Is your patient (or child) abusing inhalants?

Statistics indicate that "sniffing" and "huffing" continue to be a silent, sometimes deadly, epidemic among teens and preteens.

By Stephanie Stapleton, amednews staff. April 9, 2001.

Washington -- An unusual odor on a child's breath or clothing; spots or sores around the mouth; nausea or loss of appetite; slurred or disoriented speech; drunk, dazed or dizzy appearance; red or runny eyes or nose.

These symptoms are associated with what substance abuse experts consider to be a silent epidemic: the use by children of common household products as inhalants. It is a public health problem that remains off the radar of many parents and doctors.

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"Inhalant abuse has for so long been ignored," said H. Westley Clark, MD, MPH, director of the Dept. of Health and Human Services Center for Substance Abuse Treatment.

Hundreds of everyday items -- from glue, nail polish and gasoline to computer cleaner, refrigerants and air fresheners -- can be used by kids to get a quick high by sniffing directly from an open container or "huffing" from a rag soaked in the substance and held to the face.

Inhalants are the most popular recreational drug among 12-year-olds, according to the Substance Abuse and Mental Health Services Administration's most recent National Household Survey. In addition, almost half a million young people use inhalants in any given month. According to the survey, there were an estimated 991,000 new inhalant users in 1998, up from 390,000 in 1990.

Although these young people view inhalants as harmless fun, they can take a serious toll, causing brain, respiratory, liver, kidney and bone marrow damage as well as short-term memory loss and hearing impairment. In the worst-case scenario, inhalants can cause sudden death, and there is no way to tell which child will succumb or how many sniffing sessions it will take. And, statistics indicate, those who do not suffer illness may go on to try other drugs.

Getting the message out

Increasingly, experts are focusing on the need to both raise awareness and focus resources on developing treatment strategies. Inhalant abuse is considered a very difficult drug use pattern to address, and more than 50% of patients who need treatment are between ages 12 and 17.

National Inhalants and Poisons Awareness Week, held March 18-24, was geared toward this objective and was the subject of a congressional resolution sponsored by Sen. Frank Murkowski (R, Alaska) and Senate Minority Leader Tom Daschle (D, S.D.).

Murkowski became involved after a constituent in Bethel, Alaska, asked for his assistance in helping his grandson break the addiction. "The goal is to never have another young person die from an inhalant," he said.

But public education is not an easy goal to achieve because the substances in question have very harmless, regular uses.

"In the kitchen, in the garage, in every American home ... [these are] innocuous products that could cause death and serious injury," said Ann Brown, chair of the Consumer Product Safety Commission. "But even the best parents do not know what they should." For instance, she referred to survey findings showing that fewer than half of parents who talk to their children about substance abuse include the dangers of inhalants.

Diane Stem, of Nashville, Tenn., was among the unaware until her 16-year-old son, Ricky, died suddenly on June 20, 1996, after huffing freon from the air conditioner in his room.

"We had never heard of huffing before Ricky died. We never thought to warn him," she said. "Ricky invited a killer into his room. He didn't know. It was supposed to be harmless fun."

And closing that knowledge gap is central to the challenge. "Physicians, of course, play a critical role," said CSAT's Dr. Clark.

"The waiting room can be the first point of contact," he said. It is important to reach parents and teens with a preventive message, he added. The subject can also be tackled by the screening nurse and discussed in the context of general health messages about other lifestyle issues, including tobacco, alcohol and other drug use.

But Dr. Clark also noted that physicians definitely need to know about the dangers of inhalant abuse beyond the prevention message. Being aware of its symptoms may help when at-risk preteen or teenage patients present with the associated signs of use. For instance, he said, instead of automatically doing a workup for attention-deficit/hyperactivity disorder, physicians can ask about inhalants, too. "From a differential diagnosis point of view, this is a relevant issue to be aware of," he added.

ADDITIONAL INFORMATION:

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The Anti-Drug, sponsored by National Youth Anti-Drug Media Campaign (http://www.theantidrug.com/)

National Inhalants and Poisons Awareness Week (http://www.health.org/multimedia/webcasts/csatinhalant.htm)

Tips for Teens: The Truth About Inhalants page from the National Clearinghouse for Alcohol and Drug Information (http://www.health.org/govpubs/phd631/)

Resource guide on inhalants from NCADI (http://www.health.org/govpubs/MS466/)