Talwin

INTRODUCTION

Inhalant abuse is the intentional inhalation of a volatile substance for the purpose of achieving a euphoric state (1). It is primarily practiced by children, with onset occurring at 6-8 years of age and a peak prevalence at 14-15 years (1). It is estimated that 15-20% of the population has tried inhalants (1). Substance abuse follows a predictable progression, beginning with alcohol and cigarettes, then on to marijuana and to hard drugs (2-6). The purpose of this study was to examine the relationship between inhalant abuse and other substances of abuse.

METHODS

The study design is cross sectional and descriptive. A consecutive sample of all inmates of a juvenile detention facility present during a 3-month period were potential study subjects. They were approached to provide informed written consent to agree to be interviewed regarding substance abuse. Anonymity was guaranteed, and the potential subjects were reassured that none of the collected information would be entered into their record or shared with anyone who makes decisions regarding their futures. They were advised that participation would not result in loss of privilege or negative outcome. This study was approved by our institutional review board. Potential benefit for the participants was the offer for assistance on the discovery of a significant drug abuse problem.

Because of literacy issues in this population, a structured interview rather than an anonymous questionnaire was the more practical data collection tool. It was adapted from the American Drug and Alcohol Survey developed by the Rocky Mountain Behavioral Science Institute of Fort Collins, Colorado. It has been extensively used as an anonymous questionnaire to obtain substance abuse epidemiologic data. It was slightly modified to meet the needs of our population. It was administered by one of us (S. J. Y.), whose training included witnessed (M. T.) pretest interviews. It consisted of 49 questions and was conducted in a private room. Chips and soda were provided during the interview.

Exclusion criteria included refusal to participate, inability to speak English, major psychiatric illness, potentially violent behavior, or significant cognitive impairment. The interview was conducted at least 3 days after admission to the detention facility.

Data were analyzed relative to prevalence, age of onset, patterns of progression of drug use, and pertinent demographic variables. The chi-square or Fisher exact test were used when appropriate, with p < .05 considered significant.

RESULTS

There were 212 eligible subjects. Two declined to participate, and a third individual was excluded because of limited language comprehension. The ages of the 209 participants ranged from 12 to 19, with a mean of 15.5 years, and 173 were male. Of the subjects, 66% were Canadian First Nation (Canadian Indian), and 27% were white. Highest school grade achieved ranged from 3 to 12, with a mean of grade 8. Most of the participants (76.4%) had grown up in an urban environment, with the rest being raised in remote Indian reserves.

The lifetime and past year experiences with various substances of abuse are shown in Table 1 along with the age of initial experimentation. For inhalants, 14.4% and 2.6% of the population had lifetime and past year use experience, respectively.

NA = Not assessed.

Relationships between the use of inhalants and other drugs were tested. Because the use of alcohol, marijuana, cigarettes, and lysergic acid diethylamide (LSD) was essentially universal for this population, testing for relationships with these substances and inhalants is inappropriate. Of the remainder, significant relationships were found between inhalants and cocaine (p = .004); Talwin and Ritalin, which in our community are used as a combination (p = .001); downers (p = .01); and narcotics (p = .003). The ages of first inhalant and narcotic use, 9.7 and 14 years, respectively, were significantly different (p = .0001).

DISCUSSION

Relying on self-reporting, we studied the drug use patterns of a group of adolescents incarcerated in a juvenile detention facility. Therefore, the potential exists for under- or overreporting of experiences. However, the lifetime and past year experiences with inhalants were similar to previous local surveys (unpublished). The adolescents in our study were interviewed in a private room with assurances of confidentiality. This situation provided a safe environment for honest disclosure.

Substance abuse follows a predictable progression, beginning with alcohol and cigarettes, then on to marijuana, followed by cocaine, hallucinogens, and opiates (2-6). This progression was reported by our subjects. In those with an inhalant abuse history, this was the first substance of abuse, even preceding cigarettes by 1.5 years. A progressive phenomenon beginning with inhalants is further supported by the decreased use during the past year (2.5%) relative to the lifetime use of 14.4%. Although this sequence of drug use occurs, this does not mean that there is a causal relationship. The use of any particular substance does not necessarily result in progression along this sequence. The likelihood of substance abuse increases with the presence of several risk factors (7, 8), including attitudes, personality, behavior, social and environmental influences, and biologic or genetic factors. Therefore, the use of substances early in this progression by individuals with some of these risk factors should be regarded as a marker for the potential for progression to the use of hard drugs, thereby identifying individuals in need of intervention.

