National Institute on Drug Abuse RESEARCH MONOGRAPH SERIES Inhalant Abuse: A Volatile Research Agenda 129 U.S. Department of Health and Human Services • Public Health Service • National Institutes of Health Inhalant Abuse: A Volatile Research Agenda Editors: Charles Wm. Sharp, Ph.D. Fred Beauvais, Ph.D. Richard Spence, Ph.D. NIDA Research Monograph 129 1992 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 ACKNOWLEDGMENT This monograph is based on the papers from a technical review on “Inhalant Abuse” held in 1989. The review meeting was sponsored by the National Institute on Drug Abuse and the Texas Commission on Alcohol and Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder’s permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in this volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein. National Institute of Drug Abuse NIH Publication No. 93-3475 Printed 1992 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of American Statistics Index, BioSciences Information Service, Chemical Abstracts, Current Contents, Psychological Abstracts, and Psychopharmacology Abstracts. ii In Memoriam Sidney Cohen, M.D. 1910-1987 Throughout his distinguished career as a physician, researcher, mentor, author, and Federal administrator, to name some of the major roles he played, Dr. Sidney Cohen represented the highest level of integrity and commitment to truth. Perhaps it was that essential commitment that enabled Sid to avoid being seduced by the “psychedelic revolution” embraced so uncritically by some of his colleagues in the early 1960s. But he also never succumbed to the hysteria that maintained that all the problems of youths could be uncritically attributed to their drug use. His sense of proportion, good humor, and wide ranging knowledge of both science and history gave him a rare and wise perspective during a troubled era. Sid Cohen’s impressive skills as a communicator enabled him to make important contributions to both drug abuse research and to the public’s understanding of the drug problem. Because he liked young people and was liked and respected by them, he was particularly effective in communicating with youths. And, since he did not shrink from asking himself the hard questions, he did not hesitate to ask them of the young as well. He was among the first to debate Timothy Leary, the self-styled “psychedelic drug guru,” on college campuses, pointing out, “A pill does not construct character, educate the emotions, or improve intelligence. It is not a spiritual labor-saving device, salvation, instant wisdom, or a short cut to maturity.” This was in the early 1960s when many who should have known better thought LSD and the other hallucinogens were all those things. Sid was a gifted writer. Through hundreds of scientific articles as well as numerous books for lay audiences he conveyed the subtlety and complexity of psychoactive drugs and the hazards of their abuse. Sid’s popular books included such classics as The Beyond Within and The Drug Dilemma, both of which went through several editions. iii As a psychopharmacologist, Sid was very aware of the importance of not only the drug itself, but of its dosage and circumstances of use. Never a polemicist, Sid felt his greatest contribution to the drug dialogue was to make the public aware of the seductive hazards of drugs by acquainting them with the implications of scientific research. Some felt they knew all the answers. Sid was much more conscious of the unanswered questions. As a drug historian, Sid was very aware of how often a new analgesic, stimulant, or “recreational drug,” intitially thought to be nonaddictive, was later found to produce dependency. Sid Cohen’s energies were legendary. To the very end of his life he was astonishingly productive as well as virtually a “commuter” between the west and east coasts in his many roles as administrator, consultant, or member of innumerable advisory boards on topics ranging from drug abuse to suicide prevention and schizophrenia. Drugs, and later psychopharmacology were, however, his basic preoccupation, beginning with his early training as a pharmacist (at Columbia University) in the early 1930s. He received his medical training in Germany (at Bonn University) during those turbulent—and for him potentially perilous—years in which the Nazis rose to power. In 1976, his alma mater, Columbia University, awarded him an honorary Doctor of Science degree in acknowledgement of his many contributions to psychopharmacology. Toward the end of his life some of us sometimes wished Sid would find time to “enjoy life” more. But we forgot that for Sid to continue to work in his chosen field was more fun than anything else he could imagine. He had a small plaque on his desk that said, “It is not necessary to succeed in order to try.” Surely he succeeded far better than he knew. We continue to miss his unfailing good humor, his wisdom, his perceptiveness, and his dedication to truth. Robert C. Petersen, Ph.D. iv Sidney Cohen and I entered the field of drug abuse at about the same time—more than 30 years ago. We also began by studying the same class of drugs, hallucinogens. One other point we shared was that we had both been trained in internal medicine, not psychiatry. Although not specifically trained as a psychiatrist, Sidney could have been cast in such a role in any movie. His physical appearance was imposing. A leonine mane of graying hair swept back in pompadour style from his forehead, beneath which were a pair of piercing eyes. He conveyed an Old World charm legitimately obtained from his origin. His slightly raspy voice and the words he spoke showed empathy and compassion. I am sure that he must have been a good clinician. His research efforts in the field of substance abuse spanned many years and were well recognized by his peers. However, his greatest service might have been as an administrator. When the drug abuse problem showed signs of becoming a national menace, Sidney was lured from his comfortable southern California existence to come to Washington to administer the program that later evolved into NIDA. As a result of his efforts, funding for drug abuse research grew rapidly and mechanisms were established to distribute controlled substances to qualified investigators. He was one of the first persons to recognize the importance of inhalant abuse. When things were finally going well, he rejoined his family in California. Sidney was one of the most lucid lecturers I have ever heard. No fancy language, no jargon, but just good straightforward English. He was always careful with his facts but not afraid to slip in some sly humor. He was an excellent spokesman for the field of drug abuse and was active in many community activities as well as at the national level. He was a devoted husband who took good care of his wife, Elsa, after she had the misfortune to develop Parkinson’s disease. He had many colleagues who also became his good friends. No one is irreplaceable, but Sidney’s death left a void that many of us still feel. It is entirely appropriate that this volume be dedicated to one of the pioneers in drug abuse research—a true scholar and gentleman. Leo E. Hollister, M.D. v I respectfully conclude this tribute by noting that Sidney Cohen, a valuable colleague in the early period of the development of NIDA’s Inhalant Program, was primary in supporting both my and the Institute’s efforts. Not only because of his general knowledge and experience in the field of drug abuse, but also because of his interest in those abusing inhalants, he perceived the need for the investigation of the toxicology and drug dependence associated with solvent intoxication. Thus, he guided both me and NIDA in the early stages of this program and endorsed the accumulation of knowledge in this emerging field. Our efforts culminated in the first publication, Inhalant Abuse: Euphoria to Dysfunction, in 1977. Periodically thereafter, conversations often focused on recent advances in the field to which he contributed recent knowledge and relevant guidance, both of which were invaluable. He would be proud of the advances in the field which have been identified within this monograph, but always cognizant of, and quick to identify, the many challenges that lie ahead. I regret that he is not with us now to discuss the pertinent issues and thoughtfully approach and scientifically design studies to provide the necessary data that would allow us to reduce those tragedies associated with this state of drug dependency. Charles W. Sharp, Ph.D. vi Preface In the fall of 1989, the University of Texas, Health Sciences Center, and the Texas Commission on Alcohol and Drug Abuse convened a meeting to review the present state of our knowledge concerning inhalant abuse and to stimulate increased inquiry into various aspects of this complex problem.