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Community substance abuse trends have become all to common for the EMS responder to readily identify. As the front-line medical presence in the war on drugs, it seems like the pre-hospital professional is always the first to recognize the emergence of a substance's popularity by the "body count" we have been confronted with over the course of a week or month.
The EMS community has lived through the cocaine invasion of the 1980s and early '90s; the rise of designer drugs such as "X," "MDMA" and "Special K"; and the resurgence of high-grade heroin and a variety of offshoots known by street names like "Tango & Cash," "Super Buick" and "Polo," to name just a few. In each of these situations we were confronted with an illegal drug that, at times, was difficult to obtain due to cost, availability or access to a dealer.
When the purity or composition of a drug is changed or increased, as was the case with some of the aforementioned heroin events, the effects are immediately felt by EMS providers. All too often, responders found multiple overdose or cardiac/respiratory arrest patients. In these instances the scenes themselves or bystanders gave us the clues we needed.
What we must now face as EMS practitioners is not an illegal substance. It is not difficult to obtain and has an increasing popularity of almost epidemic proportion among the youth of this country: inhalant abuse. In many instances, it will be your clinical experience and education that will assist you in identifying the reasons your patient has an altered mental state, is unconscious or in cardiac arrest.
Inhalant abuse has been called the "cocaine of the '90s" because of its escalating popularity. It is extremely addictive and deadly, and its popularity has increased exponentially. It is reported that "Nationwide, nearly one in four seventh graders has tried it" (The Post & Courier, Charleston and North Charleston, SC).
The U.S. Substance Abuse and Mental Health Services Administra-tion (SAMHSA) reported that in any given month almost 500,000 children from 12 to 17 years of age are using or experimenting with inhalants. The SAMHSA research has shown that in 1995 almost 700,000 people of all ages experimented with inhalants for the first time. The National Institute on Drug Abuse (NIDA) documented that in 1995 about 22% of eighth graders in the United States have tried a form of inhalant. That ranks inhalants third for substance abuse after alcohol and tobacco. In higher grades it is reported that marijuana replaces inhalants in the third ranking but throughout school years inhalant abuse exceeds all other illicit drugs (National Inhalant Prevention Coalition).
More than 1,000 household items are capable of being intentionally abused. In the case of inhalants, the user is either "sniffing" (inhaling through the nose) or "huffing" (inhaling through the mouth) to achieve a high. One difficult aspect of this type of abuse is that the items being inhaled are legal and have lawful uses. These items are easily available in homes, garages or stores, making access a non-issue for the abuser.
Main categories of substances used for inhalant abuse are volatile solvents, anesthetics, nitrites and aerosols. Substances that are abused frequently include carbon-tetrachloride, gasoline, butane, propane, correction fluid, vegetable cooking spray and dessert topping sprays. The legal access and possession of these substances and their low prices make them inviting to users, especially children. In most cases, the unfamiliarity of parents or adult supervision with the products' inhalation abuse potential increases the attraction.