N A T I O N A L I N S T I T U T E O N D R U G A B U S E

Research Report
Although many parents are
S E R I E S

INHALANT
appropriately concerned about illicit
drugs such as marijuana, cocaine,
and LSD, they often ignore the dangers
posed to their children from common
household products that contain
volatile solvents or aerosols. Products
such as glues, nail polish remover,
lighter fluid, spray paints, deodorant
Abuse
and hair sprays, whipped cream What are
of different products that may
canisters, and cleaning fluids are
widely available. Many young people inhalants? have different pharmacological
inhale the vapors from these sources

I
in search of quick intoxication without nhalants are volatile sub- effects. As a result, precise
being aware of the serious health stances that produce chemical categorization of inhalants is
consequences that can result. vapors that can be inhaled difficult. One classification sys-
National surveys indicate that more
than 22.9 million Americans have to induce a psychoactive, or tem lists four general categories
abused inhalants at least once in their mind-altering, effect. Although of inhalants—volatile solvents,
lives. NIDA's Monitoring the Future other abused substances can be aerosols, gases, and nitrites—
study reveals that approximately 17.3
from the director

percent of eighth-graders have abused inhaled, the term “inhalants” is based on the form in which they
inhalants. Parents and children need used to describe a variety of are often found in household,
to know that experimentation with substances whose main common industrial, and medical products.
these substances should not be taken
lightly. Even a single session of repeated characteristic is that they are Volatile solvents are liquids
inhalant abuse can disrupt heart rarely, if ever, taken by any route that vaporize at room tempera-
rhythms and cause death from cardiac other than inhalation. This defini- tures. They are found in a
arrest or lower oxygen levels enough to
cause asphyxiation. Regular abuse of
tion encompasses a broad range multitude of inexpensive, easily
these substances can result in serious of chemicals found in hundreds available products used for
harm to vital organs including the common
brain, heart, kidneys, and liver.
Through scientific research, we
household
have learned much about the nature and industrial
and extent of inhalant abuse, its purposes.
pharmacology, and its consequences.
This research has brought the picture
These include
of inhalant abuse in our Nation into paint thinners
focus and pointed to the dangers and removers,
and the warning signs for parents,
educators, and clinicians. We hope
dry-cleaning
this compilation of the latest scientific fluids,
information will help alert readers degreasers,
to inhalant abuse and its harmful
effects and aid efforts to deal with this
gasoline,
problem effectively. glues, correc-
tion fluids,
Nora D.Volkow, M.D. and felt-tip
Director
National Institute on Drug Abuse marker fluids.

U.S. Department of Health and Human Services • National Institutes of Health

2 NIDA RESEARCH REPORT SERIES

Aerosols are sprays that

contain propellants and solvents.
What are the shoe-shining spray containing
the chemical toluene, is a local
They include spray paints, patterns of favorite. Silver and gold spray
deodorant and hair sprays,
vegetable oil sprays for cooking,
inhalant abuse? paints, which contain more
toluene than other spray colors,

I
and fabric protector sprays. nhalants—particularly also are popular inhalants.
Gases include medical anes- volatile solvents, gases, and Data from national and State
thetics as well as gases used in aerosols—are often among surveys suggest inhalant abuse
household or commercial prod- the first drugs that young children reaches its peak at some point
ucts. Medical anesthetic gases use. One national survey indicates during the seventh through ninth
include ether, chloroform, that about 3.0 percent of U.S. grades. In the Monitoring the
halothane, and nitrous oxide, children have tried inhalants Future (MTF) study, an annual
commonly called “laughing gas.” by the time they reach fourth
NIDA-supported survey of the
Nitrous oxide is the most abused grade. Inhalant abuse can
Nation’s secondary school stu-
of these gases and can be found become chronic and extend
dents, 8th-graders also regularly
in whipped cream dispensers into adulthood.
Generally, inhalant abusers report the highest rate of current,
and products that boost octane
will abuse any available sub- past year, and lifetime inhalant
levels in racing cars. Household
stance. However, effects pro- abuse; 10th- and 12th-graders
or commercial products contain-
ing gases include butane lighters, duced by individual inhalants report less abuse.
propane tanks, whipped cream vary, and some individuals will Gender differences in inhalant
dispensers, and refrigerants. go out of their way to obtain abuse have been identified at
Nitrites often are considered a their favorite inhalant. For different points in childhood. The
special class of inhalants. Unlike example, in certain parts of the 2004 MTF indicates that 10.5 per-
most other inhalants, which act country, “Texas shoe-shine,” a cent of 8th grade females reported
directly on the central nervous
system (CNS), nitrites act primarily
to dilate blood vessels and relax Students who have ever used inhalants
the muscles. While other inhalants versus other commonly abused drugs, percent
are used to alter mood, nitrites
are used primarily as sexual Marijuana
enhancers. Nitrites include cyclo- 8th Cocaine
hexyl nitrite, isoamyl (amyl)
nitrite, and isobutyl (butyl) nitrite, LSD
and are commonly known as Inhalants
“poppers” or “snappers.” Amyl
Grade

nitrite is used in certain diagnostic 10th

procedures and was prescribed
in the past to treat some patients
for heart pain. Nitrites are now
prohibited by the Consumer 12th
Product Safety Commission, but
can still be found, sold in small
bottles, often labeled as “video 0 10 20 30 40 50
head cleaner,” “room odorizer,” Percentage
“leather cleaner,” or “liquid Source: Monitoring the Future Survey, 2004
aroma.”
 NIDA RESEARCH REPORT SERIES 3
Percent of 8th-Graders Reporting Lifetime Use of Inhalants Increased

■ 8th-graders
25 ▲ 10th-graders
● 12th-graders
20
*
15
Percent

10

0
91 92 93 94 95 96 97 98 99 00 01 02 03 04

* P<.05 Source: University of Michigan, 2004 Monitoring the Future Survey

using inhalants in the past year, suggests that adverse socioeco- ■ Annual abuse of inhalants
compared with 8.8 percent of nomic conditions, a history of among 10th-graders was
8th grade males. Among 12th- childhood abuse, poor grades, 5.9 percent in 2004, also
graders, 3.4 percent of females and dropping out of school all down from a high in 1995
and 4.8 percent of males reported are associated with inhalant (9.6 percent).
using inhalants in the past year. abuse.
The National Survey on Drug
■ Among 8th-graders, 2004
abuse figures, at 9.6 percent,
Use and Health (NSDUH), What is the were down overall from the
an annual survey of drug use
among the Nation’s noninstitu- scope of 1995 peak of 12.8 percent,
tionalized civilians, reports that inhalant abuse? but were up from the 2002
similar percentages of 12- to 17- rate of 7.7 percent.

I
nhalant abuse was up
year-old boys and girls abused
significantly for the second According to the 2003 NSDUH,
inhalants in 2003. However, the
year in a row among lifetime, past year, and past
percentage of 18- to 25-year-old 8th-graders, according to the
males who abused inhalants month inhalant use among
latest MTF data, while use persons aged 12 to 17 were
within the past month was more among 10th- and 12th-graders
than twice that of females in 10.7 percent, 4.5 percent, and
continued to decline. 1.3 percent, respectively. The
that age group, suggesting that
sustained abuse of inhalants is ■ The rate of high school number of new inhalant users
more common among males. seniors who abused increased from 627,000 new
People who abuse inhalants inhalants in the past year users in 1994 to 1 million in
are found in both urban and was 4.2 percent in 2004, 2002. Inhalant initiates were
rural settings. Research on factors down from the peak of predominantly under age 18
contributing to inhalant abuse 8.0 percent in 1995. (78 percent in 2002).
4 NIDA RESEARCH REPORT SERIES

■ “Bagging”—sniffing or inhal-
How can inhalant abuse be recognized? ing fumes from substances
sprayed or deposited inside
a plastic or paper bag;
Early identification and intervention are the best ways to stop
■ “Huffing” from an inhalant-
inhalant abuse before it causes serious health consequences.
soaked rag stuffed in the
Parents, educators, family physicians, and other health care
mouth; and
practitioners should be alert to the following signs of a serious
inhalant abuse problem: ■ Inhaling from balloons filled
with nitrous oxide.
■ Chemical odors on breath ■ Drunk or disoriented
or clothing appearance Inhaled chemicals are rapidly
absorbed through the lungs into
■ Paint or other stains on ■ Slurred speech the bloodstream and quickly
face, hands, or clothes ■ Nausea or loss of distributed to the brain and
■ Hidden empty spray paint appetite other organs. Within seconds of
or solvent containers and ■ Inattentiveness, lack of inhalation, the user experiences
chemical-soaked rags or coordination, irritability, intoxication along with other
clothing and depression effects similar to those produced
by alcohol. Alcohol-like effects
may include slurred speech, an
inability to coordinate move-
ments, euphoria, and dizziness.
MTF’s lifetime prevalence 8th-graders consistently report
In addition, users may experience
figures indicate that the percent- they have ever abused inhalants?
lightheadedness, hallucinations,
ages of students who have tried Possibly, many 12th-graders fail
inhalants continue to decrease to recall their much earlier use and delusions.
steadily for 10th- and 12th- of inhalants or, more troubling, Because intoxication lasts
graders. In 2004, 12.4 percent many 8th-grade inhalant abusers only a few minutes, abusers
of 10th-graders and 11.9 percent may have dropped out of school frequently seek to prolong the
of 12th-graders said they have by the 12th grade and are no high by continuing to inhale
abused inhalants at least once longer included in the survey repeatedly over the course of
in their lives. Although lifetime population. several hours, a very dangerous
prevalence peaked for 8th- practice. With successive
graders in 1995 (21.6 percent), inhalations, abusers can suffer
rates of inhalant use among
How are loss of consciousness and death.
this group are still high. In fact, inhalants used? At the least, they will feel less
8th-graders reported a significant

I
nhalants can be breathed inhibited and less in control.
increase in lifetime use from in through the nose or the After heavy use of inhalants,
15.8 percent in 2003 to 17.3 per- mouth in a variety of ways, abusers may feel drowsy for
cent in 2004. For 10th-graders, such as: several hours and experience a
the peak was 19.3 percent in lingering headache.
1996. For seniors, rates were ■ “Sniffing” or “snorting”
highest in 1994 at 17.7 percent. fumes from containers;
These data raise a question: ■ Spraying aerosols directly
How can fewer 12th-graders than into the nose or mouth;
 NIDA RESEARCH REPORT SERIES 5
How do inhalants produce a pleasurable effect by
depressing the CNS. Evidence
sufficient amounts are inhaled,
nearly all solvents and gases
produce their from animal studies suggests that produce anesthesia, a loss of sen-
effects? a number of commonly abused sation, and even unconsciousness.
volatile solvents and anesthetic The chemicals found in sol-

M
any brain systems may gases have neurobehavioral vents, aerosol sprays, and gases
be involved in the anes- effects and mechanisms of action can produce a variety of addi-
thetic, intoxicating, and similar to those produced by tional effects during or shortly
reinforcing effects of different CNS depressants, which include after use. These effects are
inhalants. Nearly all abused alcohol and medications such as related to inhalant intoxication
inhalants (other than nitrites) sedatives and anesthetics. and may include belligerence,
A recent study indicates apathy, impaired judgment, and
Brain damage in a that toluene, a solvent impaired functioning in work
toluene abuser found in many commonly or social situations. Dizziness,
abused inhalants, including drowsiness, slurred speech,
model airplane glue, paint lethargy, depressed reflexes,
sprays, and paint and nail general muscle weakness, and
polish removers, activates stupor are other possible effects.
the brain’s dopamine sys- For example, research shows
tem. The dopamine system that toluene can produce
has been shown to play headache, euphoria, giddy feel-
a role in the rewarding ings, and inability to coordinate
effects of many drugs of movements. Exposure to high
abuse. Nitrites, in contrast, doses can cause confusion and
dilate and relax blood delirium. Nausea and vomiting
vessels rather than acting are other common side effects.
as anesthetic agents. Inhaled nitrites dilate blood
vessels, increase heart rate, and
What are produce a sensation of heat
the short- and excitement that can last for
several minutes. Other effects
and long-term can include flush, dizziness, and
effects of headache. Unlike other inhalants,
which are abused mainly for
inhalant use? their intoxicating effects, nitrites

A
lthough the chemi- are abused primarily because
cal substances found they are believed to enhance
in inhalants may sexual pleasure and performance.
produce various pharma- A strong need to continue
cological effects, most using inhalants has been report-
Courtesy of Neil Rosenberg, M.D.
inhalants produce a rapid ed among many individuals,
Brain images show marked atrophy (shrinkage) high that resembles alcohol particularly those who abuse
of brain tissue in a toluene abuser (B) compared
to a nonabusing individual (A). Note the smaller intoxication with initial inhalants for prolonged periods
size and the larger empty (dark) space within excitation, then drowsiness, over many days. Compulsive
the toluene abuser's brain. (The white outer
circle in each image is the skull.) disinhibition, lightheaded- use and a mild withdrawal syn-
ness, and agitation. If drome can occur with long-term
6 NIDA RESEARCH REPORT SERIES

inhalant abuse. Additional ■ Convulsions or seizures— The neurotoxic effects of

symptoms exhibited by long- caused by abnormal prolonged inhalant abuse include
term inhalant abusers include electrical discharges in the neurological syndromes that
weight loss, muscle weakness, brain; reflect damage to parts of the
disorientation, inattentiveness, ■ Coma—the brain shuts brain involved in controlling
lack of coordination, irritability, down all but the most vital cognition, movement, vision, and
and depression. functions; hearing. Cognitive abnormalities
■ Choking—from inhalation of can range from mild impairment
What are vomit after inhalant use; or to severe dementia. Other effects
can include difficulty coordinating
the medical ■ Fatal injury—from accidents,
including motor vehicle
movement, limb spasms, and loss
consequences of fatalities, suffered while
of feeling, hearing, and vision.
Inhalants also are highly
inhalant abuse? intoxicated.
toxic to other organs. Chronic

I
nhalant abusers risk an array Animal and human research exposure can produce significant
of devastating medical conse- shows that most inhalants are damage to the heart, lungs, liver,
quences. Prolonged sniffing of extremely toxic. Perhaps the and kidneys. Although some
the highly concentrated chemi- most significant toxic effect of inhalant-induced damage to the
cals in solvents or aerosol sprays chronic exposure to inhalants is nervous and other organ systems
can induce irregular and rapid widespread and
heart rhythms and lead to heart long-lasting
failure and death within minutes damage to the Nerve fiber deterioration in an
of a session of prolonged sniff- brain and other inhalant abuser
ing. This syndrome, known as parts of the
“sudden sniffing death,” can nervous system.
result from a single session of For example, both
inhalant use by an otherwise animal research
healthy young person. Sudden and human
sniffing death is particularly pathological

Reproduced with permission from the Journal of Neuropathology & Experimental Neurology.
associated with the abuse of studies indicate
butane, propane, and chemicals that chronic abuse
in aerosols. Inhalant abuse also of volatile solvents
can cause death by: such as toluene
damages the
■ Asphyxiation—from repeated
protective sheath
inhalations, which lead to around certain
high concentrations of nerve fibers in
inhaled fumes displacing the brain and
the available oxygen in peripheral nervous
the lungs; system. This exten-
■ Suffocation—from blocking sive destruction
air from entering the lungs of nerve fibers is
when inhaling fumes from clinically similar
a plastic bag placed over to that seen with
neurological Dark-stained patches show areas where nerve fibers have
the head; lost their protective sheath in a specimen of brain tissue
diseases such as removed from a deceased inhalant abuser.
multiple sclerosis.
 NIDA RESEARCH REPORT SERIES 7
Hazards of chemicals found in commonly abused inhalants

