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Introduction

Volatile substances cover a wide variety of chemical compounds which give off vapour or fumes when exposed to air [1]. They are also called 'inhalants' as they exist in a form that can be inhaled [2]. Such substances include many commercial and household products such as cleaning agents, glue, felt-tipped pens, liquid paper, butane gas (from cigarette lighters), nail polish remover, degreasers, paints, and petrol. They are legal, readily available, and inexpensive substances. Their use for recreational sniffing has become relatively common, particularly among adolescents in Australia. Petrol sniffing has become a particular problem for some Indigenous communities.

Volatile substance use (VSU) - also referred to as glue sniffing, petrol sniffing, inhalant abuse, or solvent abuse - is defined as the deliberate inhalation of a gas or fumes given off at room temperature from a substance for its intoxicating effect [3]. These substances are easily absorbed through the lungs and carried to the brain, where they act to depress the central nervous system. Substances can be inhaled directly from the container or sprayed into a plastic bag or onto a cloth before inhaling through the nose and mouth [4]. VSU is not a new phenomenon, but it can be a serious problem. The problem is difficult to control because the active substances are found in so many common products that have legitimate uses [2]. People that use these substances in this way risk long-term health problems, or sudden death [2].

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Effects of volatile substance use

Inhalation of volatile substances produces a variety of short-term effects - from pleasurable feelings of excitement, to alcohol-like intoxication, to disinhibition and loss of consciousness [5]. The effects are experienced within a few minutes and only last for a short time, usually less than an hour.

Short-term:
Some immediate effects of inhalation of volatile substances include: euphoria and excitement, feeling light, sensations of numbness, dizziness.

These effects may be followed by:
giddiness, nausea, slurred speech, sneezing, coughing, shortness of breath, indigestion, chest pain, hallucinations, muscle weakness, loss of motor coordination, slowed reflexes.

Repeated inhalation over a period of minutes or hours can result in:
disorientation, headaches, nose bleeds, fits, blood-shot eyes, unpleasant breath, rash around nose and mouth (called sniffer rash), unconsciousness, seizures.

Heavy regular use can cause:
chronic headache, extreme fatigue, weakness, tremors, thirst, weight loss, irritability, hostility, depression, anxiety, sinusitis, ataxia, dysarthria, peripheral neuropathy.

Long-term use can result in:
damage to internal organs, the brain and the nervous system. Some damage can be reversed by ceasing use of certain substances, but permanent damage can occur to the brain, liver, and kidneys [4].

Blood - reduction of blood cells/blood disorders
Liver - impaired functions, possible disease
Kidney - damage, impaired functions and possible disease
Brain - permanent damage rare, although interference common
Lungs - suffocation by coating inside of lungs with inhaled substance [6]

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Classification of volatile substances

Volatile substances can be divided into four main classes:

• solvents; such as glue, liquid paper, petrol, and paint thinners
• aerosols; such as hair spray, deodorant sprays, and spray paint
• anesthetics; such as ether and nitrous oxide
• nitrates; such as amyl nitrate and butyl nitrite [2]

Solvents

Contain the compound toluene. Toluene can cause brain damage, kidney damage, and liver problems. Reports have indicated that toluene is associated with renal tubular acidosis, encephalopathy, metabolic acidosis, cerebellar dysfunction, pulmonary cardiomyopathy, and acute cardiotoxicity [7].

Hexane and lead are often found in toluene-containing fluids. Hexane has been associated with peripheral neuropathy. Tetraethyl lead, an additive used in petrol until recently, has intoxicant properties [7]. Chronic petrol sniffers may suffer from ataxia, tremor and encephalopathy attributable to tetraethyl lead toxicity [7].

Copper, zinc and tin found in many chrome-based paints have serious toxic effects on circulatory system, liver and kidneys. Trichlormethane, found in liquid paper, makes the heart muscle overly sensitive to adrenaline, so any sudden exertion can trigger a heart attack [8].

Aerosols

Contain butane and propane. Inhalation can cause asphyxia, cardiac arrythmias, and fluid in the lungs and brain. Deaths have been reported from use of aerosols [2].

Trichlorofluoromethane is also used as an aerosol propellant. This compound makes the heart muscle overly sensitive to adrenaline, so any sudden exertion can trigger a heart attack [8].

