NDARC's Professor Shane Darke discusses his recently published study on deaths related to inhalant misuse in Australia.
There has been a great deal of recent concern regarding volatile solvent (or inhalant) misuse. The term covers the inhalation of substances that vaporise at room temperature for intoxication or sexual experience enhancement. While there is a wide range of such solvents, they may be broadly categorised as gas fuels (e.g. cigarette lighter canisters, gas bottles), petroleum (gasoline), aerosol propellants (e.g. air fresheners, deodorant spray), solvents from adhesives and paints (e.g. glue, spray paints), volatile anaesthetics (e.g. nitrous oxide) and nitrites (e.g. amyl nitrite). Acute risks include asphyxia, seizures, cerebral oedema,
cardiac arrythmia, acute respiratory arrest, as well as intense agitation and an acute psychosis that may increase the acute risk of self-harm or traumatic injury. Hydrocarbons have been associated with 'sudden sniffing death', a syndrome characterised by sudden collapse shortly after inhalation due to cardiac and/or respiratory arrest.
In a recent paper, we reported on all documented deaths in Australia between 2000 and 2021 associated with inhalant misuse identified through the National Coronial Information System. We identified 164 cases, with a mean of 26.5 years and 80% male. While 28% involved teenagers, the majority (65 per cent) were aged between 20 and 39, and 9% were over 40. The most frequent cause of death was unintentional toxicity (61%). In 20% of cases, death was due to asphyxia caused by volatile solvent administration. There were 20 cases of suicide, primarily using physical means, and 7% were due to a traumatic accident.
The most frequently used volatile solvents involved in fatal incidents were gas fuels (35 per cent), followed by petrol (20 per cent), adhesives/paints (20 per cent) and aerosol propellants (13 per cent). Nitrous oxides were used in 12 per cent of fatal incidents. Reflecting the pre-eminence of gas fuels, butane was the most commonly detected volatile solvent (39%). Toluene (30%), most commonly from adhesives and paints, was the next most common.
The most commonly reported acute presentation before death was sudden collapse (22 of 47 witnessed events). The prevalence of acute pneumonia amongst autopsied cases was low (6%), which, together with reports of sudden collapse, suggests that death was extremely rapid in many cases.
To reduce the morbidity and mortality associated with inhalants, we must not focus solely on young people, as important as those cases are. Many deaths are of older people, a trend consistent with that seen overseas. We need to make it clear that these are not harmless products and that inhaling them is unsafe. While there is a great deal of media attention given to nitrous oxide, these represent a minority of cases, and the dangers associated with using what might be seen as harmless commercial products must be made clear. Moreover, there needs to be recognition that medical attention is imperative in cases of sudden collapse. Finally, we should avoid terms that might glamorise the practice, such as 'chroming', 'nanging' or 'huffing'.
You can download the study, 'Characteristics and circumstances of volatile solvent misuse-related death in Australia, 2000-2021' in Clinical Toxicology here.
For further information about volatile inhalants, please consult NDARC's fact sheet on volatile inhalants: