Source:
Richard Scatterday, M.D., Kaiser Permanente
Toluene,
and toluene containing compounds
(representing
the "aromatic hydrocarbons")
a. Found in:
Gasoline; some glues; some paints, thinners and paint removers;
some nail polishes; typewriter correction fluid.
b. Historically,
the predominant euphorigenic substance utilized in inhalant abuse
settings.
c. Toluene
and toluene-containing compounds are ubiquitously encountered
in home, school and work place settings.
d. As a low
molecular weight, highly lipid-soluble substance, toluene is avidly
absorbed by the lungs, brain, heart, liver, reproductive organs
and other lipid-rich tissues. The capacity of these organs to
concentrate and store toluene and similar compounds is illustrated
by the fact that shortly after inhalation, brain concentrations
may be ten times greater than blood levels.
e. Chronic
abuse of toluene-containing products has been associated with
serious brain toxicity, documented by loss of brain tissue mass
on computerized tomographic (CT) scans, and by white matter degeneration
on magnetic resonance imaging (NM) scans. Such brain damage results
in impairment of cognition and other brain functions, gait disturbance
and loss of coordination.
f. Toluene
may cause effects upon the heart's rhythm regulating system that
can cause fatality by the "Sudden Sniffing Death" mechanism.
g. Serious
lung injury can result when toluene-containing paint preparations
are inhaled.
h. Kidney
problems, including renal tubular toxicity resulting in serious
acid-base derangement, and kidney stone formation have been reported
with chronic toluene abuse.
i. Significant
losses of hearing and vision have been reported in association
with toluene abuse.
j. Toluene
can cause multifactorial adverse impact upon reproductive toxicity,
including:
- chromosomal
alteration and breakage
- germ cell
injury
- abnormalities
in the physiology of pregnancy
- fetal malformation
or death
- premature
birth
- perinatal
complications including increased rates of infant withdrawal
syndrome
- maternal-child
adjustment disorders including an increased prevalence of child
abuse
Butane
and Propane
(including
the "aliphatic hydrocarbons")
a. Found in:
paint sprays, hair sprays, air fresheners, fuel gas, lighter fluid.
b. Readily
available to youth and abuseable when commercially packaged as
"lighter fluid" (butane) or as fuels.
c. Marked
propensity for causation of the "Sudden Sniffing Death Syndrome"
via their cardiac effects.
d. Because
of their flammability and explosives and a strong association
with smoking of tobacco or illicit drugs, their abuse has been
associated with serious burn injuries.
Gasoline
(a
mixture of "aromatic" and "aliphatic" hydrocarbons)
a. The universal
use and availability of gasoline in the U.S. and worldwide contributes
to its abuse by inhalation.
b. Gasoline
inhalation may be particularly prominent in relation to other
forms of drug abuse in the late childhood and pre-adolescent years,
in rural settings and among certain socioeconomic groups.
c. Gasoline
contains aromatic (ring-structured) hydrocarbons, especially toluene
and benzene, along with C6-C8 aliphatic (straight-chained) hydrocarbons
are the primary euphorigenic components of gasoline.
d. Purposeful
inhalation yields intoxication lasting up to 5-6 hours, but reaching
a peak within 3-5 minutes.
e. Additives,
historically including lead, and a variety of inorganic chemicals
and impurities aggravate the toxicity of the major hydrocarbon
components of gasoline.
f. Gasoline's
explosiveness and combustibility are universally recognized. The
stage is set for serious burn injuries when youth whose judgment
is impaired by intoxication combine gasoline inhalation with the
smoking of marijuana, tobacco or other drugs.
g. Gasoline
components affect the rhythm-controlling tissues of the heart
in a way that predisposes to dangerous, potentially fatal heart
rhythms (the "Sudden Sniffing Death Syndrome").
h. Benzene,
a gasoline component, may cause serious injury to the bone marrow,
impairing immunologic functioning, and perhaps causing increased
risk of leukemia. It can also cause reproductive system toxicity.
i. TCP, a
gasoline additive, can cause degeneration of motor nerve cells.
The lead in it can cause lead poisoning.
Trichlorethylene
and trichlorethane-containing preparations
(representing
the "chlorinated hydrocarbons")
a. Found in:
Anitfreeze, some paints, some glues, adhesives, sealants, caulking
compounds.
b. Historic
use as general anesthetic agents.
c. Striking
portraits of toxicity based upon past use as general anesthetic
agents.
d. Trichlorethylene
and trichlorethane-containing agents are also ubiquitously encountered
in home, school and work place settings.
e. Trichlorethylene
and trichlorethane-containing products have been associated with
a significant risk of "Sudden Sniffing Death" due to the induction
of fatal cardiac rhythm abnormalities.
f. In a Dallas
postmortem study of three adolescent trichlorethylene inhalation
fatalities, two of the three victims had hepatic cirrhotic changes.
A closely related compound formerly used extensively in the dry
cleaning industry is so toxic that the equivalent of one teaspoon
is able to cause potential fatal liver necrosis.
g. While adequate
studies are lacking of the dangers of trichlorethylene and trichlorethane
when purposefully inhaled, chronic workplace exposure has been
associated with:
- cirrhosis
of the liver
- electrocardiographic
changes and heart muscular injury
- reproductive
complications, especially miscarriage. Studies involving intrapartum
exposure of rats to trichlorethylene have demonstrated growth
retardation, and skeletal and soft tissue abnormalities.
The
Freons
("halogenated
hydrocarbons" characterized by mutually
potentiating chemical and physical hazards in the abuse setting)
a. The freons
are a major cause of "Sudden Sniffing Death" via the induction
of fatal cardiac arrhythmias.
b. Respiratory
obstruction and death due to sudden cooling/cold injury to the
respiratory tract may occur.
c. When inhaled
from a high pressure source, pulmonary injury with rupture of
alveoli ("air sacs") and/or of the fine tissue layer covering
the lung can occur, resulting in life-threatening collapse of
a segment, lobe or the entire lung.
d. Freon also
appears to decrease the ability of certain special cells that
line the pulmonary alveoli to produce a special phospholipid chemical
(surfactant) that functions to maintain the air sacs in a non-collapsed
state. Chronic freon inhalation could hypothetically predispose
to air sac collapse by inhibiting surfactant production.
e. Serious
freeze injuries to the skin can occur when individuals inhaling
freon lose consciousness, leaving the cold container in juxtaposition
to unprotected skin.
f. With other
chlorinated hydrocarbons, chronic high-dose exposure to freons
may cause hepatic injury.
g. Studies
in animal models suggest that repeated exposure to high doses
of fluorocarbons during pregnancy may present serious teratogenic
(induction of birth) hazard.
Butyl
Nitrite and Isobutyl Nitrite
("Rush,"
"Locker Room;" representing the "alkyl nitrites")
a. The nitrite
compounds have been associated with the causation of fatal cardiac
rhythm disturbance (Sudden Sniffing Death Syndrome).
b. Chronic
abuse of butyl nitrite and similar compounds appears to suppress
immunologic functioning. A relationship has been proposed between
the use of butyl nitrite by homosexual males for sexual enhancement,
and the development of AIDS. If this relationship exists, the
immunosuppresive effects of these compounds may be contributory.
c. Clinical
studies also suggest an association between abuse of butyl and
other nitrites for sexual enhancement by homosexual males and
the development of Kaposi's Sarcoma.
d. Butyl nitrite
is capable of causing serious injury to the red blood cells due
to potent "oxidizing" effects of these compounds. The oxygen-carrying
molecule of red blood cells, hemoglobin, is permanently converted
by these effects to a nonfunctional form (methemoglobin), thus
interfering with oxygen supply to vital tissues. These oxidizing
effects can be so severe that in susceptible persons (glucose-6-dehydrogenase
deficiency and other hereditary disorders that limit the ability
to withstand oxidant challenge) massive red blood cell breakdown
has occurred.
Nitrous
Oxide
a. Found in
whipped cream canisters, whippets.
b. Characterized
by distinctive modes of access and settings of abuse.
c. The most
serious abuse complication is death via brain anoxia when the
pure gas is extensively inhaled.
d. Altered
perception and motor coordination caused by nitrous oxide intoxication
have been a significant cause of motor vehicle and other accidents.
e. Prominent
venous dilatory effects of nitrous oxide inhalation can cause
sudden position-related blood pressure changes sufficient to induce
syncopal ("blackout") episodes, with potential for serious injury.
f. Chronic
abuse, though unusual, can occur. Such abuse may interfere with
vitamin B-12 metabolism resulting in neurologic and hematologic
complications.
g. Chronic
abuse may result in both depression of heart muscular functioning
and in cardiac rhythm disturbances.
i. Chronic
abuse has also been linked with risk of miscarriage, birth defects,
kidney and liver defects.
Hazards
presented by the inhalation of aerosol
preparations or other pressurized gases.
a. The inhalation
of aerosol preparations involves, almost by definition, a multi-toxic
hazard.
b. Aerosol
preparations are capable of generating particularly high concentrations
of the inhaled chemicals. Upon their release from aerosol containers,
butane and other propellants become available for inhalation at
concentrations much higher than those involved with the inhalation
of vapors released much more slowly from liquid products, or viscous
materials such as glues and adhesives. Aerosol preparations releasing
these propellants are capable of producing nearly a 100 % concentration
of the desired substance.
c. Aerosol
preparations can cause respiratory tract injury through exposure
to surprisingly cold temperatures. The aerosol contents expand
suddenly upon release, resulting in cooling to temperatures as
low as 20 degrees Celsius.
d. Gases inhaled
from tanks or air conditioning systems may expose the respiratory
system to sufficient pressures to cause rupture and life-threatening
pulmonary collapse.
e. Abuse of
aerosol preparations was identified in the United Kingdom as a
major factor in an increased incidence of inhalant related sudden
death.
Methylene
Chloride
a. Found in:
Degreasers, waxes, paints, paint removers, some paint and varnish
thinners, pesticide sprays, lubricants.
b. The body
converts methylene chloride to carbon monoxide and chloride. This
solvent affects the heart muscle and heartbeat.
c. Long-term
exposure to fumes causes cancer in laboratory animals.
