Review of Inhalants: Euphoria to Dysfunction Editors: Charles Wm. Sharp, Ph.D. Mary Lee Brehm, Ph.D. NIDA Research Monograph 15 October 1977 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institution on Drug Abuse Office of Science 5600 Fishers Lane Rockville, Maryland 20857 Review of Inhalants: Euphoria to Dysfunction ACKNOWLEDGMENT The Research Triangle Institute organized and conducted the conference on June 7-8, 1977, in San Francisco, for which the papers in this monograph were written; assembled the bibliogra- phy; and prepared the monograph for publication. The work was done under NIDA contract 271-75-1016. Library of Congress catalog number 77-089150 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of Biosciences Informa- tion Service, Chemical Abstracts, Psychological Abstracts, and Psychopharmacology Abstracts. DHHS Publication No. (ADM) 85-553 Printed 1977 Reprinted 1979, 1985 iv FOREWORD Inhalant abuse presents somewhat unique challenges to drug abuse research, treatment, and prevention.Inhalants, or volatile solvents, do not show up in large or alarming percentages in national surveys, nor until recently were they taken very seri- ously--"glue-sniffing" has been the rather innocuous sounding popular description of the practice. But, such solvents are often the first drugs used by preteen- agers to produce a state of altered consciousness (a "high"). Under certain conditions (poverty, minority, rural situations), solvents are the most readily available intoxicants.Users tend to be young (mean age 14, range 7-17), and the seriousness of the problem becomes apparent when one finds that continued inhala- tion of industrial solvents--including lacquer thinner--can result in paralysis or even death. By virtue of the youth and vulnerability of the primary using population, the ready accessibility and increasing prevalence of these intoxicants for other common uses, and the nagging possi- bility that our survey techniques may not adequately be capturing the actual extent of use, we have a special responsibility, in my view, to be sure that we are doing all we can. This monograph provides a thorough review of the literature and critical assessment of the state of our knowledge in the several papers presented, and an important post-1970 selected bibliog- raphy on the topic. It should prove a useful text and reference. William Pollin, M.D. Director National Institute on Drug Abuse v PREFACE Inhaling psychotropic substances and vapors for mind altering and recreational purposes is older than pharmacognosy. Although one of the oldest and simplest forms of producing an intoxicated state, inhalation of volatile solvents has provoked only limited efforts to define its basic elements, to evaluate the consequences, or to deal with the problem in a systematic way. There are many reasons for this lack of interest and support. One of the primary reasons is a derogatory attitude towards the majority of the population of inhalers not only on the part of the general populace but also on the part of those from other drug cultures. Use of inhalants has no mystical or religious associa- tions . Many users, themselves, refer to inhalants as a second choice of drug for producing an altered consciousness. State- ments range from, “Anybody who would inhale that stuff must be a nut," to "I'd rather have alcohol or marihuana if I could get it. " This view may be reinforced by frequent harassment and debasement by law officials, school authorities, parents, and even siblings or fellow drug users. Another important reason for lack of focus on the problem may have resulted from calling the practice “glue sniffing.’ Although there was an apparent upsurge in the use of glue during the sixties, other forms of inhalant abuse were almost ignored and this labeling may have led to a limited approach to the problem. There is good reason to believe that most other substances which are being used today were used extensively then. Although the predominant product may change, the use of many mixtures may vary less than expected. A general attack on the use of glue led people to believe that this was an effective deterrent to "glue sniffing." However, distribution and availability may be more likely to influence the choice of substances used than the deter- rent forces of press and legal attacks. Contributing to the availability of substances has been the capability of the petro- leum, chemical, and related industries, to provide an increasing array of volatile organic substances to choose from during the past 50 some years. Also, the greater the diversity of sub- stances, the less any one government agency or consumer group will be able to focus on the total problem. Although