Why are we focusing on
Non- injecting drugs and HIV?
M4 /PPT04
Substance use, HIV and MARA
A special focus: solvents, inhalants
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Types of inhalants:
1. Volatile solvents
Liquids that evaporate quickly at room temperature:
• Industrial or household solvents or solventcontaining products (including paint thinners or
paint removers, degreasers, dry-cleaning fluids
and fast drying glues and adhesives)
• Paint-on correction fluids, permanent felt -tip marker fluid and electronic contact cleaners
• Nail polish remover, lighter fluids, cleaning
products
• Petrol and petroleum products
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• VCT course focused on injecting drug use
• Very few HIV programs have looked at the
relationship between solvent use and HIV
• High rates of solvent& inhalant use in
Pakistan among MARA
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Types of inhalants:
2. Aerosols
Includes anything that comes from an aerosol
can:
• Household aerosol propellants such as those in
spray paints, hair or deodorant sprays
• Fabric protector sprays
• Aerosol computer cleaning products
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Types of inhalants:
3. Gases
Types of inhalants:
4. Nitrates
• Gases used in household or commercial products
including butane lighters and propane tanks,
whipped cream aerosols or dispensers and
refrigerant gases
• Medical anesthetic gases: ether, chloroform,
halothane and nitrous oxide ("laughing gas")
• Nitrites include nitrates or gases used in medical
anesthesia or some household products
• Helium, Freon (gas from air conditioners,
refrigerators or other cooling equipment)
• Volatile nitrites are often sold in small brown
bottles and labeled as "video head cleaner," "room
odorizer," "leather cleaner," or "liquid aroma"
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South Asia & Pakistan
• Manufactured superglues
• Toluenes (in paint thinners)
• Petrol
• Iodex (muscle stress relieving balm)
àYouth working in transportation centers
such as bus or truck stands will have easy
access to solvents, fuels and paints that can
be inhaled.
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• Amyl nitrite is a prescription drug to treat angina:
nitrites are sealed in capsules and are "popped" to
release the vapors and are referred to as "poppers"
in street language
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Activity 1 : large group
• Local names and methods of use
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• All inhalants are absorbed
through the lungs and travel
quickly in the blood to the
brain.
• This produces an immediate
and brief intoxication.
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How are these substances used?
• Sniffed directly from an open container or
inhaled from a rag soaked in the substance
and held to the face
• Open containers or soaked rags can be
placed in a bag where the vapors can
concentrate before being inhaled
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How are these substances used?
How are these substances used?
• Users inhale vapors or aerosol propellant
gases using plastic bags held over the mouth
• By breathing from an open container of
solvents, such as gasoline or paint thinner
• Nitrous oxide gases from spray products
(e.g.aerosol hairspray) are sprayed into
plastic bags; some users may filter the
aerosolized particles out with a rag.
• Some gases such as propane and butane
gases are inhaled directly from the canister.
• Permanent drawing markers can be put into
a plastic bag and then stepped on and
crushed to breathe the vapors
• Vapors from pocket lighters are inhaled
through the nostrils
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Different types of inhalants produce
different effects
How do inhalants make you feel?
• Inhaled solvents usually produce an alcohol-like
effect, but with more distortion of perception
(shape, size and color of objects) and distortion of
time and space
• Nitrous oxide produces a dreamy mental state, loss
of motor control, hallucinations and an increased
threshold for pain
• Nitrites dilate blood vessels and relax muscles
– New users may be initially excited, then become
drowsy and fall asleep
– People who use solvents more often may feel euphoric,
exhilarated and have vivid fantasies
– Some feel giddy, outgoing and confident
– Physical effects may include dizziness, nausea,
vomiting, blurred vision, sneezing and coughing,
staggering, slow reflexes and sensitivity to light.
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Use and long term effects
• Serious health problems
– People who use solvents regularly for a long
time can damage their liver, kidneys, lungs,
heart, brain, bones and blood
– Sometimes this damage heals when drug use is
stopped; sometimes it is permanent.
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– Heartbeat quickens, blood rushes to the head, creating a
"rush"
• Nitrites also cause headaches, dizziness, nausea
and flushing
– Some men use nitrites during sex for the drugs' capacity
to relax muscles and promote blood flow
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Activity 1: Solvent abuse in Pakistan
1. Discuss the names and “nicknames” of
solvents abused in different regions of
Pakistan
2. Discuss the common signs and symptoms
of their use (one by one)
3. Discuss how solvent use may be related to
HIV transmission
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Patterns of use are cues to
•
Social and recreational use as a means of enhancing social
interaction or the enjoyment of some leisure activity
•
Symptomatic use as a means of reducing unpleasant
sensations or experiences or to avoid challenging
situations or responsibilities
•
Dependent use so that other responsibilities are neglected
and harm may result.
–
–
Such dependent use becomes habitual
Abstinence may be associated with the onset of withdrawal
symptoms and the discomfort of withdrawal will become a
motivator for renewed drug use.
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Long term use
• Widespread and long-lasting
damage to the brain and
other parts of the nervous
system
• Memory impairment,
attention deficits, and
diminished non-verbal
intelligence and even severe
dementia
• Extensive exposure to
inhalants can also cause loss
of feeling, vision and hearing
and difficulties in
coordination or limb spasms
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What are the signs or symptoms or
inhalant use?
