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Inhalant Use Disorder INHALANT USE DISORDER DANA BARTLETT, RN, BSN, MSN, MA Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material, written textbook chapters, and done editing and reviewing for publishers such as Elsevire, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students. ABSTRACT An inhalant use disorder is diagnosed according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and includes use of traditional categories of inhalants, such as aerosols, gases, nitrites, and solvents. Inhalants are often used to describe volatile substances that the user inhales for a psychoactive effect. Chemicals misused as inhalants are often found in various household products that some United States jurisdictions have started to regulate. Identification and treatment of an inhalant use disorder requires partnership with professionals and community support persons. Inhalant use disorders require a unique approach by all members of the interdisciplinary health team to raise awareness of the risk, prevention, and available treatment of an addiction to solvents. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 2.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 0.5 hours (30 minutes). Statement of Learning Need Clinicians need to be informed about how to identify and diagnose an inhalant use disorder according the DSM-5 criteria. To diagnose accurately, clinicians need to able to know of the physical and psychological effects of an inhalant use disorder and the available treatment for individuals with an acute solvent intoxication and an inhalant use disorder. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Course Purpose To provide information about DSM-5 criteria to diagnose an inhalant use disorder as well as the treatment and ongoing support for those affected by it. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Dana Bartlett, RN, BSN, MSN, MA, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – All have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC. Release Date: 6/17/2016 Termination Date: 6/17/2019 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 Introduction An Inhalant use disorder is defined by the American Psychiatric Association as the “ . problematic pattern of use of a hydrocarbon- based inhalant substance leading to clinically significant impairment or distress.”1 Still commonly known as solvent abuse or volatile substance abuse, this substance use disorder puts users at risk for significant acute and chronic clinical effects and long-term inhalant use can cause irreversible physical and psychiatric damage. Because inhalants are widely available and can be legally purchased they are often the first choice of adolescents who are beginning to experiment with altering consciousness and their use is associated with illicit drug use, as well. Intoxication from commonly used inhalants is rapid in onset, dissipates quickly, and does not produce a marked hangover, and these qualities make inhalants a popular “starter” drug. Fortunately, inhalants have never been as popular as alcohol or marijuana and although adolescents may use them for a (relatively) brief period of time, the incidence of the disorder declines significantly after the teenage years,1 and there is statistical evidence that in recent years inhalant use disorder has been declining.2 However, these are dangerous substances. As mentioned previously the commonly used inhalants can cause significant clinical effects, including sudden death. Although long-term, chronic use is quite uncommon, it has been estimated that at least 10% of American adolescents aged 13 have used an inhalant at least once.1 Given the nature of the risk, inhalant use disorder is a serious public health problem. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Products And Solvents Commonly Used There are dozens of legal and commercially produced substances that are used for inhalant use. Examples include:3-6 Table 1: Substances Used For Inhalant Use Air fresheners Cleaning products Computer keyboard cleaners Fluorinated hydrocarbons, a.k.a., Freon Gasoline Glue Hair spray Lighter fluid Nail polish remover Nitrous oxide Pain stripper Paint thinner Simple asphyxiant gases, i.e., butane, propane Spray paints Typewriter correction fluid Whipped cream dispensers Many of the products listed in the table above differ in their ingredients and some are quite similar or almost identical to each other. Regardless of the differences or similarities, each one contains a solvent or is a compound that can be used as a solvent. The solvent is volatile and can easily evaporate to form a vapor. In addition, many of these solvents are hydrocarbons. The definitions of these terms are important to remember. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 Table 2: Definitions Solvent A solvent is defined as a substance that is capable of dissolving. Solvents are valued for this capability and are often used as a carrier vehicle for other chemicals or compounds. Examples include: simple petroleum distillates are often used as a carrier vehicle in household pesticides and alcohol is used as a solvent/carrier vehicle in products such as mouthwashes and solid deodorants. Toluene is one of the most common solvents and is often found in the products such as glue that are used for inhalant use. Volatile Volatility is defined as the ability to evaporate and form a vapor. Vapor A vapor is defined as the gaseous form of a liquid. Hydrocarbon A hydrocarbon is an organic compound that contains carbon and hydrogen only. Hydrocarbons are derived from petroleum (oil), they can be gases or liquids, and hydrocarbon-based products are perhaps the most common solvent used. Hydrocarbons are in use everywhere; gasoline, lighter fluid, kerosene, and paint thinner are hydrocarbons. Substances that are used for solvent use rarely involve a single compound. In addition, some of the products in Table 1 may: 1) not contain a hydrocarbon, 2) be a mixture of many hydrocarbons, 3) be a mixture of hydrocarbons and non-hydrocarbon compounds; and, 4) not be used as solvents. For example, gasoline and the simple asphyxiants are hydrocarbons, they are volatile and they are often used, but they are not solvents. Glues themselves are not solvents, but they typically contain hydrocarbons such as hexane and toluene that are used as solvents, and they often contain acetone, a ketone which is not a hydrocarbon but that forms a vapor that can cause intoxication. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 This complexity in nomenclature and in the nature of the products that may be inhaled can make understanding solvent use difficult. But if the definitions in Table 2 and the definition of solvent use are kept in mind, understanding the problem of an inhalant use disorder becomes simpler. An example is typewriter correction fluid, which contains a hydrocarbon, petroleum naphtha. The petroleum naphtha is used as a solvent for the other ingredients of the correction fluid, and the chemical properties of petroleum naphtha allow it to easily form a vapor. It is the vapor from the petroleum naphtha that is inhaled and produces intoxication; and, an inhalant use disorder is the deliberate inhalation of the vapors from volatile organic compounds for the purposes of altering consciousness. Table 3: Commonly Used Solvents/Products Acetone: Glues, nail polish removers, paint removers Amyl nitrite: Vasodilator, cyanide antidote Butane: Fuels for lighters, stoves, etc. Fluorocarbons:
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