• depressed reflexes
• nosebleeds and sores around the mouth and nose.

Short-term effects are similar to those from alcohol. They usually subside after an hour, with the initial high subsiding after only seconds or minutes. Mild hangovers or headaches can occur after the immediate effects wear off and, in extreme cases, these can last up to several days, depending on how much was inhaled.

If large quantities are inhaled over a short period the effects are intensified and the user may become disorientated and lose control of their body and feelings. This can lead to dangerous behaviour and result in injury.

Long-term effects

Heavy and frequent use of inhalants can result in intensified short-term effects and can cause serious physical and psychological problems, including:

• pale appearance and weight loss
• tremors
• feelings of tiredness
• constant thirst
• facial sores
• memory loss
• personality changes
• irritability
• stupor or coma
• seizures
• irregular heartbeat
• problems with breathing
• brain and nerve damage.

The lead in petrol, and some chemicals in other inhalants, may build up in the body irritating the lining of the stomach and intestines, damaging the brain, nervous system, kidneys and liver and can also cause various types of cancer. Inhaling chrome based paints (chroming) may lead to bloodshot eyes as blood vessels in the eye burst, eventually leading to blindness. Amnesia may also result.

Medically long-term use can cause damage to the brain. Hepatitis, bone marrow suppression and renal failure are also noted.

A small number of deaths have occurred from inhalant use, most commonly from cardiac arrest, known as ‘sudden sniffing death’. Death at first time use following inhalation from aerosols and fire extinguishers has also been documented.

Dependence, addiction and overdose risk

Prolonged use of inhalants increases the likelihood of becoming tolerant, meaning a user's body adapts to the effects of inhalant use and needs more to achieve the desired high.

Psychological dependence can develop where inhalants are used to manage day to day functioning leading to clouded thoughts and actions.

Physical dependence is considered rare, buts occurs when users develop withdrawal symptoms including shaking and sweating until they receive another dose of their preferred inhalant.

Withdrawal symptoms also happen when the user decides to suddenly stop their inhalant use. Withdrawal effects are usually mild, but some users can experience extreme symptoms including anxiety, depression, loss of appetite, irritation, aggressive behaviour, dizziness, tremors, and nausea.

Death from inhalant abuse and it can be random meaning users can die from there 1^st use, 50^th use or 100^th use. It is impossible to guarantee safe use. See the special section on sudden sniffing death.

Law and penalities

As most inhalants in New Zealand are common household products, it is not practical to make them illegal.

Although it is not illegal to possess inhalants, police can hold people under the influence of inhalants for detoxification under the Alcoholism and Drug Addiction Act 1966.

Furthermore the Child Youth and Family Act 1989 states that when a child or young person is in a situation where their physical or mental healthy is likely to be impaired, police can deliver the child to the custody of their parents or guardian, with child consent.

Some councils have enacted by-laws restricting the use of ‘mind altering’ substances in public places. This gives police the power to seize such products and move users away from public places.

The Summary of Offences Act 1981 was recently amended to make it an offence for retailers to sell spray cans to under 18-year-olds and requiring that spray cans are only accessible by retail staff.

While this measure was originally intended to reduce the incidence of graffiti, it gives retailers the right to refuse sale of products to people they suspect will abuse them.

Drug trends

Inhalant use in New Zealand is not widespread and research indicates that inhalants are tried and used by very few people. Those who do are generally young teenagers and most users fall in to the experimentation category. Inhalant abuse is episodic and largely a group activity especially for teenagers who are experimenting.

However inhalant research in New Zealand is very limited and generally does not capture the younger age groups.

According to the latest Drug Use in New Zealand Survey 2007/2008 published in 2009:

• 2.2 percent of 16- to 64-year-olds have ever used inhalants (this includes nitrites) and only 0.1 percent have used in the past year
• 1 percent of 16- to 64-year-olds have ever used solvents (this includes glues, butane) and use increases with neighbourhood deprivation
• 15 years of age was the median age of use for those that had ever used solvents
• 0.1% of 16- to 64-year-olds had ever used solvents. Males were more likely to use than females. 

Reducing the harm

The Drug Foundation’s message is clear: no drug use is the safest drug use. However, we know there will be occasions when people ignore warnings and use drugs in a dangerous manner. To help keep communities safe we therefore provide information about proven methods of drug harm reduction.

Those intending to use inhalants should note the following list of steps to help reduce the risks involved.

• Surround yourself with a close group of friends at all times and make sure not all are using solvents so others can look after you if something goes wrong.
• Do not spray aerosols directly into the mouth. This can be very dangerous. One effect is that aerosol substances are very cold and may freeze the throat causing breathing to become irregular or stop.
• Do not use lighters or matches around inhalants as they are often very flammable.
• Do not put plastic bags over your head as this can cause suffocation.
• Do not drive while under the influence of inhalants as they can affect coordination and the ability to judge speed and distance.
• Do not combine inhalants with alcohol as the combined effects can be very unpredictable.
• Do not use inhalants if you have a personal or family history of mental health problems.
• Do not use inhalants when in a negative state of mind; or to cloud negative feelings because they could make those negative feelings worse. Also you are more likely to become aggressive and engage in risky behaviours that may harm yourself and/or others.
• It is important to note that it is impossible to guarantee safe use of inhalants. Death and overdose is a very real risk with inhalant abuse and it can be random, meaning users can die or overdose from their 1^st use, 50^th use or 100^th use.
• The likelihood of death can be reduced if peers are aware of the signs and are able to resuscitate the user immediately, as in many cases there is no time to wait for medical attention.