•
•
•
•
•
•
•
•
•
Paint or stains on body or
clothing
Spots or sores around the mouth
Red or runny nose
Watery, red eyes
Chemical breath odor
Drunk, dazed or dizzy
appearance
Drowsiness or unconsciousness
Nausea, loss of appetite
Loss of interest in normal daily
activities
•
•
•
•
•
•
•
Anxiety, excitability, irritability
Inability to concentrate
Substance odor on breath and
clothes
Poor muscle control
Change in sleep patterns
Prefers group activity to being
alone
Reduced attendance in school,
Lower grades or poor
attendance at or attention to
work
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Long term use
• Sniffing glue and paint thinner causes kidney abnormalities
• Sniffing the solvents toluene and trichloroethylene cause
liver damage
• Heart and lungs may also be affected
• Some of the damage to the nervous and other organ
systems may be at least partially reversible when inhalant
abuse is stopped
• But many of the problems are irreversible
• Research indicates that inhaling nitrites depletes many
cells in the immune system and impairs immune system
mechanisms that fight infectious diseases
– This has implications for HIV survival
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Long term use
“Sudden Sniffing Death"
• Frequent or long-term use of nitrites can pose
additional risks, including:
• Prolonged inhaling of the highly concentrated
chemicals in solvents or aerosol sprays can cause
irregular and rapid heart rhythms à heart failure
and death within minutes of a session of prolonged
sniffing
• Can result from a single session of inhalant use by
an otherwise healthy young person
• Particularly associated with the abuse of butane,
propane, and chemicals in aerosols
– Glaucoma leading to blindness. Nitrites increase
pressure in the nerves and blood vessels in the eyes.
– Blood Cell Damage. Nitrites damage red blood cells
and may cause an often-fatal anemia in which blood
can no longer transport oxygen.
• This type of poisoning happens most often to users
who swallow (rather than sniff) the chemical and
it requires immediate medical treatment
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Inhalant abuse can also
cause death by:
Inhalant abuse can also
cause death by:
•
•
•
•
•
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Asphyxiation
Suffocation
Convulsions or seizures
Coma
Choking
Fatal injury - from accidents
Source:http://www.nida.nih.gov/ResearchReports/Inhalants/Inhalan ts4.html
• Spraying butane directly into the throat, the jet of fluid can
cool rapidly to –20 °C by expansion, causing prolonged
spasm of the larynx [throat] and suffocation.
• The anesthetic gases present in the inhalants appear to
sensitize the user to adrenaline. When intoxicated, a
sudden surge of adrenaline (e.g., from a frightening
hallucination or run-in with the law), can cause a fatal
cardiac arrhythmia [disturbances regularity of heartbeat]
• Actual overdose from the drug does occur, however, and
indeed inhaled solvent abuse is statistically more likely to
result in life -threatening respiratory depression than
intravenous use of opiates such as heroin.
Source:http://www.drugabuse.gov/pdf/monographs/148.pdf
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•
Withdrawal symptoms
Depending on the substance, these may include:
• Anger,
• Irritability,
• Generalized aches and pains
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Other problems
• Poor nutrition due to nausea, loss of
appetite
• Young people may be using inhalants to
overcome feelings of hunger when they
can’t afford food.
• In many settings it will be easy to have
‘free’ access to inhalants
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Drug and alcohol interactions,
including ARV
• NO research specifically into ARV….but
• Liver and kidney damage – inability to clear drugs
normally, build up to toxicity
• Confusion and intoxication – forgetting to take
medications on schedule
• Inhaling nitrites depletes many cells in the immune system
and impairs immune system mechanisms that fight
infectious diseases
• Researchers believe that nitrites may impair immune
response and contribute to the onset of secondary
infections often seen in people with AIDS
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Other problems
• The methods of sharing do not pose any risk of
blood-borne infection such as occurs through
sharing injecting drug solutions and equipment
• Individuals who abuse nitrites to enhance sexual
function and pleasure à more likely to engage in
unsafe sexual practices à greatly increase the risk
of contracting and spreading such infectious
diseases as HIV and AIDS and hepatitis
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More danger
• Particularly dangerous practices include:
– Putting a plastic bag completely over the head
– Spraying directly into the mouth
– Having lighted cigarettes around due to risk of
catching fire
– Mixing volatile substances with other
drugs/alcohol
– Using alone
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Help for Volatile Substance Abuse
(VSA) rehabilitation
• Unfortunately, few, if any, of the drug
rehabilitation services in Pakistan deal with
VSA
• Programs in other countries often focus on
life skills and anger management.
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Activity 2: Patterns of use &
Therapeutic cues
• In your small groups
• Discuss what questions you can ask a client
to determine their pattern of use
• Drawing on your professional background,
discuss the different approaches for each
described pattern giving explicit examples
• Present your findings to the large group
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Activity: Working in your groups
• Review the “stages of change” model –
previously discussed in the VCT Training
course
• A copy is appended in your Lecture Notes
for this module
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