Volatile Substance Abuse Legal and Lethal Methods of use Causes of death Effects Signs Specific dangers Incident management Dependence and treatment options Assessment and intervention ID: 318055
Download Presentation The PPT/PDF document "Toolkit 2" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Toolkit 2 Volatile Substance Abuse: Legal and LethalSlide2
Methods of useCauses of deathEffectsSignsSpecific dangersIncident management
Dependence and treatment optionsAssessment and intervention
Toolkit 2
completion
aims
Aims
To understand, in relation to Volatile Substance Abuse (VSA):Slide3
VSA methods of use*Spraying straight from can into mouth Sniffing directly from a container
Using towels/cloths/clothing etc. as a filter Spraying into bag and placing over headSniffing from a clothSniffing from bagsInhaling from masks and balloonsVSA methods of use
*see slide notesSlide4
Deaths by method of inhalation*
Causes of deathSlide5
VSA product categories & physiological effectVSA Effects
*see slide notes
Product
Physiological effect
Solvents
Central Nervous
Sytem
(CNS) depressants
Gases/Aerosols
CNS depressants
Nitrites (Poppers)
Muscle relaxant,
blood vessel dilator
Nitrous Oxide
Dissociative*Slide6
Amyl Nitrites (Poppers)Nitrites differ pharmacologically from other inhalants. Instead of directly affecting the central nervous system, they primarily cause vasodilation (the widening of blood vessels) and smooth muscle relaxation.Nitrites are inhaled primarily to enhance sexual feelings and to intensify sexual experience.Evidence suggests that, in some cases, the inhalation of poppers has been responsible for causing permanent eye damage.*
VSA Effects
*see slide notesSlide7
Psychoactive impact:the ‘buzz’ of VSA
Desired effects*euphoria
h
allucinations
exhilaration
sense of invulnerabilitydisinhibition
Negative effects*
d
rowsiness
headaches
n
ausea
d
iarrhoea
r
eckless
behaviour
a
ggression
d
eath
VSA Effects
*see slide notesSlide8
Long-term or chronic use*Chronic users may present with a variety of symptoms as a consequence of long-term use, including:
chronic headachessinusitis, nosebleeds, runny nosediminished cognitive functionuncoordinated muscle movementschronic coughingchest pain or anginatinnitus
extreme tiredness, weakness, dizziness
depression / anxiety
shortness of breath
indigestion
stomach ulcers
VSA Effects
*see slide notesSlide9
Cues for detecting recent use*red, watery eyessneezing and coughing
constant sniffing excessive sweatingchemical smell on breathstaining on clothing, fingers, nose, or mouthunusual spots, marks, rashes and sores around nose and mouthapparent intoxication / altered behaviour / risk taking incoherence
, confusion
poor
coordination
VSA Signs
*see slide notesSlide10
DangersSudden Sniffing Death
suffocation from plastic bagsfires/burns/explosion through heat/piercing/smokingharm from inhalation of other chemicals in product (e.g. perfume in deodorants)frost or freeze burns from spraying directly from the can
Central Nervous System(CNS) depression to unconsciousness
c
hoking on vomit while unconscious
e
rratic behaviour and accidents
VSA Dangers
WARNING: The following slide contains images of physical harm caused by VSA. Some viewers may find these images distressing.Slide11
Dangers
VSA Dangers
Burns caused by the cold temperatures
of butane gas.Slide12
The greatest risk:Sudden Sniffing Death*
Gases, aerosols, and solvents can make the heart oversensitive to the effect of adrenaline. A burst of activity leads to more adrenaline, leading to an even greater risk.
This oversensitivity can remain for several hours following recovery from the psychoactive phase.
A heart that stops beating as a result of VSA can be very difficult to resuscitate. Defibrillation needs to be administered within 10 minutes.
Other substances can increase the risk of Sudden Sniffing Death. Stimulants and depressants can both cause harmful interactions.
VSA Dangers
*see slide notesSlide13
Aggression, crime and VSA* Violent crimes committed in the UK under the influence of volatile substances, 1996-2012.
VSA Dangers
*see slide notes
Crime reported
Occurrence between
1996-2012
Murder
37
Rape / serious sexual assault
39
Assault / serious threat of assault
198
Arson
27Slide14
VSA myth: frozen throat or lungs
The throat and/or lungs or do not ‘freeze’. What may occur is Vagal Inhibition When butane is sprayed directly into the throat, the jet of fluid can cool rapidly to −20⁰C which may stimulate the nerves of the larynx. This causes a reflex with nerve impulses passing up to the brain via one set of nerves, then connecting in the brain and relaying impulses down to the heart via the vagus nerves, resulting in cardiac arrest.*
VSA Dangers
*see slide notesSlide15
VSA scenario* You enter a person’s room, either their own home orsupported accommodation, and witness that they are
actively inhaling a deodorant aerosol. They are under theinfluence and incoherent. Given the risk of Sudden Sniffing Death, what actions do you take immediately and post incident?
