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Tackling volatile substance abuse in Scotland: A training course for the social care workforce

VSA background

Terminology

Volatile Substance Abuse (VSA) is often referred to as “solvent abuse” or “sniffing”. A volatile chemical is any substance that becomes a gas at room temperature and pressure, and as such includes butane gas commonly used in cigarette lighter refills and aerosols. VSA is now the widely accepted term, but it is not universally used.

In the USA and other countries “inhalant abuse” is the common terminology and a widely used street term is “huffing”.

There are other colloquial terms for VSA, “buzzing” or “buzzing gas” is common, as is “tooting” in some regions and “gashead” or “gluehead” are common derogatory terms. Most other names appear to be very local or transient.

What is VSA?

One definition of Volatile Substance Abuse (VSA) is the inhalation of volatile chemicals found in many everyday products, such as solvent based adhesives, cigarette lighter refills, aerosols and numerous other products.

Immediate effects

When volatile substances are taken into the lungs they are very rapidly absorbed and the intoxicating effects start within thirty seconds or so. The fumes within the lungs are rapidly absorbed into the bloodstream and they reach the brain very quickly starting with a dulling of inhibitions, disorientation and dizziness, nausea and vomiting. Finally death can occur if sniffing continues.

Volatile substances affect the cell membranes in a similar way to alcohol or anaesthetics (they do not form chemical attachments to specific cellular receptor sites, as is the case with a number of drugs). This means that their effects are gradual and progressive, rising with the exposure, but can also be reversed by reducing the amount of exposure.

The initial euphoria is fleeting and is followed by intoxication similar to that of alcohol. Objects may look different or out of perspective. Delusions and hallucinations can occur.

Patterns of use appear to vary; some may maintain a level of intoxication by repeated use, whereas others may become more and more intoxicated through the session. Other effects may include salivation, flushing and vomiting. Coughing and sneezing are frequently reported. A solvent hangover is likely to be less severe than that of alcohol and is unlikely to act as a deterrent.

Risks

Volatile substances when inhaled have the direct capacity to suddenly and unpredictably kill and there is no way to avoid these risks.

Mortalities
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The numbers of fatalities in the United Kingdom are far from insignificant. For some age groups the rate exceeds the number of deaths from leukaemia, pneumonia and drowning put together.

In the age group 15-19 VSA accounts for 1.2% of all male deaths compared with 26.7% from road traffic accidents. Since VSA first came to public attention in the early 1970s, the number of deaths has risen, peaking at 151 in 1991.

VSA deaths are monitored by a continuous study conducted by St George’s Hospital Medical School. In total between 1971 and 2004 (the last recorded year) there have been 2152 recorded deaths, of which 283 were in Scotland. In 2004 alone, 47 deaths were recorded in the UK.

VSA is frequently neglected as an issue in relation to illegal drugs. However in comparison with illegal drugs, VSA results in many more deaths amongst people of school age. In 2004 for the UK, among those aged 10-15 years, there were eight deaths associated with VSA compared with three deaths from drug misuse (for further information see St George’s Volatile Substance Abuse Mortality Study).

Most deaths result from the direct toxic effects of volatile substance (its effect upon the heart). Deaths also occur following the inhalation of vomit, suffocation on plastic bags and trauma following accidents while intoxicated.

Age, sex, length of use, regional differences etc

Since 1971 half of the deaths relating to VSA have been of young people aged under the age of 18. Most commonly, deaths occur in the 14-17 age group. The youngest death was of a boy aged seven.

The vast majority (80.9% in 2004) of deaths overall were male, however this difference is not reflected in prevalence studies which generally report similar proportions of males and females experimenting with solvents. Also in 2004 the ratio of male to female deaths in the under-18 year olds fell to just over two to one.

In 23% of cases in 2004, the victim was not known to have had any previous history of VSA. In many more cases there has not been a long history of abuse. In the same year 59% of the deaths resulted from sniffing taking place in the home or in the home of a friend.

Generally there is a greater incidence of VSA deaths per head of the population the further north in the United Kingdom. Data for Scotland in the 10 year period 1995-2004, as provided by the Crown Office and General Register Office for Scotland, shows that it has the fourth highest VSA mortality ratio of all UK jurisdictions. The mortality ratio for Scotland for this period is 134 compared to 158 in the North East of England, 137 in the East Midlands and 136 in Northern Ireland. The ‘all England’ figure for the same period is 96 and for Wales is 89. There was a drop in the Standardised Mortality Ratio (SMR) for Scotland between the 10 year periods of 1994-2003 (143) and 1995-2004 (134).