Volatile Substance Use Research Articles

Association of volatile substance, nitrous oxide and alkyl nitrate use with mental health in UK adolescents.

'Inhalants' have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants. We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence. We conducted a cross-sectional analysis using data from 13- to 14-year-old adolescents across England and Wales collected between September 2019 and March 2020. Multilevel logistic regression examined associations between lifetime use of volatile substances, nitrous oxide and alkyl nitrates with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations. Of the 6672 adolescents in the study, 5.1% reported use of nitrous oxide, 4.9% volatile solvents and 0.1% alkyl nitrates. After accounting for multiple testing, adolescents who had used volatile solvents were significantly more likely to report probable depressive (odds ratio = 4.59, 95% CI 3.58, 5.88), anxiety (odds ratio = 3.47, 95% CI 2.72, 4.43) or conduct disorder (odds ratio = 7.52, 95% CI 5.80, 9.76) and auditory hallucinations (odds ratio = 5.35, 95% CI 4.00, 7.17) than those who had not. Nitrous oxide use was significantly associated with probable depression and conduct disorder but not anxiety disorder or auditory hallucinations. Alkyl nitrate use was rare and not associated with mental health outcomes. Adjustment for use of other inhalants, tobacco and alcohol resulted in marked attenuation but socioeconomic disadvantage had little effect. To our knowledge, this study provides the first general population evidence that volatile solvents and nitrous oxide are associated with probable mental health disorders in adolescence. These findings require replication, ideally with prospective designs.

The hidden crisis: Volatile inhalant substance use disorders in adolescents from Cuttack’s urban slums: A case series

Abstract: Substance abuse has been defined as the use of chemical substances for nonmedical purposes to achieve alterations in psychological functioning. The substances commonly abused in India include nicotine, alcohol, cannabis, and opioids. However, the use of solvents and propellants is also on the rise as these are inexpensive, legally available household, industrial, office, and automobile products; which are more commonly available to children and adolescents. Organic solvents are cheap and relatively easy to obtain, so they carry the risk of becoming a “gateway drug” for users. We hereby describe three cases of volatile substance abuse in the slum areas of Cuttack who were reported in our medical college.

Educating students about volatile substance use in Australian schools: Is the current approach evidence-based, and how should we do it?

Australian national, state and territory school-based drug education policies advise that volatile substance use (VSU) should be excluded from general drug education curriculum for fear of alerting young people to the intoxicating properties of substances such as petrol, sprays and glues. We review evidence from the United States and United Kingdom on the effects of including volatile substances in school-based drug education, to argue that these policies are due for reconsideration. Nitrous oxide and nitrites are classified as volatile substances along with solvents such as those listed above, although their patterns of use, effects and harms are different. In an era of widespread social media access, more young people than in the past are likely to have heard about VSU. But because VSU is often short-term, parents and teachers may be unaware when young people in their care consume volatile substances. The general silence about VSU in schools, difficulty in detecting use and the varying sets of risks associated with inhaling different substances mean that young people may be unaware of toxicity or harm reduction strategies when they consume volatiles as drugs. We consider some implementation challenges to be negotiated if VSU education were introduced in Australian schools.

Epidemiology and survival outcomes of out-of-hospital cardiac arrest following volatile substance use in Queensland, Australia

Introduction The deliberate inhalation of volatile substances for their psychotropic properties is a recognised public health issue that can precipitate sudden death. This study aimed to describe the epidemiological characteristics and survival outcomes of patients with out-of-hospital cardiac arrests following volatile substance use. Methods We conducted a retrospective cohort analysis of all out-of-hospital cardiac arrest attended by the Queensland Ambulance Service over a ten-year period (2012-2021). Incidents were extracted from the Queensland Ambulance Service cardiac arrest registry, which collects clinical information using the Utstein-style guidelines and linked hospital data. Results During the study period, 52,102 out-of-hospital cardiac arrests were attended, with 22 (0.04%) occurring following volatile substance use. The incidence rate was 0.04 per 100,000 population, with no temporal trends identified. The most commonly used product was deodorant cans (19/22), followed by butane canisters (2/22), and nitrous oxide canisters (1/22). The median age of patients was 15 years (interquartile range 13–23), with 14/22 male and 8/22 Indigenous Australians. Overall, 16/22 patients received a resuscitation attempt by paramedics. Of these, 12/16 were bystander witnessed, 10/16 presented in an initial shockable rhythm, and 9/16 received bystander chest compressions. The rates of event survival, survival to hospital discharge, and survival with good neurological outcome (Cerebral Performance Category 1–2) were 69% (11/16, 95% CI 41–89%), 38% (6/16, 95% CI 15–65%) and 31% (5/16, 11–59%), respectively. Eight patients in the paramedic-treated cohort that used hydrocarbon-based products were administered epinephrine during resuscitation. Of these, none subsequently survived to hospital discharge. In contrast, all six patients that did not receive epinephrine survived to hospital discharge, with 5/6 having a good neurological outcome. Conclusion Out-of-hospital cardiac arrest following volatile substance use is rare and associated with relatively favourable survival rates. Patients were predominately aged in their adolescence with Indigenous Australians disproportionately represented.

Poisonings from hydrocarbon inhalant misuse in Australia.

Inhalational misuse of volatile substances has been a significant public health concern because of the risk of sudden death and associated chronic complications such as encephalopathy. The Australian Government released a Consensus-based clinical practice guideline in 2011 on the management of volatile substance use in Australia, which noted a lack of available data particularly on harms. This study aimed to measure (1) the number of calls received by the New South Wales Poisons Information Centre (NSWPIC) regarding inhalational hydrocarbon exposures or poisonings and (2) the number of unintentional deaths reported to the National Coronial Information System (NCIS) in Australia. We performed a retrospective review of all recreational inhalational hydrocarbon exposure calls to the NSWPIC between 1 January 2010 and 31 December 2020. A search was made of the NCIS database in all states and territories over the same period to determine the number of non-intentional inhalational hydrocarbon-related deaths in Australia. Between January 2010 and December 2020, there were 752 primary calls made to the NSWPIC regarding hydrocarbon use or exposure. Age or age bracket was recorded in 748 cases, with 508 (67%) calls involving children or adolescents. Over the same time, there were 58 unintentional deaths involving the recreational use of inhalational hydrocarbons. The median age at death was 23 years (interquartile range = 15-30 years), and 72% (42 cases) were male. Cause of death was predominately acute suffocation/asphyxia, encephalopathy related to chronic use, cardiac arrest likely from sudden sniffing syndrome or thermal injuries secondary to unintentional fires sparked by the volatile agents. Although death and cardiac arrest are uncommon among people in Australia who misuse hydrocarbons for recreational use, the deaths and cardiac arrests tend to occur in adolescents.

All in a scent - naphthalene dependence confined to pregnancy: a case report

BackgroundInhalant or volatile substance use is a health issue with significant medical and psychiatric sequelae. Inhalants or volatile substances are volatile organic substances found in domestic and commercial products which are inhaled to obtain pleasurable effects. They are easily accessible, cheap, and legal. Common inhalants are spray, paints, glue and shoe polish whilst naphthalene or ‘mothball’ abuse is reported less commonly. We report a case of a 29-year-old female who inhaled and ingested naphthalene during her pregnancy. This case report is unique because the dependence on naphthalene was confined to pregnancy and resolved as soon as she delivered. This brings up the question whether pregnancy in general increases the risk of substance dependence in vulnerable populations or whether the dependence in this patient during pregnancy is due to individual factors.Case presentationThe patient we report is a 29-year-old female who developed a strong desire to inhale mothballs during her third pregnancy. The pattern of use started in the first trimester meeting the criteria for dependence syndrome and resolved completely by the second day following delivery. She had features suggestive of harmful use in her second pregnancy as well.ConclusionsThe case report emphasizes that pregnant women should be screened for psychoactive substance use. Equally important is the need for adequate psychoeducation about the myths and cultural beliefs associated with pregnancy-related cravings and the potentially devastating consequences of harmful cravings on the neonate and the mother. The case highlights how chemicals used in day-to-day activities can lead to dependence.

Epidemiology and Characteristics of People with Injury Due to Volatile Substance Use to Induce Euphoria

Background: Unhealthy substance use is a public health challenge. Much of the focus of interventions is upon narcotics, stimulants, hallucinogens, central nervous system depressants, and alcohol. However, inhalants are also commonly used in an unhealthy manner and are under-recognized. The purpose of this study is to describe incident emergency department visits for volatile substance use to induce euphoria (VSUIE) injuries in the U.S. Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2015 to 2018. Descriptive frequencies, bivariate analyses using Rao-Scott Chi-Square, and multivariable logistic regression analyses were conducted to describe and examine the association between ED visits and VSUIE. Results: The estimated (weighted) number of VSUIE ED visits during 2015–2018 was 13,130 (95% Confidence Interval, CI: 8,383–17876; Coefficient of variation, CV = 0.18) and accounted for 0.02% of all ED visits. Males were more likely than females (p < .0001), and young adults (ages ≥18 to ≤ 35 years) were more likely than older adults to have a VSUIE ED visit (p <.0001). Conclusion: VSUIE ED visits occur more commonly in young adults than older adults and adolescents. The widespread use of volatile substances to induce euphoria is an under-reported public health issue with life-threatening consequences. Use of volatile substances by adolescents is a particular concern which needs attention and interventions to prevent its initiation.

Üniversite öğrencilerinde madde kullanımı, şiddet ve bazı psikolojik özellikler

Ozet Amac: Madde bagimliligi gunumuzde onemli bir halk sagligi sorunudur. Bu calisma, universite ogrencilerinde sigara, alkol ve uyusturucu madde kullaniminin yayginligini ve bunu etkileyen faktorleri arastirmak amaci ile yapildi. Yontem: Kesitsel tipteki bu arastirmada veriler, Hatay Mustafa Kemal Universitesi Egitim Fakultesi, Ziraat Fakultesi ve Reyhanli Saglik Meslek Yuksek Okulu ogrencilerinden elde edildi. Her fakulte ya da yuksek okuldan bir, iki, uc ve dorduncu siniflardan birer sube secildi ve siniflarda ½ sistematik orneklem ile de ogrenciler secildi. Calismaya toplam 396 ogrenci katildi. Arastirmaya katilmayi kabul edenlere gozlem altinda soru kagidi uygulandi. Bulgular: Katilan ogrencilerin yas ortalamasi 20.9±2.3 ve %55.1’i erkektir. Yasam boyu sigara, alkol ve uyusturucu madde kullanimi sirasiyla %73.2, %56.6 ve %9.6 idi. Erkeklerde sigara, alkol ve uyusturucu madde kullanimi daha yuksek bulundu. Babasinda ve kardesinde sigara ve alkol kullanimi oykusu olanlarda sigara ve alkol kullanimi daha yuksek saptandi. Yakin akrabalarinda uyusturucu madde kullanimi bildirenlerde, uyusturucu madde kullanimi daha fazla bulundu. Sigara kullananlarda siddete ugrama ve siddet uygulama, sigara icmeyenlere gore daha yuksek idi (p<0.001). Hayat boyu siddete ugrayanlarin ozguven ve sosyal destek skorlari dusuk, surekli kaygi puanlari yuksek bulundu (p<0.01). Ucucu madde kullananlarda surekli kaygi puani yuksek (p<0.05), sosyal destek puani dusuk idi (p<0.05). Sonuc: Sigara icme, alkol ve uyusturucu madde kullanimi Hatay’da universite ogrencilerinde yaygindir. Bulgularimiz ucucu madde kullanimi ile yuksek surekli kaygi ve dusuk sosyal destek arasinda iliski oldugunu desteklemektedir. Anahtar Kelimeler: Madde kullanimi, universite ogrencileri, ozsaygi, ozguven, kaygi, siddet Abstract Aim: Substance abuse is an important public health problem. This study examined the prevalence of cigarette smoking, alcohol and substance use among the university students, as well as factors associated with the use of addictive substances. Methods : In this cross-sectional study, the data were obtained from the students of the Faculty of Education, Faculty of Agriculture and Health Professions High School. One class per educational year and per branch were selected from all of the schools. The participants were selected by a ½ systematic sampling methods. A total of 396 students participated and self-completed the survey. Results : The mean age of the students was 20.9 ± 2.3, and 55.1% of all participants were males. Lifetime tobacco, alcohol, and illicit drug use were identified as 73.2%, 56.6% and 9.6% respectively. Among the male students, cigarette, alcohol and substance abuse were higher than among the female students. Among the students who reported their father’s and siblings’ smoking and drinking, cigarette and alcohol use were higher. Among the students who reported having relatives using substances, the perceived possibility/desire/risk to use addictive substances in the future was more common for any period of life. Exposure to violence (either as a perpetrator or as a victim) was more frequent among the smokers (p <0.001). Self-esteem and social support scores were lower, and trait anxiety scores were higher among those who had been exposed to violence (p <0.01). Among the students who reported volatile substance use, trait anxiety scores were significantly higher (p <0.05) and social support scores were lower (p <0.05). Conclusion: Smoking, alcohol use and illicit drug use were common among the university students in the province of Hatay. Our finding supported the view that volatile substance abuse was associated with high trait anxiety and low social support Key words: Substance use, university students, self esteem, self efficacy, anxiety, violence