Anaesthetics

Include ether, chloroform, enflurane, ethylene, cyclopropane, fluroxene, halothane, methoxyflurane, trichloroethylene, and nitrous oxide (also known as laughing gas). Inhalation of anesthetics can cause lightheadedness and giddiness. Dizziness and mild euphoria last only a few minutes.

Toxicity of this group of volatile substances relates mostly to hepatic injury, cardiac arrhythmias, nephrotoxicity, malignant hyperthermia, hypoxia, and nervous system damage [7].

Nitrates

Contain amyl nitrate and butyl nitrite. Effects of nitrate inhalation include ringing in ears, abdominal cramps, diarrhoea, and dilation of blood vessels, causing reduced blood pressure, flushing and fainting, relaxation of smooth muscle tissue, feelings of warmth, and a throbbing sensation [9]. Toxic effects include confusion, headache, vasomotor collapse, methaemoglobinaemia, and haemolytic anaemia [7].

Some studies have linked nitrate use with the development of Kaposi's sarcoma and acquired immunodeficiency syndrome (AIDS) [7].

Types of volatile substance users

Volatile substances belong to the category of psychoactive drugs which are central nervous system depressants [10]. They are not generally regarded as being physically addictive, but the effects can be strongly self-reinforcing and may lead to psychological addiction [10]. Volatile substance users are classified into three types: experimental, social (recreational), and chronic users (habitual).

VSU involves mainly young people rather than adults. The general age range of users is between 10-19 years with the mean age of 12-15 years, but use by children less than 10 years old is not uncommon [1]. This trend is in contrast with other drug use, which usually begins and increases through the teen years. Most young Australians will never use volatile substances [11], and those that do usually do so for the purpose of experimenting (due to curiosity, peer pressure, and ready availability of substances) [1]. People experimenting with volatile substances may sniff only once or twice and then stop. Some users, after experimentation, may continue to use these substances in the social or recreational context, where use is in groups and on a regular basis. Chronic users are characteristically individuals that are dependent on the pleasurable experience of inhalation to deal with underlying emotional or economic problems. Use is on a daily basis, and these users often inhale alone rather than in groups. Very few users become dependent on volatile substance inhalation.

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Substance use in Australia

In 2000, approximately 2.1 million Australian youths aged 12 to 17 had used inhalants at some time in their lives. This constituted 8.9 percent of Australians in this age group, the majority of which had used glue, shoe polish, or toluene (3.9 percent) and gasoline or lighter fluid (3.3 percent) [12].

According to an earlier survey conducted in 1998, 1% of the Australian population aged 14 years and over had used inhalants in the 12 months preceding a national household survey, and nearly 4% had used inhalants at some time in their lifetime [13]. The proportion of females reporting using once a week or more was higher than the proportion of males, but substantially greater proportions of females than males also reported very infrequent use (Table 1).

Table 1: Frequency of inhalant use; proportion (%) of recent users aged 14 years and over, Australia 1998

Frequency	Males	Females	Persons
Once a week or more	1.8	6.0	3.2
About once a month	27.7	10.2	21.9
Every few months	22.7	-	15.1
Once or twice a year	25.4	37.8	29.5
Less often	21.2	41.5	28.0

Source: Australian Institute of Health and Welfare [13]

Petrol sniffing

Petrol sniffing has been recognised as a problem for many years and has been identified as a practice predominant in minority and underprivileged groups [14]. It is the substance of choice primarily because of its ready availability, cheapness, and the rapidity of mood alteration produced by its inhalation [15].

Inhalation of petrol is a dangerous pastime in which Aboriginal youths (aged about 8 to 20) of both sexes are known to indulge, as a defiant form of recreation, in parts of Central Australia and Arnhem Land [16]. It has become an endemic problem for the greater Indigenous community - one which is destroying the lives of Aboriginal youth around the country [17].

Inhalation of petrol causes euphoria and intoxication for 3 to 6 hours. Prolonged inhalation may lead to violent excitement followed by loss of consciousness, coma, or death [7].

