inhalant inhalant inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. they are inhaled at room temperature through volatilization (in the case of gasoline or acetone) or from a pressurized container (e.g., nitrous oxide or butane), and do not include drugs that are sniffed after burning or heating. for example, amyl nitrite (poppers), nitrous oxide and toluene – a solvent widely used in contact cement, permanent markers, and certain types of glue – are considered inhalants, but smoking tobacco, cannabis, and crack are not, even though these drugs are inhaled as smoke or vapor. not to be confused with inhaler. inhalant usea man huffing an inhalantspecialtytoxicologycomplicationspneumoniacardiac arrestpoisoningsuffocationcomapulmonary aspirationheart attackhypoxiamethemoglobinemia while a few inhalants are prescribed by medical professionals and used for medical purposes, as in the case of inhaled anesthetics and nitrous oxide (an anxiolytic and pain relief agent prescribed by dentists), this article focuses on inhalant use of household and industrial propellants, glues, fuels, and other products in a manner not intended by the manufacturer, to produce intoxication or other psychoactive effects. these products are used as recreational drugs for their intoxicating effect. according to a 1995 report by the national institute on drug abuse, the most serious inhalant use occurs among homeless children and teenagers who "... live on the streets completely without family ties." inhalants are the only substance used more by younger teenagers than by older teenagers. inhalant users inhale vapor or aerosol propellant gases using plastic bags held over the mouth or by breathing from a solvent-soaked rag or an open container. the practices are known colloquially as "sniffing", "huffing" or "bagging". the effects of inhalants range from an alcohol-like intoxication and intense euphoria to vivid hallucinations, depending on the substance and the dose. some inhalant users are injured due to the harmful effects of the solvents or gases or due to other chemicals used in the products that they are inhaling. as with any recreational drug, users can be injured due to dangerous behavior while they are intoxicated, such as driving under the influence. in some cases, users have died from hypoxia (lack of oxygen), pneumonia, heart failure or arrest, or aspiration of vomit. brain damage is typically seen with chronic long-term use of solvents as opposed to short-term exposure. even though many inhalants are legal, there have been legal actions taken in some jurisdictions to limit access by minors. while solvent glue is normally a legal product, a scottish court ruled that supplying glue to children is illegal if the store knows the children intend to inhale the glue. in the us, thirty-eight of 50 states have enacted laws making various inhalants unavailable to those under the age of 18 or making inhalant use illegal. classification inhalants can be classified by their intended function. most inhalant drugs that are used non-medically are ingredients in household or industrial chemical products that are not intended to be concentrated and inhaled. a small number of recreational inhalant drugs are pharmaceutical products that are used illicitly. product category another way to categorize inhalants is by their product category. there are three main product categories: solvents; gases; and medical drugs which are used illicitly. permanent markers, as well as dry erase markers, have the potential to be inhalants solvents a range of petroleum-based products that can be used as inhalants. a wide range of volatile solvents intended for household or industrial use are inhaled as recreational drugs. this includes petroleum products (gasoline and kerosene), toluene (used in paint thinner, permanent markers, contact cement and model glue), and acetone (used in nail polish remover). these solvents vaporize at room temperature. ethanol (the alcohol which is normally drunk) is sometimes inhaled, but this cannot be done at room temperature. the ethanol must be converted from liquid into gaseous state (vapor) or aerosol (mist), in some cases using a nebulizer, a machine that agitates the liquid into an aerosol. the sale of nebulizers for inhaling ethanol was banned in some us states due to safety concerns. gases computer-cleaning dusters are dangerous to inhale because the gases expand and cool rapidly upon being sprayed. a number of gases intended for household or industrial use are inhaled as recreational drugs. this includes chlorofluorocarbons used in aerosols and propellants (e.g., aerosol hair spray, aerosol deodorant). a gas used as a propellant in whipped cream aerosol containers, nitrous oxide, is used as a recreational drug. pressurized canisters of propane and butane gas, both of which are intended for use as fuels, are used as inhalants. medical anesthetics several medical anesthetics are used as recreational drugs, including diethyl ether (a drug that is no longer used medically, due to its high flammability and the development of safer alternatives) and nitrous oxide, which is widely used in the 2010s by dentists as an anti-anxiety drug during dental procedures. diethyl ether has a long history of use as a recreational drug. the effects of ether intoxication are similar to those of alcohol intoxication, but more potent. also, due to nmda antagonism, the user may experience all the psychedelic effects present in classical dissociatives such as ketamine in the forms of thought loops and the feeling of the mind being disconnected from one's body. nitrous oxide is a dental anesthetic that is used as a recreational drug, either by users who have access to medical-grade gas canisters (e.g., dental hygienists or dentists) or by using the gas contained in whipped cream aerosol containers. nitrous oxide inhalation can cause pain relief, depersonalisation, derealisation, dizziness, euphoria, and some sound distortion. classification by effect common household products such as nail polish contain solvents that can be concentrated and inhaled, in a manner not intended by the manufacturer, to produce intoxication. misuse of products in this fashion can be harmful or fatal. it is also possible to classify inhalants by the effect they have on the body. some solvents act as depressants, causing users to feel