There are many, many different types of inhalants that may be abused. Due to the breadth of possibilities, we will confine our focus to some of the most commonly abused inhalants. These include common drugs of abuse as well as non-drug inhalants that nevertheless produce mind-altering effects. Something does not necessarily need to be considered a “drug” to produce unhealthy and potentially fatal complications. 1, 2
Some commonly abused inhalants include:
Used as both an anesthetic in dentistry as well as a component of pressurized whipped cream cans, this compound produces an intense, although very short-lived, euphoria. When inhaled from whipped cream cans it is also known as whippits or whippets. It is not illegal to own nitrous oxide in the US, and coupled with its low cost and ease of access, this has led to increased rates of nitrous oxide abuse in recent years. Nitrous oxide can produce some very dangerous and potentially fatal consequences when abused for long periods or in large amounts.
Toluene is an industrial chemical as well as a veterinary treatment for parasites in dogs and cats. In industrial applications, it is found in some paints, adhesives, and cosmetics as well as a component of the petroleum refining process. Through huffing or inhaling products containing large amounts of toluene, it can produce a high and calming euphoria. Through chronic use, this can lead to a variety of neurological complications, and it may be possible to experience toluene withdrawal.
Amyl nitrite is both a psychoactive drug and a vasodilator and it is used to enhance the experience of sex. As a mind-altering substance, it acts as a depressant leading to relaxation and lowered inhibitions. As a vasodilator it opens blood vessels, increasing blood flow to the extremities in particular. Using too much amyl nitrite can result in hypoxic brain damage or death, and other risks may be increased when it is used in combination with other drugs.
Computer keyboard duster contains the hydrocarbon difluoroethane, and by inhaling these “duster” products, a brief euphoria can be produced. This high lasts very briefly, usually a minute or two at most and frequent use can lead to dependence and withdrawal upon duster cessation. Through chronic duster use, it is possible to damage the kidneys and the brain, and this could result in a variety of negative outcomes.
Since inhalants of abuse cover a wide range of drug types and effects, there is likewise a wide range of risks and dangers associated with their use. Certain inhalants may pose unique risks, as we will cover in detail below, but there are certain risks that may apply to all inhaled substances.
Some of the common risks of most inhalants of abuse include:
While these risks may be the common risks of inhalant abuse, different inhalants pose specific risks. The particular risks of individual inhalants include:
The immediate risks of nitrous oxide abuse include vitamin B12 deficiency. This can produce a variety of issues, both neurological and physical. A condition known as megaloblastic anemia is closely linked to nitrous oxide exposure, and this can happen very quickly. Being exposed to a 50/50 air and nitrous mixture for as little as 12 hours can produce signs of megaloblastic anemia in an otherwise healthy person. This is a condition that is characterized by the improper formation of red blood cells by bone marrow. These malformed cells may be oversized, abnormal, and immature and are unable to effectively carry blood throughout the body.
After long periods of use and the subsequent vitamin B12 deficiency this produces, both brain and nerve damage become very real possibilities. This occurs through a process known as demyelination and is a direct result of prolonged nitrous oxide use. Nerves in the brain and body are coated in places by a sheath of a fat and protein mixture called myelin which helps the nerves conduct signals throughout the brain and body. Myelin is made out of specialized cells, known as Schwann cells, that are specifically for this purpose. Nitrous oxide interferes with the process of myelin production, so through chronic use, these myelin sheaths wear down. Since they cannot be repaired regularly the myelin will degrade and lose the ability to effectively aid in nerve signal conductance. This can produce a loss of sensation in the body at first, followed by weakness, and this can even damage nerves in the spinal cord and brain, leading to a variety of cognitive or mobility issues.
Vitamin B12 replacement is the standard treatment for demyelination, but recovery from nitrous oxide-induced demyelination is uncertain. Some people may regain some function or sensation, but a complete recovery seems to be unlikely. The damage done to the brain itself can be very long-lasting, or even permanent depending on the severity. 5, 6, 7, 8, 9, 28, 29
Toluene is an extremely common solvent found in many industrial and commercial applications all over the world. When inhaled in large doses it can affect several neurotransmitter systems and produce euphoria and relaxation. It does this by increasing signaling of the neurotransmitter GABA. This is an inhibitory neurotransmitter that has a calming and relaxing effect on many other neurotransmitter systems and neurological processes. Toluene also reduces signaling at the NMDA glutamate neurotransmitter receptors, which is an excitatory neurotransmitter that affects a huge number of brain functions. This combination of increasing inhibition and decreasing stimulation can result in a profound depressive effect during abuse.
