Overview of disorders of volatile inhalant use

A wide variety of volatile inhalants is consumed in Australia; the most common are:

nitrous oxide (eg sold in small canisters as a propellant for whipped cream) used to achieve brief intoxication
amyl nitrite used as a party drug and to enhance sexual experience (chemsex)Alcohol and Drug Foundation (ADF), 2021 Australian Institute of Health and Welfare (AIHW), 2020.

Other volatile inhalants include:

petrol
solvents, such as toluene, found in glues, paints, paint thinners and correction fluids
acetone in nail polish remover
butane in deodorants and gas canisters.

The use of volatile inhalants is described by colloquial terms. Substances can be inhaled fromThe Royal Children's Hospital Melbourne (RCH):

a soaked cloth on the nose and mouth—’huffing’
a plastic bag—’bagging’
a container—’sniffing’.

Use of volatile inhalants in Australia has increased from 0.4% of the population in 2001 (reporting use in the past year) to 1.7% in 2019. Use is more prevalent among some populations, such as young people (of whom 13% report use in the past year). Around one-third of use occurs monthlyAustralian Institute of Health and Welfare (AIHW), 2020. Volatile inhalants are readily available, and it is rarely feasible to reduce access to them.

The spectrum of substance use in these guidelines is described by the terms ‘hazardous use’, ‘harmful use’ or ‘substance dependence’, outlined in Terminology describing the spectrum of substance use.

Harms result from acute intoxication and chronic consumption of volatile inhalants. Presentations of acute intoxication vary according to the substance; they are most frequently characterised by euphoria, disinhibition and excitation, but also feature drowsiness, disorientation, hallucinations and ataxia, particularly at high doses. Most patients experiencing inhalant intoxication can be treated with removal of the causal agent, and bed rest. Deaths are rare, but may arise through asphyxia, ventricular fibrillation and other cardiac arrhythmias. Advice on the management of volatile inhalant toxicity is available in Hydrocarbon poisoning: Inhalation and in Nitrous oxide poisoning in the Toxicology and Toxinology guidelines.

Chronic, high-level exposure to some volatile inhalants can result in diffuse neurotoxicity, with varying symptoms, most commonly peripheral neuropathy and encephalopathy. Use of nitrous oxide is associated with functional vitamin B₁₂ deficiency and subacute combined degeneration of the spinal cord. Other organ systems, including the kidney and liver, may also be affected by volatile inhalant use.

Chronic use of volatile inhalants can result in dependence. Although inhalant withdrawal is not well described, symptoms reported on abrupt stopping after dependent use include headaches, nausea, vomiting, hallucinations, rhinorrhoea, craving, tachycardia, depressed mood, agitation, insomnia and anxietyPerron, 2009.