Substance Use & Misuse, 32 (12&13), 1871-1876, 1997

Death Among Inhalant Abusers’

James C. Garriott, Ph.D.’

ABSTRACT

Inhalant use is a significant problem among youth in the southwestern US. One of the recognized consequences of this practice is sudden death due to arrhythmogenic properties of certain inhalants, now reduced since banning of most uses of the freons. The current study included deaths from all causes of detected inhalant users. A striking preponderance of the 39 cases involved death from violent circumstances or suicide, as opposed to deaths resulting directly from the toxic effects of inhalants.

Key word. Inhalants; Death; Toxicity; Violence; Suicide

SUMMARY AND CONCLUSIONS

The 39 deaths studied occurred in Bexar County, Texas between 1982 and 1988. All cases had inhalants detected at autopsy, which verified recent inhalant use prior to death. The following agents were detected, in order of frequency (number of cases): toluene (32), trichloroethylene/l ,1,1 -trichloroethane (4), dichlorodifluoromethane (I) , gasoline components (l), and nitrous oxide (1). Most were teenagers (54%), but nearly half (46%) were over 20 years old. The average age was 19.3 years, ranging from 8 to 32 years of age. Seventy-nine percent had Hispanic surnames. The majority of the deaths involved violent circumstances as follows: suicide, 28%; accident, 26%; and homicide, 23%.

Only seven of the cases (18%) fit into the typical inhalant-induced “sudden death” category, resulting from cardiac arrhythmia or other toxic effects of inhalants. These seven deaths were due to

Inhalant-Induced Deaths.

’ Summary and conclusions basedon NIDA Research Monograph #129, pp 181-191. Send requests for reprints to James C Carrion, Ph.D., D-ABFT, Bexar County Forensic Science Center, 7337 Louis Pasteur, San Antonio, TX 78229-4565.

1871 Copyright 0 1997 by Marcel Dekker, Inc.

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1872 GARRIOTT

gasoline, Freon 12 (dichlorodifluoromethane), typewriter correction fluid (trichloroethylene/trichloroethane), and nitrous oxide.

These results are highly significant in relating individual agents with their acute toxicity. Notable is the lack of acute toxicity (lethality) of toluene, the most common agent chosen by users. Although 82% of the deaths involved toluene, no deaths occurred in which it was the sole agent responsible for the death. On the other hand, freon, nitrous oxide, and gasoline were detected only in inhalant-induced deaths.

Accident and Homicide. Accidents and homicides accounted for 49% of the deaths. These tended to result from aberrant behavior, such as aggressiveness or bizarre accident-prone actions (such as carelessly entering heavy traffic or lying on railroad tracks).

Suicide. An unexplained correlation occurred between method of suicide chosen and inhalant abuse; 10 of the 11 (91'?h) suicides of inhalant users were from hanging, whereas only 18% of non-inhalant-user suicides in the same age range chose hanging as their method.

Summary. This analysis provides a new perspective of some effects of inhalant abuse--an association with violent death, especially suicide. About three fourths of the deaths resulted from nondrug-related causes. The majority of the individuals had used products containing the solvent, toluene, as evidenced by its detection in bodily specimens at autopsy. This relationship with violent death may be similar to that observed for alcohol, a central nervous system depressant. Effects such as general central nervous system depression, impaired thinking and judgment, and slowed reaction times are common to both intoxicants. The association may be more pronounced with toluene, however, due to the long half-life (up to 72 hours). Inhalants also have been associated with aggressive, especially self-aggressive, behavior as has been alcohol. The high proportion (28%) of inhalant users committing suicide, as well as those dying from homicide (23%) may be related to that phenomenon. Suicide is a common outcome of severe clinical depression, and chronic solvent users have been reported to have higher rates of depression. However, the high rate of suicide by hanging (10 of 11) is not yet explained, especially because less than one in five non-inhalant-using teenage suicide victims chose this method. Both the high incidence of suicides, as well as violent or bizarre behavior leading to violent death may be evidence of neuropathy and cerebral dysfunction in chronic inhalant users. Su

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DEATH AMONG INHALANT ABUSERS 1873

Utilisateurs d’inhalants et mortalit6

James C. Garriott, Ph.D.

