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Inhalant abuse in children and adolescents

Holly Perry, MD
Section Editor
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH


The epidemiology, clinical manifestations, toxic effects, and management of inhalant use will be reviewed here. Substances that are snorted (eg, cocaine) or smoked (eg, tobacco, marijuana, cocaine, and opiates) are discussed separately. (See "Cocaine: Acute intoxication" and "Cannabis use and disorder: Epidemiology, comorbidity, health consequences, and medico-legal status" and "Treatment of cannabis use disorder" and "Opioid intoxication in children and adolescents".)


In the United States, inhalant abuse is common with approximately 11 percent of high school students reporting having used inhalants in their lifetime [1]. An estimated 6 in 1000 United States children between the age of 12 and 17 are currently abusing inhalants [2,3]. Unlike nearly all other classes of drugs, their use is most common among younger adolescents with use peaking between seventh and ninth grade [4].

The incidence of inhalant abuse in children 12 to 18 years old has fluctuated over the past 25 years. Incidence of use tripled between 1983 and 1993 [5], peaking in 1995, and then showed a steady decline until 2002. Incidence was unchanged for the next 11 years but showed a significant decrease in 2013 [3,4]. Unlike other drugs of abuse, male and female adolescents report a similar rate of inhalant abuse [2]. In the past, Native American children and those residing in rural areas were at higher risk for inhalant abuse [6-10]. However, rates of abuse have fallen steadily in these groups and are now at levels comparable to the general population. Education on prevention and treatment is thought to be responsible for this trend [11,12].

Similar to national survey data, exposures in 12 to 17 year old patients reported to United States regional poison control centers declined from 73 cases per million in 1993 to 33 cases per million in 2003, and the peak age of exposure was 14 years [9]. Among all patients, there were 167 deaths out of 35,453 exposures between 1993 and 2008. Butane, propane, and air fresheners were associated with the highest fatality rate. Males comprised 73 percent of all cases reported to poison centers suggesting that boys may have riskier inhalant abuse behaviors. In the United Kingdom, deaths due to volatile substance abuse peaked in the early 1990s and subsequently have declined after education campaigns and laws prohibiting cigarette lighter refills went into effect [13].

Numerous studies have demonstrated significant mental health and behavioral comorbidities among patients who are inhalant abusers. They are more likely to have an episode of major depression [2,14,15], suicidality [16], conduct disorder [14], and are at an increased risk for future drug abuse problems [17].

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Literature review current through: Nov 2017. | This topic last updated: Oct 27, 2017.
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