We could find little in the literature regarding the location of inhalants in this progression of substance use. This seems surprising because inhalant abuse is reasonably prevalent, with an onset at a young age. However, we found four studies, two from the United States and one each from England and Germany, that described data regarding inhalant abuse by heroin addicts (9-12). In most of these subjects, inhalants preceded heroin.

Several characteristics of the study cohort may limit the generalizability of our findings. These include the gender (male) and racial (Canadian First Nation) preponderance and the suboptimal educational attainment. However, an association between the latter and inhalant abuse has been documented by others (13, 14).

For children incarcerated in a juvenile detention facility in our community, inhalant abuse is associated with the later use of other substances of abuse. If this finding is replicated in other populations, it underscores the need for effective prevention strategies.

ACKNOWLEDGMENT

This work was supported by a grant from the Children's Hospital of Winnipeg Research Foundation.

REFERENCES

(1.) American Academy of Pediatrics, Inhalant abuse, Pediatrics 97:420-423 (1996).

(2.) Hamburg, B. A., Braemer, H. C., and Jahnke, W. A., Hierarchy of drug use in adolescence: Behavioural and attitudinal correlates of substantial drug use, Am. J. Psychiatry. 132:1155-1167 (1975).

(3.) Yamaguchi, K., and Kandel, D., Patterns of drug use from adolescence to young adulthood. II Sequences of progression, Am. J. Public Health 74:668-672 (1984).

(4.) Blaze-Temple, D., and Lo, S. K., Stages of drug use: A community survey of Perth teenagers, Br. J. Addict. 87:215-225 (1992).

(5.) Ellickson, P. L., Hays, R. D., and Bell, R. M., Stepping through the drug use sequence: Longitudinal scalogram analysis of initiation and regular use, J. Abnorm. Psychol. 101:441-451 (1992).

(6.) Kandel, D. B., Yamaguchi, K., and Chan, K., Stages of progression in drug involvement from adolescence to adulthood: Further evidence for the gateway theory, J. Stud. Alcohol 53:447-457 (1992).

(7.) Bry, B. H., McKeon, P., and Pandina, R. J., Extent of drug use as a function of number of risk factors, J. Abnorm. Psychol. 91:273-279 (1982).

(8.) Newcomb, M. D., Maddahian, E., and Bentler, P. M., Risk factors for drug use among adolescents, Am. J. Public Health 76:525-531 (1986).

(9.) Davies, B., Thorley, A., and O'Connor, D., Progression of addiction careers in young adult solvent misusers, Br. Med. J. 290:109-110 (1985).

(10.) Altenkirch, H., and Kindermann, W., Inhalant abuse and heroin addiction: a comparative study on 574 opiate addicts with and without a history of sniffing, Addict. Behav. 11:93-104 (1986).

(11.) Langrod, J., Secondary drug use among heroin users, Int. J. Addict. 5:611-635 (1970).

(12.) D'Amanada, C., Heroin addicts with a history of glue sniffing: A deviant group within a deviant group, Int. J. Addict. 12:255-270 (1977).

(13.) Chadwick, O., Yule, W., and Anderson, R., The examination attainments of secondary school pupils who abuse solvents, Br. J. Educ. Psychol. 60:180-191 (1990).

(14.) Sterling, J. W., A comparative examination of two modes of intoxication--an exploratory study of glue sniffing, J. Crim. Law Criminol. Police Sci. 55:94-97 (1964).

Sarah J. Young, M.D. Sally Longstaffe, M.D. Milton Tenenbein, M.D.([dagger])

Departments of Pediatrics and Child Health Department of Community Health Sciences University of Manitoba

(*) Presented at the Academic Pediatric Societies annual meeting, May 7, 1996, Washington, D.C.

([dagger]) To whom correspondence and reprint requests should be addressed at Children's Hospital, 840 Sherbrook Street, Winnipeg, Manitoba R3A 1S1, Canada. Telephone: (204) 787-2445. Fax: (204) 787-4807. E-mail: mtenenbein@hsc.mb.ca

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