Before I moved to Alaska, I considered myself fairly knowledgeable about the use of illicit drugs. I was, after all, a child of 60s and 70s who had lived in southern California for six years in the mid to late 70s, and illicit drug use was viewed quite casually. Many of my friends at that time had smoked pot (marijuana), snorted coke (cocaine), dropped acid (LSD), and eaten mushrooms (usually psilocyban), and spoke of their experiences without compunction. And alcohol, of course, was the social glue of college life. But I had never even heard of huffing.
When I moved here, I discovered that huffing is the most common form of substance abuse in rural Alaska. Huffing and sniffing are forms of inhalant abuse (sometimes known as “solvent abuse” in other parts of the world): deliberately breathing in fumes of a substance in order to get high. There are over a thousand substances which can be huffed; indeed, one inhalant abuse counselor says that anything which is not air can be huffed. He is probably right.
In the villages of the Yukon-Kuskokwim Delta, gasoline is the most common substance being huffed. Even at $5 per gallon (that’s village price; in Bethel we’re only paying $4.86 per gallon. HA!), gas is a cheap way to get high and is readily available.
Four-wheel ATVs are everywhere in the villages; they are the primary mode of transportation. It is a simple thing for a kid to unscrew the gas cap, stick his (or her) nose in and take a few deep whiffs. Some kids soak a rag in gasoline and breathe deeply through it. They may keep the rag in a ziplock baggy and huff repeatedly.
Other popular substances for huffing in the Delta are propane, Magic Markers, glue, perfume, hair spray, and Lysol. In the Bethel grocery stores, hair spray and Lysol are only sold at the check out stand, to prevent inhalant abusers from using them to get high in the store and then putting the empty can back on the shelf. The current prize for “brand snobbery” among huffers goes to Axe deodorant—it is, right now, the coolest thing to be huffing. Apparently it contains toluene, which produces the most desirable high. Also on the “cool” list is John Deere brand yellow paint. Who knows why? It just is.
Huffing behavior often begins very young, sometimes by 7 or 8 years of age. Most huffers are young people between 10 and 17 years old, but the habit may persist into the twenties or thirties. I have seen a 34-year-old man as a patient who admits to huffing. The behavior seems to peak in 14 and 15-year-olds; after that age they are more easily able to obtain alcohol and marijuana. Most huffers say that they would prefer to drink and smoke pot if they could.
The high from huffing lasts for about 30 to 90 minutes, depending on the substance used. The short duration is one of the appeals; teens can get high in their bedrooms on common household products and then come down for dinner without anyone noticing. It is believed to be a psychotic kind of high, riveting, intense, more powerful than marijuana or alcohol; more like an opiate high. And highly addicting. It occurs almost immediately after inhaling, and makes the user feel giddy, carefree, powerful. A former huffer told me that is was just lots of fun; she and her friends would giggle and laugh uncontrollably for a little while.
Huffing has become deeply interwoven in the culture of rural Alaska. Studies in the lower 48 usually indicate that something like 20% of eighth graders have tried inhalants at least once. Anecdotal reports from village teenagers and from health aides are that nearly 100% of the kids in their villages have tried it. It is a staggering thought. We recently had a death in one of the villages from huffing. A 10-year-old boy wrapped his lips around the opening in a five-gallon gas can and took a few deep fast breaths. Less than an hour later, he was dead.
Permanent brain damage can result from long term inhalant abuse, and sudden death is possible from even a single use. Sudden Sniffing Death Syndrome occurs when an acutely intoxicated huffer is startled, causing a sudden release of catecholamines which excite the heart to become arrhythmic and cardiac arrest occurs.
Physiological effects of short term use include severe headaches, rashes around the nose and mouth, anorexia and weight loss, rapid or irregular heartbeat, red and glassy eyes, nausea and vomiting, night sweats, frequent cough, drowsiness, constipation, and diminished sensitivity to pain, among others. When some or many of these symptoms are suddenly present in a young person who did not have them before, it may be a tip-off to huffing. A noticeable chemical or gasoline odor on the breath is a definite clue.
The long term physiological effects are more severe. Besides death, they include brain damage, loss of vision and hearing, slurred speech, forgetfulness, and damage to liver, kidneys, heart, lung, bone marrow, and central nervous system.
The short term psychological effects of huffing are part of what makes this population so difficult to work with in recovery. These include emotional volatility, paranoid delusions, passive-aggressive attitude, memory loss, impaired judgment and coordination, severe mood swings, and temporary hallucinations, both auditory and visual.
The long term psychological effects include inhalant psychosis, ongoing hallucinations, lowered intelligence, and anti-social personality disorder.
The problem of inhalant abuse tends to be under-recognized, in part because we (as parents, or as health care providers) don’t think of it, don’t look for it, don’t ask about it. In this area, if you ask a huffer whether he uses drugs, he’ll say no. Gasoline is not a drug. Hair spray and Lysol and Axe deodorant are not drugs. If you ask a huffer if she huffs, she will be very reluctant to tell you that she is inhaling chemicals or solvents.
Yupik Eskimo culture takes pride in honesty; for the most part, a direct question will receive an honest response. Patients are very candid and do not tend to minimize how much alcohol they drink; they may volunteer without being asked that they smoke marijuana. Huffers, on the other hand, are generally ashamed of huffing, and will not admit it easily. Of the many forms of substance abuse, it is ranked the lowest of the low. Huffers are sometimes referred to as “brain-dead gasheads”.
Treatment for inhalant abuse is long and difficult. A number of substance abuse treatment centers in the lower 48 have inhalant programs; but, to the best of my knowledge, the only treatment center exclusively for inhalant abuse is the one right here in Bethel, Alaska.
The McCann Center opened in 2003. It is a residential facility with 14 beds and a waiting list over a year long. Length of stay is typically 8 to 14 months, at a cost of $300/day per resident. Since it opened, 90 graduates have completed the program there, and for some it was a life-changing, life-saving experience.
But relapse is not uncommon among inhalant abusers. Kids at McCann Center are often abused, neglected, angry, and sometimes violent to start with, kids with severe emotional disturbance. If they are simply returned to the environment in which the behavior began, it is highly likely to recur. Counselors at the McCann Center say that the kids need 24/7 supervision for two years after leaving the program. Of course, not all kids who experiment with inhalants have such severe emotional problems. Huffing may result from simple boredom and peer pressure. But it can quickly become addictive and ruin lives.
The key is prevention. An ounce of it is worth ten pounds of cure. Adults need to be more aware of the pervasiveness of huffing, the easy and cheap availability of substances that can be used, the strong peer pressure to do so, and the early signs and symptoms of the behavior. Young people need to be educated about the devastating effects of huffing on their bodies, questioned about what their friends are up to, and noticed when their own behavior undergoes a sudden change. We all need to be paying attention.
An excellent article was published in the American Family Physician on inhalant abuse in September, 2003. It was entitled “Recognition and Prevention of Inhalant Abuse”, by Carrie Anderson, M.D. and Glenn Loomis, M.D. Here is the link: http://www.aafp.org/afp/20030901/869.html
Many thanks to the staff at McCann Center for source materials and information on inhalant abuse in the Y-K Delta.
Labels: Bush Medicine