Volatile substance misuse

  • Fumes inhaled using small container (sniffing), soaked cloth (huffing), plastic bag (bagging), spray can (chroming)
  • Volatile chemicals quickly pass through lungs into brain — intoxicating effect is short (minutes) so use is typically repeated over several hours
  • No safe level of volatile substance use
  • You must know reporting requirements under your state/territory legislation

Immediate effect

  • Feeling friendly, happy, ‘high’ within 1–5 minutes
  • Dizzy, numbness, muscle weakness, unsteady walk, slurred speech, blurred vision, nausea, vomiting
  • Disconnected from environment, hallucinations (seen and heard), strange behaviour, poor judgement, unconscious
  • Chest pain — suffocation (loss of oxygen), rapid pulse, abnormal heart rhythm
  • Risk of choking (inhaled vomit), fits, coma, death
  • ‘Hangover’ headache — may last a few days

Long-term effects

  • General — poor appetite, poor nutrition, tired, problems sleeping, headache, weakened immune system
  • Central nervous system — fits, poor memory, poor coordination, mood swings, irritable, depressed, brain damage, peripheral nerve damage
  • Psychosocial — learning difficulties, behavioural problems in school, family stress
  • Cardiorespiratory system — coughs/colds, breathless, pneumonia, irregular heartbeat, high or low BP, heart damage, heart attack
  • Pregnancy — miscarriage, birth defects, low birth weight, lung problems, SIDS
  • Signs of use — loss of vision and smell, sores around mouth and nose

Do not

Do not grab, scare, chase person — may stress heart if weakened by volatile substance misuse

Make sure you and person are safe

  • Ensure a quiet, calm environment for assessment and care
  • If person intoxicated — observational assessment only
  • See Mental health assessment for interviewing safely
  • If you smell fumes on person or clothes — work in area with fresh air, remove any items that may cause ongoing fume exposure
  • Warn person not to be exposed to flame/smoking

3 main problem areas

  • Physical sickness, injury
  • Fits
  • Self-harm or aggressive behaviour

Ask

  • Identify substance used — opal fuel, unleaded fuel, deodorant, lighter fluid, glue, paint, other aerosols
  • Medicines, other drug use
  • Pregnancy
  • Physical illness — include diabetes, RHD, chronic lung disease
  • Thoughts or ideas of suicide or self-harm
  • Frightened, worried, seeing or hearing things

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL

Do

  • Stay calm, supportive and explain what is happening
  • If seeing or hearing things that are not present — see Psychosis
  • If severe behaviour — see Mental health emergency
  • Contact family/carer
  • If person can swallow safely — give water and ask family to give them food
  • Monitor person for 2–4 hours until stable

If very restless, aggressive, family having trouble — medical consult for

  • Diazepam oral — adult 5–10mg/dose up to 40mg/day with one repeat at maximum 30 minute interval
    • For child dose — medical consult
  • If psychotic features — consider olanzapine oral — adult 5–10mg/dose up to 20mg/day with one repeat at maximum 30 minute interval 
    • For child dose — medical consult

If mildly restless, cooperative, not unwell

  • Send home with family — make sure someone stays with person and knows how to contact you if something goes wrong
  • If giving medications for use at home — ensure someone else can vouch for their safe keeping and administration
  • Plan follow-up with family and medical officer

Follow-up and ongoing management

Supporting resources