relaxed or drowsy while others act as stimulants. all commonly abused inhalants act as asphyxiant gases, although a common myth is that their primary effects are only due to oxygen deprivation. in reality, the majority of abused inhalants still exhibit psychoactive effects, although oxygen deprivation does add to the notable effects. nitrous oxide can be categorized as a dissociative drug, as it can cause visual and auditory hallucinations. other agents may have more direct effects at receptors, as inhalants exhibit a variety of mechanisms of action. the mechanisms of action of many non-medical inhalants have not been well elucidated. anesthetic gases used for surgery, such as nitrous oxide or enflurane, are believed to induce anesthesia primarily by acting as nmda receptor antagonists, open-channel blockers that bind to the inside of the calcium channels on the outer surface of the neuron, and provide high levels of nmda receptor blockade for a short period of time. this makes inhaled anesthetic gases different from other nmda antagonists, such as ketamine, which bind to a regulatory site on the nmda-sensitive calcium transporter complex and provide slightly lower levels of nmda blockade, but for a longer and much more predictable duration. this makes a deeper level of anesthesia achievable more easily using anesthetic gases but can also make them more dangerous than other drugs used for this purpose. chemical structure tanks of medical-grade nitrous oxide. inhalants can also be classified by chemical structure. classes include: category icd-10 examples example image aliphatic hydrocarbons t52.0 petroleum products (gasoline and kerosene), propane, butane aromatic hydrocarbons t52.1t52.2 toluene (used in paint thinner and model glue), xylene ketones t52.4 acetone (used in nail polish remover) haloalkanes t53 hydrofluorocarbons, chlorofluorocarbons (including many aerosols and propellants), 1,1,1-trichloroethane, trichloroethylene, chloroform (the latter two being antiquated inhalational anaesthetics) nitrites t65.3t65.5 alkyl nitrites (poppers such as amyl nitrite) nitrous oxide t59.0 nitrous oxide (found in whipped cream canisters) administration and effects inhalant users inhale vapors or aerosol propellant gases using plastic bags held over the mouth or by breathing from an open container of solvents, such as gasoline or paint thinner. nitrous oxide gases from whipped cream aerosol cans, aerosol hairspray or non-stick frying spray are sprayed into plastic bags. some nitrous oxide users spray the gas into balloons. when inhaling non-stick cooking spray or other aerosol products, 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. once these solvents or gases are inhaled, the extensive capillary surface of the lungs rapidly absorbs the solvent or gas, and blood levels peak rapidly. the intoxication effects occur so quickly that the effects of inhalation can resemble the intensity of effects produced by intravenous injection of other psychoactive drugs. ethanol is also inhaled, either by vaporizing it by pouring it over dry ice in a narrow container and inhaling with a straw or by pouring alcohol in a corked bottle with a pipe, and then using a bicycle pump to make a spray. alcohol can be vaporized using a simple container and open-flame heater. medical devices such as asthma nebulizers and inhalers were also reported as means of application. the practice gained popularity in 2004, with the marketing of the device dubbed awol (alcohol without liquid), a play on the military term awol (absent without leave). awol, created by british businessman dominic simler, was first introduced in asia and europe, and then in the united states in august 2004. awol was used by nightclubs, at gatherings and parties, and it garnered attraction as a novelty, as people 'enjoyed passing it around in a group'. awol uses a nebulizer, a machine that agitates the liquid into an aerosol. awol's official website states that "awol and awol 1 are powered by electrical air compressors while awol 2 and awol 3 are powered by electrical oxygen generators", which refer to a couple of mechanisms used by the nebulizer drug delivery device for inhalation. although the awol machine is marketed as having no downsides, such as the lack of calories or hangovers, amanda shaffer of slate describes these claims as "dubious at best". although inhaled alcohol does reduce the caloric content, the savings are minimal. after expressed safety and health concerns, sale or use of awol machines was banned in a number of american states. the effects of solvent intoxication can vary widely depending on the dose and what type of solvent or gas is inhaled. a person who has inhaled a small amount of rubber cement or paint thinner vapor may be impaired in a manner resembling alcohol inebriation. a person who has inhaled a larger quantity of solvents or gases, or a stronger chemical, may experience stronger effects such as distortion in perceptions of time and space, hallucinations, and emotional disturbances. the effects of inhalant use are also modified by the combined use of inhalants and alcohol or other drugs. in the short term, many users experience headaches, nausea and vomiting, slurred speech, loss of motor coordination, and wheezing. a characteristic "glue sniffer's rash" around the nose and mouth is sometimes seen after prolonged use. an odor of paint or solvents on clothes, skin, and breath is sometimes a sign of inhalant abuse, and paint or solvent residues can sometimes emerge in sweat. according to nih, even a single session of inhalant use "can disrupt heart rhythms and lower oxygen levels", which can lead to death. "regular abuse can result in serious harm to the brain, heart, kidneys, and liver." dangers and health problems addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. inhaled solvents were ranked 13th in dependence, 13th in physical harm, and 8th in social harm. statistics on deaths caused by heavy inhalant use are difficult to determine. it may be severely under-reported because death is often attributed to a discrete event such as a stroke or a heart attack, even if the event happened because of inhalant use. inhalant use was mentioned on 144 death certificates in texas during the period 1988–1998 and was reported in 39 deaths in virginia between 1987 and 1996 from acute voluntary exposure to used