L’utilisation d’inhalants constitue un probleme significatif parmi les jeunes du sud-ouest americain. Une des consequences est la mort soudaine due aux proprietes arythmogeniques de certaines de ces substances. L’etude considere I’ensemble des deces d’utilisateurs d’inhalants. Une preponderance frappante parmi les 39 cas englobe le deces dans des circonstances violentes ou par suicide, par opposition aux morts resultant directement des effets toxiques de ces produits.

Sterfte onder gebruikers van oplosmiddelen

James C. Garriott, Ph.D.

Gebruik van oplosmiddelen is een belangrijk probleem onder de jongeren in het zuidwesten van de Verenigde Staten. Een van de bekende gevolgen van dit gebiuik is plotselinge dood door de hartritme-verstorende eigenschappen van bepaalde oplosmiddelen, welke nu is afgenomen door het uitbannen van het gebruik van freons (drijfgassen). De huidige studie omvat alle sterftegevallen onder gebruikers van oplosmiddelen. Een opmerkelijke meerderheid van de 39 gevallen betrof sterfte door geweld of zelfmoord, dit tegenover sterfgevallen direct voortkomend uit de toxische effecten van oplosmiddelen.

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1874 GARRIOTT

Mortalidad Entre 10s Abusadores de Inhalantes

James C. Garriott, Ph.D.

El us0 de inhalantes es un problema significativo entre la juventud del suroeste de 10s Estados Unidos. Una de las consecuencias reconocidas de esta prhctica es la muerte repentina debida a las propiedades arritmogenicas de ciertos inhalantes, propiedades actualmente reducidas desde que se prohibio la mayoria de 10s usos de 10s “freons”. El presente estudio incluy6 muertes por cualquier causa de individuos que se detect6 que usaban inhalantes. Una sorprendente preponderancia de 10s 39 casos implico la muerte por circunstancias violentas o por suicidio y no como resultado direct0 de 10s efectos toxicos de 10s inhalantes.

Mode entre abusadores de inalantes.

James C. Garriott, Ph.D.

0 us0 de inalantes 6 um problema importante entre jovens no sudoeste dos EUA. Uma das consequsncias reconhecidas desta prhtica C a morte subita, devido As propriedades arritmog&nicas de certos inalantes, agora reduzidas desde a aboliG8o da maioria dos usos dos propelentes. 0 presente estudo incluiu mortes por todas as causas em usuhrios de inalantes. Uma maioria impressionante dos 49 casos envolveu morte por circunsthcias violentas ou suicidio, em oposi@o a mortes diretamente resultantes dos efeitos toxicos dos inalantes.

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DEATH AMONG INlL4LANT ABUSERS I875

Tod durch Missbrauch von Inhalantien

James C. Garriot, Ph.D.

Konsum von lnhalantien ist ein nicht m ubersehendes Problem unter Jugendlichen in den sudwestlichen USA. Eine der bekannten Folgen dieser Praktik ist der plotzliche Tod durch eine Herzrhythmusstorung, die von gewissen Inhalantien ausgehen kann. Die vorliegende Studie schloss Todesfalle aus allen Ursachen bei bekannten Konsumenten von Inhalantien ein (N = 39). Auffallend ist, verglichen mit Fsllen, die direkt auf die toxische Wirkung der Inhalantien zuriickgehen, die Haufigkeit von Todesfallen durch Gewalt oder Selbstmord.

Death Among Inhalant Abusers

James C. Garriott, Ph.D.

L’uso di inalanti e’ un problema rilevante tra la gioventu’ americana del sud-ovest. Una delle conseguenze riconosciute di questa pratica e’ la morte improvvisa dovuta alle proprieta’ aritmogeniche di taluni inalanti, al momento ridotta a seguito del divieto di us0 di fieon in molti casi. Lo studio include le morti provocate dalle cause di consumatori di inalanti scoperti. Una preponderante percentuale del 39% ha fatto registrare morte violenta o suicidio, in opposizione alle morti risultanti direttamente dalle conseguenze tossiche degli inalanti.

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