The Drug Foundation has produced a Volatile Substance Guide for Retailers. Retailers can play an important role in helping to reduce the incidence of inhalant abuse. It is a website which has simple tools to help retailers, including:

• ways to improve in-store displays and signage,
• training on handling difficult customers
• advice on dealing with emergencies
• tips on improving security.

It also has video clips of shop owners and health workers talking about the issue.

Retailers are able to order a range of materials from the website to support their decision to act responsibly when selling volatile substances. www.volatilesubstances.co.nz

How to get help

If you feel you or anyone you know needs help, there are a number of treatment organisations you can contact in strict confidence.

DrugHelp is a uniquely New Zealand website for people looking for help with their own or someone else’s drug use. DrugHelp shares the stories, experiences, insight and hope of people who have been there – people who have abused drugs and found a way through. www.drughelp.org.nz

The Alcohol Drug Helpline (0800 787 797) provides free and confidential support for any person concerned about their own or another person's alcohol or drug use. When you call you will talk to an experienced counsellor who is there to listen. You can trust the helpline to provide you with confidential and non-judgemental help when you need it.

The helpline is open from 10am-10pm, every day.

You can also get contact details for your local alcohol and other drug counsellor or treatment provider by calling the helpline or by visiting www.addictionshelp.org.nz .

You can contact New Zealand’s Poison and Hazardous Chemicals Information Centre toll free for advice on 0800 poison (764 766). Lines are open 24 hours per day every day. In case of poisoning or inhalation (intentional or not) call immediately.

However, if the person is having trouble breathing or unconscious call 111 immediately.

What to do in a crisis

If someone overdoses, becomes unwell, or has a bad reaction to alcohol or any other drug, do not hesitate to get emergency medical assistance. A quick response could save their life.

• Dial 111 and ask for Ambulance. Do not wait to see if the person comes right on their own.

• Stay with the person until medical help arrives. Find out if anyone on the scene knows mouth-to-mouth resuscitation and/or cardiopulmonary resuscitation (CPR). Have them stand by in case the person stops breathing or you can no longer detect a pulse.
• Ensure the person has sufficient air. Ask crowds to stand back, open windows, and loosen any tight clothing.
• If the person is unconscious roll them onto their side into the recovery position so they won’t choke if they vomit. Tilt their head back slightly to ensure their tongue does not obstruct their airway.
• If the person stops breathing apply mouth-to-mouth resuscitation, if you cannot detect a pulse begin CPR.
• When the ambulance arrives give the medics as much information as possible – what drugs were taken, when they were taken, and whether the person has any existing medical conditions.
• Before you go out, know what to do in a crisis.

Sudden sniffing death

Cardiac arrest, known as ‘sudden sniffing death’ is unique to inhalant users and highlights the significant risk associated with the abuse of inhalants. Immediately after use the user can experience arrhythmia, the irregular muscle contraction of the heart. If medical attention is not immediately sought the heart may lose the ability to effectively pump blood. This is a very rapid and unpredictable experience.

Death can also occur several hours after inhalation from respiratory depression. This dangerously slowed breathing can inhibit oxygen supply. Vomiting while the user is intoxicated or sedated can lead to choking.

Hypoxia (reduction of oxygen in the blood) can occur when users are huffing (inhalation with a plastic bag or soaked cloth over their face) restricting the amount of fresh air they can take in. Spraying directly into one’s mouth is a major risk, as the cooling agents in aerosol cans can freeze the throat and cause suffocation.

The likelihood of death can be reduced if peers are aware of the signs and are able to resuscitate the user immediately, as in many cases there is not time to wait for medical attention.

Links

A list of relevant links to further information and resources about inhalants and solvents:

www.inhalants.org.au Australia’s National Inhalant Service provides information, research and support for communities, parents, teachers and AOD workers.

www.poisons.co.nz The National Poisons Centre maintains an accurate and up-to-date database of almost all poisonous substances in New Zealand and Australia, and provides professional and timely advice during poisoning incidents.

www.moh.govt.nz/moh.nsf/indexmh/drug-use-in-nz-key-results-of-the-0708-nzadus Drug Use in New Zealand: Key results of the 2007/08 New Zealand Alcohol and Drug Use Survey.

www.parliament.vic.gov.au/ Inquiry into the Inhalation of Volatile Substances: A Comprehensive review of the evidence by the Victorian Drugs and Crime Prevention Committee, Melbourne.

www.volatilesubstances.co.nz A volatile substance guide for retailers, produced by the New Zealand Drug Foundation.

www.mentalhealth.org.nz/ Mental Health Foundation of New Zealand. (2002) Solvent and Inhalant Problems.

www.drughelp.org.nz uniquely New Zealand website that helps people who use drugs, and their loved ones, find solutions to the problems drug use has caused.