Volatile substance abuse-related deaths and other harmEvidence of harm from VSA – apart from the ever-present risk of death – is patchy. Sniffing doesn’t seem to cause brain damage (see: ‘does solvent abuse cause brain damage?’, and other harm that has been reported is based on case studies. The main risk of VSA is sudden death. Bass reported 110 such deaths in the US during the 1960s which were associated with the use of aerosol propellants and chlorinated solvents.1 There were at least 114 VS-related deaths in the USA in 19742. Fatalities have been recorded, for example, in the USA3,4 in Scandinavia5,6, and in Japan7. In the UK, there is a long-running study which identifies VS-related deaths, Deaths peaked in 1990 at 151, and by 1994 had declined to 58. However the trend may again be upwards – there were 75 deaths in 1996, the latest year for which data are available8. ARTICLE ABOUT THE ST GEORGE’s WORK: Dangerous games: UK solvent deaths 1983-88 LINK TO THE ST GEORGE’S REPORT – www.sghms.ac.uk/phs/vsa/menu.htm
VS-related deaths occur in all social classes in the UK and in all parts of the country. The age at death has ranged from 9 to 76 years, but most deaths (71%) have occurred among adolescents aged less than 20 years. Most of those who die (88%) are male. There are no published data on VS-related deaths from other countries comparable to those available in the UK, although individual cases are reported. VS-related mortality statistics provide a crude measure of the problem posed by VS in a particular country and thus can help in assessing the effectiveness of prevention programmes. However, it is not straightforward, as there are many possible circumstances that may lead to death, and the link to VS use is not always obvious. Furthermore, since the International Classification of Diseases (ICD) does not have a category specifically for VS-related deaths, it is necessary to collect data on these deaths separately. VS-related deaths can easily be overlooked if sudden deaths in children and adolescents are not investigated thoroughly. Post-mortem examination usually reveals little, except perhaps acute lung congestion and possibly cold-induced burns to the mouth and throat. A further complication is that friends or parents may remove circumstantial evidence (such as the product used or a plastic bag) from the scene prior to an investigation.
The compounds associated with VS-related deaths in the UK between 1971 and 1994 are: fuel gases - mainly LPG from cigarette lighter refills (37 per cent of cases); aerosol propellants - fluorocarbons and/or LPG (20%); and solvents from adhesives (19%). Other deaths are linked with a range of other inhalable chemicals, notably 1,1,1-trichloroethane. The ways that VS users meet their death is seldom clear. However, indirect effects (such as trauma, aspiration of vomit and asphyxia associated with the use of a plastic bag) are common among the deaths associated with solvents from adhesives, while ‘direct toxic effects’ predominate in deaths associated with fuel gases, aerosols, and chlorinated (and other) solvents. There are four modes of ‘direct’ acute VS-related death: anoxia; vagal stimulation leading to bradycardia and cardiac arrest; respiratory depression; and cardiac dysrhythmias. Of these, cardiac dysrhythmias leading to cardiac or cardiorespiratory arrest probably cause most deaths. Sudden alarm, exercise or sexual activity may precipitate an arrhythmia because VS use may sensitise the heart to circulating catecholamines; in many VS-related deaths the immediate ante-mortem event is fright and running. However, this is unlikely to be all that is occurring, since direct toxic effects of 1,1,2-trichlorotrifluoroethane have been described in isolated perfused rat hearts9. References.
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