Inhalants: Anesthetics, Industrial Solvents and Organic Nitrites – Drugs of Abuse

00:01 The next category of drugs are an interesting one. They are the inhalants.

00:05 Now, we know about anesthetic inhalant drugs, and we use them all the time, and we don't really think about it, but those same anesthetic drugs can be used to be abused.

00:15 Industrial solvents are solvents and chemicals that are available without a prescription obviously because they are used in industrial applications, but these are sometimes huffed or ingested or inhaled to get a high.

00:29 And organic nitrites are derivations of some of our anesthetic drugs that are also used.

00:34 So, let's start off with nitrous oxide.

00:38 It is the drug of choice for dentists because it gives a fairly rapid anesthesia and it also provides a feeling of wellbeing while patients are under.

00:46 Chloroform is another inhaled anesthetic agent. And diethyl ether is also used as well.

00:53 Diethyl ether is highly volatile, but it does cause euphoria and disinhibition.

01:00 This is a heartbreaking section for me. Huffing is inhaling gasoline or kerosine.

01:06 And what is really heartbreaking about this is it's most often used by children.

01:10 So, if you have a young child coming in with delirium, first thing you should think about is "Are they huffing?" Now, why is it that children are using this more than anyone else is because it's cheap.

01:21 They essentially put gasoline in a plastic bag and inhale it. Here is a picture of some kids from Tennessee.

01:26 I see kids up in the Arctic with this problem. And even kids on some of our reserves, there's a high rate of huffing dependance.

01:38 It is exceedingly toxic to the liver. It's also toxic to the bone marrow and kidneys.

01:43 Now, how we treat it are high-dose oxygen therapy or hyperbaric chambers and a lot of psychological counselling.

01:50 Problem being is that those poeple who are most prone to falling to the evils of huffing are those very same people who don't have access to hyperbaric chambers or psychosocial counselling. They are often victims of abuse themselves.

02:05 The other issue with huffing is that it may take weeks to get this solvent out of the system, typically it's a 28 day treatment. Obviously the cost is prohibitive to a lot of communities and a lot of people.

02:20 This is a picture that we took in (inaudible), which is above the Arctic Circle, and huffing is very common here. And other thing that is common is something that we've termed "Alberto V05 syndrome", but it can refer to any kind of hairspray ingestion. I actually saw a lot of this in my own practice.

02:40 What patients will do is they'll take a can of hairspray, poke a hole in it, filter it through a piece of bread which they think is getting rid of toxins but it's not, and then they drink the remnant of that hairspray.

02:54 It causes a delirium. It's very foul smelling, it has got a very unique smell.

02:59 And patients have quite a metabolic acidosis, and then they develop a secondary respiratory alkalosis.

03:05 So the typical picture is they come in, really bad odour to their breath, a foul smell, they have a metabolic acidosis and they are breathing very quickly, trying get rid of that acid through exhaling carbon dioxide.

03:22 Organic nitrites are kind of an interesting phenomenon that's started about five years ago.

03:28 These are what the jars look like. These bottles look remarkably like the five hour energy drinks that you can get commercially in the stores.

03:37 And in fact, sometimes they will reuse those same containers and then wrap them in their own marketing kind of material.

03:46 So, the illegal drug manufacturers and organized crime are very sophisticated in terms of their packaging.

03:54 These are called poppers. So, you sometimes see them in raves. They will be passed around.

03:59 People will often think that they're getting an energy drink, when in fact it's literally a small amount of liquid that turns into a gas as soon as you pop the lid.

04:09 They're often used as anal sexual intercourse enhancers because it relaxes smooth muscles, particularly the anus.

04:16 So, it started off in the gay raves in the 1980s, and it has become more common place in the rest of the underground culture.

04:26 It causes dizziness, tachycardia, low blood pressure and a lot of flushing.

04:31 There are rare reports of methemoglobinemia. So, if you have methemoglobinemia in your patient, one of the things that you have to look for is the possibility of inhaled organic nitrite abuse.

04:43 One of the other things that happnens with these patients is a lipoid pneumonia.

04:47 So, you'll have to look at the repiratory lectures through Lecturio to learn about lipoid pneumonia.

04:54 But these patients will actually die from aspiration of the liquid form if they take this product incorrectly and that causes the lipoid pneumonia and scarring.

05:07 Okay. So, we've covered a lot of ground today.

05:09 We know about the newer illicit medications and some of these designer drugs, and we understand the effects of these illicit medications and recreational medications on the body.

05:20 You can now explain these new designer drugs and hopefully you'll have a better appreciation for when these patients show up in your emergency department.

05:28 Thanks very much for listening and good luck on your exams.