These effects on GABA and glutamate are roughly similar to the way alcohol produces its effects. Likewise, toluene can produce tolerance and physiological addiction if used for long periods. Toluene may work in a similar fashion as alcohol, but it is capable of producing much more immediate and possibly fatal complications. Cardiac arrhythmia is a leading cause of sudden death during toluene intoxication, although someone may also die from deep unconsciousness in an exposed setting, leading to hypothermia and, of course, car accidents while intoxicated.
Chronic toluene use can also produce permanent, physical health complications including leukoencephalopathy. This is a brain condition that resembles dementia and can include other nerve problems such as cranial nerve issues including nystagmus and optical dysmetria. Even if chronic toluene use does not produce leukoencephalopathy proper, there are many cognitive deficits than may manifest due to toluene abuse. Some cognitive issues seen in toluene abusers include psychotic states, problems with attention, memory impairment, apathy, language problems, and visuospatial impairment. When these issues are produced by toluene use they seem to be irreversible. While symptoms improvement may not be possible, the only effective treatment to prevent symptoms from worsening is complete abstinence from toluene use. 10, 11, 12, 13, 14
Amyl nitrite only produces mild euphoria and it is more commonly used in a sex-enhancing capacity. It is also a potent vasodilator that increases blood flow to the extremities and lowers blood pressure. When used in large doses, it can result in fainting, nausea, vomiting, hypotension, and depressed breathing. Another effect may be methemoglobinemia, which is a blood condition that results in the blood being unable to effectively deliver oxygen to the cells. This can result in cyanosis, hypoxia, coma, and possibly death. 15, 16, 17, 18, 19
Also known as duster, difluoroethane is capable of producing an intense, although short-lived, high. This is a very dangerous inhalant and in addition to its direct effect on the brain and nervous system, it is quite toxic to cardiovascular health. Aside from the effects of difluoroethane itself, the method of use presents its own risks. It is not uncommon for someone to suffer extreme irritation or even frostbite to the nose and throat, which in some cases can cause the throat to swell, potentially to a dangerous degree. This could result in suffocation due to the throat swelling closed. Other risks due to difluoroethane inhalation include psychotic episodes including visual and auditory hallucinations and unconsciousness which can lead to drowning or car accidents, both of which have been documented and fatal.
Difluoroethane is known to alter the electrical activity of the heart. This can be very dangerous, as it may lead to possibly fatal arrhythmias. Using difluoroethane can lead to abnormal electrical activity in the heart which can reduce or even eliminate the heart’s ability to effectively pump blood throughout the body. This can be extremely dangerous and may result in cardiac arrest, brain damage, or death. A complication that is unique to fluoride-containing products is actually a bone condition known as skeletal fluorosis. The fluorine in this inhalant is capable of leaching calcium from bones and replacing it. This can lead to weakened bones as well as bony growths and increased blood fluoride levels.
Another potentially serious complication of difluoroethane use is the risk of both acute and chronic kidney damage. While the exact method through which difluoroethane causes kidney injury is unclear, it seems to be highly toxic to and detrimental to healthy kidney function. This could cause acute kidney injury in the short term, impaired kidney function in the long-term, or both.
Somewhat similar to toluene, difluoroethane is known to work on the neurotransmitters GABA and glutamate and is also capable of producing physiological dependence and, subsequently, withdrawal symptoms when someone suddenly stops using it. Documented difluoroethane withdrawal symptoms include increased irritability, agitation, increased heart rate, auditory hallucinations, and paranoid delusions. The timeline for difluoroethane withdrawal is still unclear, as there have been so few cases that were observed in a controlled setting. 20, 21, 22, 23, 24, 25, 26, 27
Inhalant drugs can be extremely dangerous, particularly because, in most cases, they were never intended for human use. Addiction can present serious risks and complications, and even withdrawal can lead to unintended and unfortunate outcomes. If someone has a problem with inhalant use, it is highly recommended that they enter an inhalant detox center. These centers can reduce the discomfort of withdrawal through medications and therapy while also treating any health issues that may have developed due to chronic inhalant use. In addition, these facilities can make referrals to further treatment after detox has been completed and help someone get connected with their local recovery communities. It may seem impossible at times, but recovery is possible. Don’t wait, find a local inhalant detox center and let recovery begin today.
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