What are the Predictors of Volatile Substance Use in an Urban Community of Adults Who are Homeless?

The present study explored the prevalence of volatile substance use (VSU ) in a community of homeless adults. The importance of individual life history characteristics (history of traumatic events, residential school history, mental and physical health conditions) were also examined with respect to past-year volatile substance use in this sample. Overall, the results indicate that a variety of traumatic events, particularly residential school history and a number of mental and physical health conditions, were significantly associated with VSU in this urban Canadian sample. These findings have novel implications for community interventions for VSU and highlight the importance of conceptualizing cultural and historical traumas in understanding VSU .

Initiation to street life: a qualitative examination of the physical, social, and psychological practices in becoming an accepted member of the street youth community in Western Kenya.

BackgroundThe objective of this study was to describe the physical, social, and psychological initiation practices of street connected children and youths, in Eldoret, western Kenya.MethodsThis qualitative study was conducted from August 2013 to February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside “bases/barracks”; 3) Street youth community-based organizations. In-depth interviews and focus group discussions were used to collect data. All data were audio recorded, transcribed, translated to English, and a content analysis performed.ResultsThe overall median age was 18 years (IQR 14–20.5 years) and 69.2 % of participants were male. None had gone beyond primary level of education. The majority (81.5 %) reported to be sexually active. The street community had well-defined structures and rules that were protective of members and ensured survival on the streets. To be fully accepted children had to go through an initiation ritual that had important gender differences. Common rituals between males and females included interrogation, smearing of black soot, and payment of tax. Ritual practices unique to boys were physical abuse, theft of personal possessions, volatile substance use, being forced to eat garbage, and sodomy among the physically weak. Rituals unique to girls were being forced to ‘become a wife or sexual partner’, rape, and gang rape. Physical and psychological abuse during initiation was normalized and there were no clear mechanisms of dealing with these forms of abuse.ConclusionThere were important gender differences in the initiation practices of SCCY. Normalization of physical and psychological abuse during initiation contributes to the high health risks faced by these SCCY. Appropriate interventions need to be developed in collaboration with SCCY.

Out-of-Home Care As an Institutional Risk Environment for Volatile Substance Use

The exploratory study of meanings of volatile substance use (VSU) on which this article draws (involving 28 young people living in Melbourne, Victoria, Australa, aged from 13 to 24 years, each with experience of VSU, and 14 expert workers) was not designed to investigate any relationship between VSU and living in out-of-home care while subject to protective orders. However, when asked about their lives at the time they commenced or intensified VSU, 8 participants were adamant that living in out-of-home care was a significant factor. Two narratives reiterated by these young people are identified in the article: first that VSU is part of life in out-of-home care, and second that VSU ceases to be appropriate after leaving care. Young people who are living in out-of-home care report substantially higher levels of VSU than occur across the general population. This article shows how narrative accounts (even when expressed by small numbers of participants) provide insight into how VSU and other drug use may become embedded in particular institutional settings through assuming meanings and utility for users that are specific to these environments. While previous literature on the aetiology of VSU generally emphasises individual or familial risk factors, this article argues that out-of-home care may function, at least in some instances, as an institutional ‘risk environment’ for VSU and that this should be further explored through future research. Adjusting models of care may offer new strategies for responding to this form of drug use.

Psychosocial therapeutic interventions for volatile substance use: a systematic review

Volatile substance use (VSU) is associated with a range of adverse outcomes, including cognitive impairment and death. It occurs disproportionately within young and marginalized populations. A previous international systematic review of VSU treatment identified no relevant studies. This paper reports on a systematic review of a range of study types concerning psychosocial interventions for VSU. Search parameters were developed using the Population, Intervention, Professionals, Outcomes, Health care setting and Contexts (PIPOH) tool with input from an expert committee. Included were randomized controlled trials (RCTs), comparative studies with or without concurrent controls, case series studies and grey literature, published in English during 1980-2010. The initial search identified 2344 references. After two screening phases, 23 studies of VSU therapeutic interventions remained. Of these, 19 concerned psychosocial interventions, which we discuss as: case management; counselling; recreation and engagement programmes; and residential treatment. Studies were conducted in Australia, Canada, the United States, United Kingdom and Brazil. No RCTs were identified and studies were generally of low evidentiary levels. Even when a range of study types are included, clear conclusions for volatile substance use psychological treatment are not supported, but three intervention types merit further examination: family therapy, activity-based programmes and Indigenous-led residential approaches. Future volatile substance use research could be enhanced by developing and validating outcome measurement tools. Robust multi-site studies are also required.

The incidence and characteristics of volatile substance use related ambulance attendances in metropolitan Melbourne, Australia

While there has been substantial community discussion and concern expressed about volatile substance use (VSU), there has been little research on the use and related harms of these substances compared to other drugs. In this study we address a need in existing epidemiological research on VSU harms by describing the incidence and characteristics of VSU ambulance attendances between August 1998 and May 2004 across metropolitan Melbourne relative to heroin attendances, a drug class that has received more research attention. Our analysis showed that the crude rate of VSU attendance (5.03 per 100,000 population) over the period was substantially lower than the rates of heroin “involved” and heroin “overdose” attendances (33.40 and 54.87 per 100,000, respectively). Mean age of VSU cases was 20, with users on average 8 years younger than heroin cases. Two-thirds of VSU cases were male, with the likelihood of male attendance similar to heroin involved, but significantly less likely than heroin overdose. VSU attendances were geographically more evenly distributed than heroin attendances, with VSU cases more likely to occur at public and outdoor spaces. VSU cases were also less likely to be in an altered conscious state than heroin cases, but more likely to be co-attended by police and accept transportation to hospital. We conclude that VSU and heroin related harms occurred in different cohorts across metropolitan Melbourne, and that ambulance data can supplement existing data sources to inform policy and programme development, and the monitoring of VSU harms.

Volatile substance use in sexual asphyxia

A 38-year-old man was found dead in bed dressed in female clothing with a mouth gag, handcuffs and bindings around the genitals and limbs. A respirator was also covering the mouth and nose. There were no suspicious circumstances and a diagnosis of death due to sexual asphyxia was made. Following the subsequent discovery of bottles of chloroform in the bedroom, head space analysis of blood confirmed the presence of chloroform, with a blood level of 33 mg/L. Death was, therefore, attributed to a combination of chloroform toxicity and upper-airway obstruction. Headspace analysis with follow-up quantitation may, therefore, be a useful adjunct to the investigation of such cases when devices such as respirators or gas masks are found with the body.