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Matthew Doogue, Murray Barclay
The Wellington Coroner, Mr Garry L Evans, recently investigated and reported on the deaths of six young New Zealanders due to butane inhalation (Decisions 86-91/05, 26 September 2005). These deaths occurred between January 2003 and April 2004 in people aged 15-27 years. The reports are compelling reading and strong recommendations are made about the management of drug abuse in New Zealand. These reports had widespread attention in the national media. The following is a brief overview of the clinical pharmacology of abused inhalants, in particular the properties and actions of butane.
The lifetime prevalence of inhalant abuse in New Zealanders is about 2%.1 The most commonly abused inhalants are solvents from adhesives, fuels, aerosol propellants, and nitrous oxide. Most abusers are adolescents and there is a high risk of death compared to other drug abuse.2
Abused inhalants can be loosely grouped into three groups on the basis of their pharmacological and behavioural effects.3 The first two groups are the volatile alkyl nitrites and nitrous oxide. The prototypic volatile alkyl nitrite is amyl nitrite. The basis for use and abuse of the alkyl nitrites is their vasodilatory and smooth muscle relaxant effects. Nitrous oxide is a widely used gaseous anaesthetic that is also used commercially as an aerosol (e.g. in whipped cream). Nitrous oxide has a pattern of effects...