Mortality

Recent data are not available, but in the period 1980 -1987 there were 121 deaths associated with volatile substance abuse in Australia, with the majority of deaths occurring in the 15 -20 year age group [7]. Mortality relating to volatile substance use between 1980 to 1987 indicates the relative danger of various products used [18]. The main groups of substances causing death were:

• Fuel gases - 27% (mainly butane and propane)
• Aerosols - 24% (halogenated compounds)
• Petrol - 14%
• Anaethetics - 10% (mainly nitrous oxide and chloroform)
• Solvents & other - 25% [7].

Greater proportions of deaths among 10 - 19 year olds occur with aerosol, petrol, gas, and liquid paper use (Table 2). Deaths from glue inhalation are primarily associated with accidents (plastic bag over the head, inhalation of vomit, trauma (including drowning and hanging, burns, and motor vehicle accidents) [18].

Table 2: Volatile substance use (VSU) deaths, ages 10-19 years, 1980 to 1987, Australia

Volatile substance	Number of deaths (%)
Aerosol	19 (33)
Petrol	9 (16)
Gas	8 (14)
Liquid paper	8 (14)
Thinners	5 (9)
Anaesthetics	3 (5)
Glue	2 (4)
Other	3 (5)
All substances	56

Source: National Drug Abuse Information Centre

Sudden death is an important risk in any volatile substance abuse. Mechanisms of sudden death are:

• anoxia
• respiratory depression
• vagal inhibition (usually associated with aerosols being sprayed directly into the mouth)
• cardiac arrhythmias [7].

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References

1 McAllister, I., R. Moore, and T. Makkai, Drugs in Australian society. 1991, Melbourne, Australia: Longman Cheshire Pty Ltd.
2 Avis, H., Drugs and life. 1999, Fourth edition. Boston : McGraw-Hill.
3 Commonwealth Department of Community Services and Health, National Drug Abuse Information Centre, Technical information bulletin on drug abuse No 79: drug issues affecting Aboriginal Australians. 1988, Canberra: Australian Government Publishing Service.
4 Australian Institute of Criminology, Inhalants Factsheet. 2001, Canberra: AIC.
5 Chick, J. and R. Cantwell, Seminars in alcohol and drug misuse. 1994, London: Gaskell.
6 Aboriginal Drug and Alcohol Council (1998) Volatile substances information leaflet. South Australia: ADAC.
7 Chalmers, E., Volatile substance abuse. Medical Journal of Australia, 1991. 154(Feb 18): p. 269-274.
8 Youth Substance Abuse Service, Chroming factsheet. Fitzroy, Victoria: YSAS. On http://www.ysas.org.au/
9 Julien, R.M., A primer of drug action: a concise nontechnical guide to the actions, uses, and side effects of psychoactive drugs. 2001, New York: W. H. Freeman and Co.
10 Sandover, R., S. Houghton, and T. O'Donoghue, Harm minimisation strategies utilised by incarcerated Aboriginal volatile substance users'. Addiction Research, 1997. 5(12): p. 113-136.
11 Rose, J., A. Daly, and R. Midford, Volatile substance use in Perth: patterns of use, regulation of use, constituents of glue, recommendations for management. 1992, Perth: WA Alcohol and Drug Authority.
12 Substance Abuse and Mental Health Services Administration, National household survey on drug abuse. 2000, Washington, DC: US Department of Health and Human Services.
13 Australian Institute of Health and Welfare, 1998 National drug strategy household survey. 1998, Canberra: AIHW.
14 Morice, et al., Petrol sniffing among Aboriginal Australians. 1981, Canberra: Drug and Alcohol Foundation of Australia.
15 Brady, M., Petrol sniffing among Aborigines: differing social meanings. International Journal of Drug Policy, 1991. 2(4): p. 28-31.
16 Bryce, S., T. Rowse, and D. Scrimgeour, Evaluating the petrol sniffing prevention programs of the Healthy Aboriginal Life Team [HALT]. Australian Journal of Public Health, 1992. 16(4): p. 387-396.
17 Kenny, S., Bringing communities together. Breaking the petrol sniffing cycle. Drugs in Society, 2001 (March): p. 16-17.
18 Rose, J., A. Daly, and R. Midford, Report on the usage patterns of volatile substance abuse users in Perth. 1992, Perth: WA Alcohol and Drug Authority.

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