amyl nitrite, butyl nitrite methylene chloride

(“poppers,” “video head cleaner”) (found in paint thinners and removers, degreasers)
sudden sniffing death syndrome, suppressed immunologic reduction of oxygen-carrying capacity of blood, changes to the
function, injury to red blood cells (interfering with oxygen heart muscle and heartbeat
supply to vital tissues)
nitrous oxide (“laughing gas”), hexane
benzene (found in gasoline) death from lack of oxygen to the brain, altered perception and motor
bone marrow injury, impaired immunologic function, coordination, loss of sensation, limb spasms, blackouts caused by
increased risk of leukemia, reproductive system toxicity blood pressure changes, depression of heart muscle functioning
butane, propane toluene
(found in lighter fluid, hair and paint sprays) (found in gasoline, paint thinners and removers, correction fluid)
sudden sniffing death syndrome via cardiac effects, brain damage (loss of brain tissue mass, impaired cognition, gait
serious burn injuries (because of flammability) disturbance, loss of coordination, loss of equilibrium, limb spasms,
hearing and vision loss), liver and kidney damage
freon (used as a refrigerant and aerosol propellant)
sudden sniffing death syndrome, respiratory obstruction trichlorethylene (found in spot removers, degreasers)
and death (from sudden cooling/cold injury to airways), sudden sniffing death syndrome, cirrhosis of the liver, reproductive
liver damage complications, hearing and vision damage

may be at least partially reversible conducted, and it is not possible inhalants and the development
when inhalant abuse is stopped, to link prenatal exposure to a and progression of infectious
many syndromes caused by specific chemical to a specific diseases and tumors. The
repeated or prolonged abuse birth defect or developmental research indicates that inhaling
are irreversible. problem. nitrites depletes many cells in
Abuse of inhalants during the immune system and impairs
pregnancy also may place infants What are the immune system mechanisms that
and children at increased risk of fight infectious diseases. A recent
developmental harm. Animal special risks for study found that even a relatively
studies designed to simulate nitrite abusers? small number of exposures to
human patterns of inhalant abuse butyl nitrite can produce dramatic

N
suggest that prenatal exposure itrites are abused mainly
increases in tumor incidence and
to toluene or trichlorethylene by older adolescents and
adults. Typically, individu- growth rates in animals.
(TCE) can result in reduced birth
weights, occasional skeletal als who abuse nitrites are seek-
abnormalities, and delayed ing to enhance sexual function Where can I get
neurobehavioral development. and pleasure. Research shows
that abuse of these drugs in this
further scientific
A number of case reports note
abnormalities in newborns of context is associated with unsafe information about
mothers who chronically abuse sexual practices that greatly
increase the risk of contracting
inhalant abuse?
solvents, and there is evidence

T
of subsequent developmental and spreading such infectious o learn more about
impairment in some of these diseases as HIV/AIDS and inhalants and other drugs of
children. However, no well- hepatitis. abuse, contact the National
controlled, prospective study of Animal research raises the Clearinghouse for Alcohol and
the effects of prenatal exposure possibility that there may be a Drug Information (NCADI) at
to inhalants in humans has been link between abuse of nitrite 1-800-729-6686. Information
8 NIDA RESEARCH REPORT SERIES