*see slide notes
ACTIVITY SLIDESlide16
VSA incident: assess the situation*Are you (and any others present) safe in the environment?Is the person acting aggressively or likely to become aggressive?Is the
room ventilated?Have you made sure there are no lit cigarettes or open flames in the room?(continued)VSA Incident Management
*see slide notesSlide17
VSA incident: if someone is ‘high’ on VSA*Stay calm and stay with them – so long as it’s
safe – until the effects have worn off.Ensure adequate ventilation – open windows and loosen tight clothing, etc.Keep the person calm and still. There is a risk of sudden death if exertion follows inhalation. Don’t chase or excite someone who is ‘high’.Remove the solvents from them if you can do so calmly and without using force. (continued)VSA Incident Management
*see slide notesSlide18
VSA incident: if the person is unconscious*Keep calm – assess the situation, in particular, the risks to yourself.See if the person responds by gentle shaking or loud talking.Check their Airway, Breathing and C
irculation and apply first aid if you know how.Place them on their side in the recovery position.Call an ambulance or, if possible, send someone to do it.Stay with the person if you can and keep them warm and still.VSA Incident Management
*see slide notesSlide19
Tolerance and dependence*Some users self report using 20 + cans per day to maintain the intense initial phase.Psychological dependence can occur just as it can for any substance.
VSA Dependence & Treatment
*see slide notesSlide20
dependent
intensive
p
urposive
experimental
Patterns of VSA*
Risk of Sudden Sniffing Death applies to all patterns
VSA Dependence & Treatment
*see slide notesSlide21
Dependence ICD-10 criteria* Applies to VSA as for any other type of substance misuse.Three or more of the following in a 12 month period:
Strong desire or sense of compulsion to take the substance.Difficulties in controlling substance-taking in terms of onset, termination or levels of use. A
physiological
withdrawal
state.*
Evidence of tolerance.
P
rogressive
neglect of alternative pleasures or
interests.
P
ersisting
with substance use despite clear evidence of overtly harmful
consequences.
VSA Dependence & Treatment
*see slide notesSlide22
Withdrawal* There is no physiological addiction to volatile substances. The psychological addiction may manifest itself in physical withdrawal symptoms associated with anxiety, such as:
*see slide notes
VSA Dependence & Treatment
sleep disturbances
tremors
irritability and depression
nausea
excessive sweating
fleeting illusions
agitation
l
oss of appetite
dizziness
aggressive behaviour
headaches
abdominal cramps
Withdrawal can be eased by treating the symptoms that the person is presenting with
.Slide23
PharmacotherapyThere is no proven pharmacological treatment for VSAOne case report and one preclinical study have reported positive but very preliminary evidence of potentially effective therapies for VSA:Lee, Shiffer and Dewey (2004) reported preclinical evidence suggesting that
Vigabatrin, a selective GABA transaminase inhibitor could be an effective treatment.*Shen (2007) 100mg of lamotrigine daily reduced cravings in 21yr old user of 4 years, achieving 6 months of abstinence.*The use of short acting benzodiazepine (i.e. Lorazepam or Oxazepam) to reduce anxiety has also been suggested. Cited by Howard et al (2011)*VSA Dependence & Treatment
*see slide notesSlide24
Assessment*GPs and Drug Services are required to submit a completed SMR25a/b form for all patients/clients who receive a comprehensive assessment of their care/treatment needs in relation to their substance misuse. Although the SMR25 specifies only illegal substance use is to be recorded, Volatile Substances are included and specified throughout the SMR25.Clear and unambiguous inclusion of questions about volatile substance use at assessment and in advising/promoting of service strands offered will help to better engage VS users and aid disclosure of VSA.
*see slide notes
VSA Assessment & InterventionSlide25
Addressing supply
Partnering with the local Trading Standards authority is recommended following disclosure of VSA at assessment.Trading Standards respond to intelligence reports received from any stakeholder.Addressing the source
of supply can be a key factor in supporting VSA recovery and relapse
prevention.
It has the additional benefit of enhancing retailer awareness in broader VSA prevention.
VSA Assessment & InterventionSlide26
Interventions* Brief Interventions can be very effective for experimental/recreational VSA in younger users.Family support both for the benefit of the family and the user, whether the user is engaged in services or not, is recommended. Even basic knowledge about VSA can help to identify it and help the family to cope.
Multidisciplinary joint working as required for chronic cases, which may present or be assessed as dual diagnosis.VSA Assessment & Intervention
*see slide notesSlide27
Psychosocial interventionsEarly intervention is recommended due to risk of death.All psychosocial interventions are applicable. Short session Motivational Interviewing can help determine/promote change readiness and bridge the gap from assessment to treatment.
Shorter sessions and/or breaks within the session in the early stages can help.VSA Assessment & Intervention
*see slide notesSlide28
Proactive prevention activity is vital
Every stakeholder with a responsibility to prevent VSA should be able to evidence that they have tried, to the best of their ability, to inform about this dangerous type of substance misuse. Education is effective for VSA.The use of volatile substances, as with use of other psychoactive drugs, impacts not only personal health but also:*familiesworkplace safetycommunitiessociety
VSA
Prevention
*see slide notesSlide29
How Re-Solv can helpFamily and user support at Community for Recovery: www.communityforrecovery.org.
Recent research findings: www.re-solv.org.Free workforce training via direct delivery, resource cascade and online facility: http://training.re-solv.org.Capacity-building partnership work with other organisations.Development of resources for partners.Information literature.Consultation and guidance for stakeholders on policy, law and governance. International partnership support and guidance.
Slide30
Contact detailsScotland: Marina Clayton Development Manager Scotland07505 000024 scotland@re-solv.org
Re-Solv UK Head Office01785 817885 information@re-solv.orgSlide31
Questions?
?
?
?
Published August 2013. Review date August 2014.