Abstracts of theses and treatises
Burns C (1996) An end to petrol sniffing? Unpublished Doctor of Philosophy thesis, University of Sydney, Sydney, New South Wales.
Petrol sniffing has been present in a minority of remote Australian Aboriginal communities for over 25 years and has also been reported among the youth of other indigenous groups. Although many interventions have been attempted, those Aboriginal communities where the practice has been entrenched continue to be affected by social upheaval, while petrol sniffers themselves often interact heavily with the juvenile justice system.
Between 1981-1991 there were over 63 Aboriginal deaths, mainly males, associated with petrol sniffing. Hospital admissions for petrol sniffing related illness can be considerable, with 70 admissions reported at Royal Darwin Hospital alone between 1991-1994 for what has been described as petrol sniffer's encephalopathy. The relative contribution of volatile hydrocarbons and alkyl-lead additives and their metabolites to petrol sniffing related toxicity has been controversial. The use of chelation therapy for encephalopathic petrol sniffers has been questioned and the prognosis for this group has often been stated to be poor.
There were three broad parts to the thesis. Firstly, a hospital-based study to evaluate treatments and a review of mortality. Secondly, an examination of the sole use of unleaded petrol by one remote Aboriginal community, Maningrida, for over three years as a harm-reduction strategy, with some comparisons with another community (community LP) which had used only leaded petrol. Thirdly, an evaluation of the success of Maningrida in developing strategies which were implemented in 1993 to prevent petrol sniffing. These included the introduction of aviation gasoline (Avgas) instead of petrol as an aversion strategy and the implementation of employment and skills training programs. A follow-up visit to Maningrida some 20 months after petrol sniffing had ceased allowed prospective comparison to ascertain any physical improvements with abstinence in those who had been petrol sniffers and other changes that had occurred in the community.
The methods utilised included biochemical indices of lead and hydrocarbon exposure, review of hospital records and self-reported patterns of drug use. A test battery to assess neurocognitive deficits that may result from petrol sniffing was also developed and was found suitable for use in the field studies in two remote Aboriginal communities. Apart from a physical neurological assessment this included a portable computerised neuropsychological test battery and eye movement assessments developed by collaborators in this study.
The work makes four broad contributions to the literature on Aboriginal petrol sniffing. Firstly, this has been the only study to prospectively examine the success of one Aboriginal community in preventing petrol sniffing through the introduction of specific strategies. Although the use of Avgas as an aversion strategy and employment strategies were key elements in the success, community resolve and support to prevent petrol sniffing also emerged as crucial elements. A review of those elements which may have previously constrained prevention and those which supported success at this location has been included and may also assist other affected communities in developing prevention strategies.
Secondly, apart from identifying neurocognitive deficits in petrol sniffers still resident in their communities, residual deficits and improvements in neurocognitive function associated with the cessation of petrol sniffing at Maningrida were also identified. Both volatile hydrocarbons and lead additives in petrol were identified as contributors to the neurocognitive deficits found in petrol sniffers in this study.
Thirdly, the hospital-based study identified that hospitalised petrol sniffers invariably had been exposed to leaded petrol and had a heavy body burden of inorganic lead. Chelation therapy mobilised comparable amounts of inorganic lead to reports of chelation in cases of inorganic lead intoxication. Airway management and vigilance against sepsis were found to be critical for survival of hospitalised petrol sniffers. With expert care, outcomes are by no means bleak.
Fourthly, the use of unleaded petrol as a harm-reduction strategy for petrol sniffers was examined and it was concluded that it was useful in reducing morbidity requiring hospitalisation. Nevertheless because volatile hydrocarbons as well as lead additives were found to contribute to neurotoxicity, caution was urged with this strategy, particularly the potential for the development of long term toxicity.
Nine broad recommendations relating to both prevention and harm-reduction have been made, along with suggested means of implementation. The recommendations relating to harm-reduction focus on the use of unleaded petrol and the need to maintain vigilance for the development of toxicity, particularly in the longer term. The recommendations relating to the prevention of petrol sniffing focus on the need for Commonwealth Government support and community involvement in developing strategies which are suitable and effective for particular communities and regions.
For further information on this subject look in the Australian Indigenous HealthInfoNet Bibliography or return to the theses page.
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