specialists are available to help

you locate information and Glossary
resources. Anesthetic: An agent that causes insensitivity to pain. Epidemiology: The sum of the factors controlling the
Fact sheets, including InfoFacts, presence or absence of a disease or condition.
Central nervous system: The brain and spinal cord.
on the health effects of inhalants, Toxic: Causing temporary or permanent effects that
Dementia: A condition of deteriorated mental function. are detrimental to the functioning of a body organ or
other drugs of abuse, and
group of organs.
other drug abuse topics are Dopamine: A neurotransmitter present in regions of
the brain that regulate movement, emotion, motivation, Withdrawal: A variety of symptoms that occur after
available on the NIDA Web site
and feeling of pleasure. use of an addictive drug is reduced or stopped.
(www.drugabuse.gov), and can
be ordered free of charge in
English and Spanish from the
National Clearinghouse for References
Alcohol and Drug Information Balster, R.L. Neural basis of inhalant abuse. Drug and Sharp, C.W., and Rosenberg, N.L. Inhalants. In:
(NCADI) at www.health.org. Alcohol Dependence 51(1-2):207-214, 1998. Lowinson, J.H.; Ruiz, P.; Millman, R.B.; and
Langrod, J.G. (eds.), Substance Abuse: A
Bowen, S.E.; Wiley, J.L.; Evans, E.B.; Tokarz, M.E.; Comprehensive Textbook, 3d. ed. Baltimore:
and Balster, R.L. Functional observational battery Williams and Wilkins, 246-264, 1996.
comparing effects of ethanol, 1,1,1-trichlorethane,
Access information ether, and flurothyl. Neurotoxicology and Teratology Sharp, C.W., and Rosenberg, N. Inhalant-related
on the Internet 18(5):577-585, 1996. disorders. In: Tasman, A.; Kay, J.; and Lieberman,
J.A. (eds.), Psychiatry, Vol. 1. Philadelphia:
• What’s new on the NIDA Web site Edwards, R.W., and Oetting, E.R. Inhalant use in the W.B. Saunders, 835-852, 1997.
United States. In: Kozel, N.; Sloboda, Z.; and De La
• Information on drugs of abuse Substance Abuse and Mental Health Services
Rosa, M. (eds.), Epidemiology of Inhalant Abuse:
• Publications and communications An International Perspective. National Institute on Administration. National Findings From the
(including NIDA NOTES) Drug Abuse Research Monograph 148. DHHS 2003 National Survey on Drug Use and Health.
Publication No. NIH 95-3831. Washington, DC: SAMHSA, 2003.
• Calendar of events
U.S. Government Printing Office, 8-28, 1995. Soderberg, L.S. Immunomodulation by nitrite inhalants
• Links to NIDA organizational units may predispose abusers to AIDS and Kaposi’s
Fendrich, M.; Mackesy-Amiti, M.E.; Wislar, J.S.; and
• Funding information sarcoma. Journal of Neuroimmunology
Goldstein, P.J. Childhood abuse and the use of
(including program announcements 83(1-2):157-161, 1998.
inhalants: Differences by degree of use. American
and deadlines) Journal of Public Health 87(5):765-769, 1997. Soderberg, L.S. Increased tumor growth in mice
• International activities exposed to inhaled isobutyl nitrite. Toxicology
Jones, H.E., and Balster, R.L. Inhalant abuse in Letters 104(1-2):35-41, 1999.
• Links to related Web sites pregnancy. Obstetrics and Gynecology Clinics of
(access to Web sites of many other North America 25(1):153-167, 1998. Woody, G.E.; Donnell, D.; Seage, G.R.; et al.
organizations in the field) Non-injection substance use correlates with risky
National Institute on Drug Abuse. National Survey sex among men having sex with men: Data
Results on Drug Use From the Monitoring the Future from HIV/NET. Drug and Alcohol Dependence
Study, 2004 (www.monitoringthefuture.org). 53(3):197-205, 1999.
NIDA Web Sites
National Institute on Drug Abuse. NIDA InfoFacts,
www.drugabuse.gov Inhalants, 2004.
www.inhalants.drugabuse.gov
PRIDE Surveys National Summary for Grades 4 thru 6,
www.steroidabuse.org 2002-2003.
www.clubdrugs.org Riegel, A.C., and French, E.D. Acute toluene induces
biphasic changes in rat spontaneous locomotor
NCADI activity which are blocked by remoxipride.
NIH Publication Number 05-3818
Printed 1994, Reprinted 1996, 1999, Revised July 2000,
Web Site: www.health.org Pharmacology, Biochemistry and Behavior Revised March 2004, Revised March 2005
62(3):399-402, 1999. Feel free to reprint this publication.
Phone No.: 1-800-729-6686