these differ- ent mixtures may have several uses in industry and in the home and may manifest distinctly different toxicological actions, most have a common chemical and biological action dependent on their lipophilic nature. Another important reason for not focusing on inhalant abuse may be due to the type of products abused. Many of these "solvents" vii have been used for several decades and are generally considered “safe” by the average user. Agencies charged to control their safety and hazard in industry and the home have been concerned mainly with the acute toxic phase of the physiological insult. Attention has been directed more recently towards chronic and continuous long-term exposure, especially towards carcinogenicity . Also, many other "pollutants" are considered more toxic, and therefore, less attention has been focused on the more common solvents. In drug abuse circles, opiates, barbiturates, ampheta- mines, hallucinogens, and, more recently, marihuana, cocaine, and phencyclidine have been considered the major drugs of abuse. Solvent abuse is still generally considered a "minor" problem. The data here show that its use may be as much or more preva- lent than that of several of the substances mentioned above. Further, the toxicity of many of these solvents exceeds that of other drugs of abuse. Possibly the oldest form of this type of abuse is associated with the field of anesthesiology. Although scientists in the field have studied most aspects related to these drugs, they have not care- fully evaluated the recreational use of anesthetics. Not only are some of the abused inhalants used as anesthetics, the state of intoxication is comparable to Phase I-II (or "light") anesthesia. It is therefore very appropriate for those in this field to apply their techniques and knowledge to the study of inhalant abuse, especially now that they are concentrating on analogous problems associated with the repeated administration of anesthetics. One of the first attempts to survey the inhalant problem was by Bass in 1970. Although the National Institute on Drug Abuse has included the use of inhalants in surveys, no thorough evaluation of the prevalence of solvent abuse exists. Despite these defi- ciencies , this publication has been assembled through the efforts of several qualified scientists to review that information which is presently available and to discuss the relevant issues associated with inhalant abuse. Hopefully, many investigators will be stimu- lated to study this problem. Also, clinicians and others in the community may be able to make use of this information and in- crease their efforts and cooperation in resolving the problem. Because of the more complete treatment elsewhere, inhalants such as cocaine, marihuana, and other drugs taken intranasally or otherwise inhaled as a second route of administration are not covered here. Also not discussed is the misuse of many of the inhaled substances through accidental or purposeful ingestion. This effort has been a culmination of many people's effort, thought, and reports. It is the intention that this compendium be the basis for energizing thought and action in this area not only in interest but also in support at all levels of our society. viii Perhaps society can begin to look on this group, as it is begin- ning to look on alcoholics, with less disdain and view them as a group needing more positive consideration in home, school, and the community at large. Charles Wm. Sharp, Ph.D. Research Biochemist Division of Preclinical Research National Institute on Drug Abuse ix CONTRlBUTORS Dr. Domingo M. Aviado Dr. Sidney Cohen Senior Director of Biomedical Director, Council on Alcohol Research and Drug Abuse and Allied Chemical Corporation Principal Investigator, P.O. Box 1021R Marijuana Research Project Morristown, New Jersey 07960 13020 Sky Valley Road Los Angeles, California 90049 Dr. Robert E. Bowman Professor of Psychology Department of Psychology Dr. Betsy S. Comstock Primate Laboratory Associate Professor of Psychiatry University of Wisconsin Baylor College of Medicine 22 North Charter Street Houston, Texas 77025 Madison. Wisconsin 53706 Dr. Mary Lee Brehm Research Psychologist Dr. Eric G. Comstock Center for the Study of Social Behavior Director, Institute of Clinical Research Triangle Institute Toxicology Research Triangle Park, North Carolina 27709 1802 Medical Towers 1709 Dryden Dr. James V. Bruckner Houston, Texas 77030 Assistant Professor of Pharmacology Department of Pharmacology University of Texas Medical School Dr. Daniel Couri at Houston Professor of Pharmacology P.O. Box 20708 Director of Toxicology Houston, Texas 77025 Department of Pharmacology, Toxicology Division Ma. Eleanor Carroll