Volatile Substance Abuse: An Overview for Practitioners

1. Volatile Substance Abuse:An Overview for Practitioners Legal and Lethal

2. Solvent Abuse, Volatile Substance Abuse (VSA)….what is it? “VSA is too dangerous – don't do it” Advisory Council on the Misuse of Drugs ‘Buzzing’ of 'Sniffing' aerosols, solvents, glues or gases is called VSA or Solvent Abuse. This is when everyday household products are breathed in on purpose to achieve extreme intoxication Solvent abuse can and does kill on even the first episode of use In aerosols, it is the propellant that is abused. The propellant is Butane or Propane Gas. The same Butane as in Cigarette Lighter Refills which cannot be sold to under 18 year olds 100s of everyday products can be abused Control of these products is extremely difficult

4. LL Laughter not always the best Medicine British Medical Journal 2 November 2018 “Recreational use of Nitrous Oxide (NO2), commonly known as Laughing Gas, is under-recognised in the UK. With potentially serious health risks, greater awareness of this emerging public health problem is needed” Extract from BMJ report 2 Nov 2018 Laughing Gas Whippet Re-Solv stock image “We do not know if there is a safe level of N02 use” BMJ “To reduce harm local authorities must publicise the adverse effects associated with frequent N02 use” BMJ UK Recreational Use of Laughing Gas • 8.8% of 16-24 year olds used NO2 in 2016, a rise from 6.1% in 2013 • 2017 Global Drugs Survey The Psychoactive Substances Act 2016 banned NO2 for recreational use

5. Why is VSA of concern? • Solvent abuse can and does kill – every time of abuse, even 1st time • Sudden Sniffing Death is unique to VSA • Almost 2,500 recorded deaths. Does not include death by burns/explosions/accidents/falls/ or murder/suicide. • Absolute Harm Reduction not an option – no safe way to ingest • Multiple Risks to health • Not illegal • Associated particularly with children/YP – youngest death age 7 in Scotland • Treatment very limited, expensive and ineffective • Extremely hidden activity

6. Not just Abuse which is dangerous: Accidental Misuse The Glasgow School of Art Fire 2014 An investigation by the Scottish Fire and Rescue Service concluded the fire was caused by the propellant gas – butane - from an aerosol of expanding foam getting into a hot projector . BBC News, 22 July 2015

7. VSA & The Law Psychoactive Impact – The ‘Buzz’ Aerosols, Gases, Solvents Immediate intense intoxication, like being extremely drunk but hallucinations often experienced, effect lasts a few minutes then person returns to completely sober state Laughing Gas (Nitrous Oxide, N02) Immediate effect, euphoria, disorientated, giggly, sound distortions, sometimes hallucinations, lasts few minutes at most Poppers Immediate stimulant, head rush effect, lasts 5 minutes or so GHB (Paint Stripper) About 10 minutes to feel effects which are euphoria, reduces inhibitions and cause sleepiness. Effect can last up to 7 hours

8. Signs and symptoms of VSA Physical Extremeintoxication, dazed appearance, nausea, headaches or dizziness, red, runny eyes and nose, sores, disrupted sleeping and eating, inability to concentrate, slurred speech Behavioural Excited, aggressive, anxiety, irritability, anger, apathy, confused, dazed Situational Missing products, damaged nozzles, containers found in concealed places, aerosols that seem full of product but won't spray, heavy use or smell of products, white rings or stains on clothing/rags, plastic bags or cans/containers with chemical smells, rapid consumption of products

9. Risks and Dangers Sudden Sniffing Death (SSD) Suffocation from plastic bags Explosion through heat/ piercing/smoking Fires/burns from heat/piercing/smoking Harm from inhalation of unwanted associated products, particularly from aerosols Harm to lips and skin from direct contact with solvents Frostbite or freeze burns to lips from direct valve inhalation CNS depression to unconsciousness Falls Criminality from aggressive effect Accidents via hallucinogenic effects (thinking can fly etc)‏ Choking on vomit while unconscious.

10. The Greatest Risk Of VSA is heart failure. VSA makes the heart over sensitive to the effect of adrenaline, a hormone in the body. Even normallevels of adrenaline. Stress and exertion increase levels of circulating adrenaline and increase the risk of heart failure This over sensitivity persists for up to 24 hours after the abuse of solvent has ceased. The person has recovered from the ‘buzz’ but not from the risk of the heart stopping unpredictably. Resuscitation of heart failure resulting from solvent abuse or accidental exposure is extremely difficult and rarely successful

11. Best Defence? Prevention • Education is critical. People often unaware of the huge amount of products which can be used. A lot of these products are used daily by families, adults and young people • Identify triggers….why do we use any drug? • Teach and promote coping skills…..stress is part of life. How do you deal with it? • Talk openly and often with children and young people. Paint pictures and use everyday situations/press stories to engage in meaningful interaction, build trust and promote dialogue • Start prevention efforts. NOW. Waiting for a case of suspected use is waiting for a death

12. Questions?For further information, free resources and support contact:www.re-solv.orgscotland@re-solv.orgTel: 01785 817885 07505 000024