Scope & epidemiology

Inhalant use is often under‑reported. Commonly affected groups include adolescents, marginalized youth, and individuals with limited access to other substances. Products used include glues, aerosol sprays, solvents, paint thinners, nitrites and gases (e.g., butane).

Types of inhalants

• Solvents: glue, paint thinner, gasoline.
• Aerosols: spray paints, deodorants, hair sprays.
• Gases: butane, propane, nitrous oxide.
• Nitrites: ‘poppers’ (amyl/isobutyl nitrite) — primarily cause vasodilation and are used for sexual disinhibition.

Recognition — acute features

• Signs of acute intoxication: dizziness, euphoria, slurred speech, ataxia, nystagmus, altered consciousness.
• Severe complications: sudden sniffing death (cardiac arrhythmia), aspiration, hypoxia, methemoglobinemia (nitrites), and trauma from impaired judgment.
• Look for physical clues: chemical smell, stained fingers/lips, rags or containers, or evidence of inhalant paraphernalia.

Chronic harms

• Neurocognitive impairment: memory, attention, executive dysfunction; sometimes irreversible with prolonged heavy use.
• Cardiomyopathy, peripheral neuropathy, liver and renal toxicity.
• Social and developmental harms in adolescents, including school dropout and legal issues.

Assessment

1. Detailed substance history: product type, frequency, mode (huffing, bagging), co‑ingestants and recent episodes of loss of consciousness.
2. Physical exam and baseline observations (HR, BP, SpO₂, temperature). Assess for neurological deficits and signs of hypoxia/aspiration.
3. Investigations as indicated: pulse oximetry, arterial blood gas if hypoxic, ECG (arrhythmia risk), methemoglobin level for nitrite exposure, basic metabolic panel and LFTs.
4. Assess psychosocial risk: homelessness, family support, legal issues, and readiness to change.

Acute management

• Initial stabilization: ABCs — ensure airway protection, oxygen for hypoxia, and treat aspiration as per standard protocols.
• Cardiac monitoring for arrhythmias; treat arrhythmias per ACLS guidelines and consider urgent cardiology consultation for persistent cardiac instability.
• For nitrite exposure with methemoglobinemia, treat with methylene blue where indicated (consult toxico‑logy). Avoid methylene blue in G6PD deficiency without specialist advice.
• Manage agitation with benzodiazepines; avoid antipsychotics as they may lower seizure threshold or worsen cardiac risk in some cases.

Treatment and rehabilitation

• Brief interventions and motivational interviewing are effective engagement tools for adolescents and adults beginning treatment.
• Psychosocial treatments: cognitive behavioral therapy, family interventions, school‑based programs, and community outreach are mainstays — no approved pharmacotherapy for inhalant dependence.
• Address comorbidities: treat mood, anxiety or conduct disorders and coordinate with social services for housing, education and vocational support.
• Consider inpatient admission for those with medical complications, severe dependence, or unsafe social environments.

Harm reduction strategies

• Educate about acute risks (sudden death, hypoxia) and safer practices (avoid confined spaces, do not mix with other depressants).
• Engage families, schools and community workers to reduce access and provide alternatives (sport, vocational training).
• Provide basic first‑aid training for witnesses and encourage seeking immediate help for loss of consciousness or collapse.

Key takeaways

• Inhalant use can cause life‑threatening acute medical events — prioritise stabilization and cardiac/respiratory monitoring.
• No specific medications are approved for dependence; psychosocial interventions and community supports are central to treatment.
• Early intervention in adolescents, family engagement and harm reduction reduce morbidity and improve outcomes.