Friday, September 3
Drugs and Sports - Inhalants
 Editor's note: This is the seventh of an eight-part series of articles examining the effects of commonly abused substances on athletic performance and overall health. Dr. Gary Wadler, a New York University School of Medicine professor and lead author of the book "Drugs and the Athlete", has also won the International Olympic Committee President's Prize for his work in the area of performance-enhancing drugs in competitive sports. He joined us to address the issue of inhalant abuse.

What are inhalants?

Inhalant use is the deliberate inhalation or "sniffing" of common, legal substances to achieve a mind-altering state referred to as a "high. Inhalants are products with a variety of industrial, commercial, and household uses and can broadly be categorized as either solvents (liquids) or gases. Solvents include such products as paint thinners, gasoline and glue but also include such things as felt-tip marker fluid. Household inhalant gases include butane lighters, propane gases, whipped cream and hair spray aerosols, airplane glue and spray paints. Commercial inhalant gases include refrigerant gases, medical anesthetic gases, e.g., ether and nitrous oxide (so-called laughing gas), and other medical inhalants, e.g., amyl nitrate. Amyl nitrite, normally used to revive those who have fainted or been rendered unconscious, is a clear yellowish liquid that is sold in a cloth-covered, sealed bulb. When broken, the bulb makes a snapping sound, thus the nicknames of snappers or "poppers.

Inhalants enter the bloodstream and are rapidly distributed to the brain as well as to other organs of the body such as the liver, kidneys and bone marrow. "While some inhalants are metabolized and then excreted by the kidneys, others are eliminated unchanged from the body, primarily through the lungs," says Wadler. "Consequently, the odor of various solvents may remain on the breath for several hours following their inhalation." Most inhalants are fat-soluble, therefore the complete elimination of inhalants may take sometime since they are released rather slowly from fatty tissues back into the blood."

What are the short-term adverse effects of inhalant abuse?

Although the array of inhalants varies in their effect, for the most part they behave like anesthetics to slow down various bodily functions. Short-term effects appear soon after inhalation and disappear within a few hours. Initially, the user is stimulated and disinhibited, but with successive inhalations, speech becomes slurred, the gait becomes staggered, hallucinations may appear, drowsiness ensues, respirations become depressed and the user may lapse into unconsciousness if continuously exposed to the fumes.

Deaths due to suffocation, dangerous behaviors associated with intoxication, and aspiration have been associated with acute inhalant abuse. As with other drugs of abuse, the use of inhalants while taking other depressant drugs such as alcohol and tranquilizers increases the risk of loss of consciousness, coma and even death.

What are the long-term adverse effects of inhalation abuse?

The long-term adverse effects associated with repeated abuse of inhalants varies depending upon the specific inhalant abused and include weight loss, electrolyte imbalance, nosebleeds, and mouth sores. "Some solvents, such as aromatic hydrocarbons (e.g., gasoline) irreversibly interfere with the formation of blood cells in the bone marrow, while others (e.g., dry-cleaning fluids) may impair liver and/or kidney function", says Wadler. "Some glues may produce permanent hearing loss while others may irreversibly destroy nerve function."

While the short term effects of inhalants on the central nervous system (slurred speech, euphoria, hallucinations) can last from minutes to hours, the long term adverse effects on the central nervous system are irreversible and result from the dissolving away of brain cells by the solvents. Clinically this can be manifested as irreversible dementia, gait disturbances and loss of coordination.

Behavioral symptoms in regular heavy sniffers include mental confusion, fatigue, depression, irritability, hostility, and paranoia

What is Sniffing Death Syndrome?

One mechanism of death that may account for the largest percentage of deaths from acute inhalant abuse has been referred to as the "Sniffing Death Syndrome." Sudden sniffing deaths typically occur in association with strenuous exercise or with sudden emotional stress, e.g., being discovered inhaling by an authority figure. According to Wadler, "Inhalants sensitize the heart to epinephrine. Activities or events that acutely raise blood epinephrine levels can result in fatal rhythm disturbances of the heart. Particularly disturbing is the fact that sudden sniffing death can occur with the very first experimentation with inhalation abuse, and in fact, in one study, 22% of deaths occurred in individuals with no known prior inhalant abuse."

Are inhalants addictive?

Regular inhalant use induces tolerance, which means increased doses are necessary to produce the same effects. After a year, for example, a regular glue sniffer may be using from eight to ten tubes of plastic cement to maintain the "high" originally achieved with a single tube.

Psychological dependence on inhalants, the compulsive need to keep taking them is fairly common. Youthful solvent abusers can be among the most difficult patients to cure.

Physical dependence occurs when the body has adapted to the presence of inhalants and withdrawal symptoms occur if their use is stopped abruptly. Upon sudden discontinuation of the inhalants, some chronic users suffer chills, hallucinations, headaches, abdominal pains, or delirium tremens (DTs - the "shakes").