The substance primarily associated with solvent abuse in the UK today is butane gas. Over half of all solvent abuse deaths involve the inhalation of butane.
What products contain butane gas?
Many household products contain butane. For example, cigarette lighter refills contain butane. Butane and propane are also used as the propellant in aerosols such as deodorants, hairsprays and so on.
Many aerosols in the UK carry the Solvent Abuse Can Kill Instantly (SACKI) warning on the back.
What are the effects of inhaling butane?
Butane is a depressant and users report a range of highs, including euphoria and hallucinations. The effect is short-lived. Chronic users will often continue inhaling to prolong the effect.
Is it addictive?
Butane can lead to a psychological addiction but it is not physically addictive.
What are the health risks of inhaling butane?
Over half of all deaths associated with solvent abuse are due to butane.
- Butane is highly flammable so there is a high risk of burns or explosions, particularly for smokers.
- Some butane users report suffering from slurred speech and slower reactions while they are using, but find that these symptoms do not continue once they stop. Other people feel that butane abuse has contributed to longer-term physical or mental health issues.
- Death from choking, suffocation, asphyxiation or a form of heart failure known as ‘sudden sniffing death syndrome’ (SSDS).
There is no ‘safe’ way to inhale butane gas that avoids the risk of SSDS.
Harm reduction
Any inhalation may lead to death
It doesn’t matter how often someone has used solvents; there is always the risk of death. There is no such thing as a ‘safe’ way to do it that will take away the risk of death from heart failure.
Re-Solv strives to support people toward eliminating harm from gas and solvent use, which can only be achieved through abstinence from use. However we understand that for some people this may take time, and the following practice may reduce some risks:
- Don’t do it alone (have someone with you who can call an ambulance).
- Avoid spraying directly into the mouth.
- Never cover your face with a mask or plastic bag (covering your face with a mask or bag will increase the risk of suffocation).
- Don’t smoke or light cigarettes – these gases are highly flammable.
- Don’t mix with alcohol, any other drugs or prescribed medicines.
Don’t argue with, chase or excite someone who is high on gases/solvents. Raising their adrenaline levels may increase their risk of death.
See the Drugwise website for further information about the principle of Harm Reduction. Drugwise (external link)
There is more information on our page Symptoms and Risks of Solvent Abuse.
Other gases
- Propane is associated with the same health implications and serious risk of death as butane.
- Nitrous oxide – see our nitrous oxide page here. Nitrous oxide
- Helium does not cause intoxication.
What is Butane Gas?
Butane is a highly flammable, colourless, odourless gas. Butane is a hydrocarbon, found in household and industrial products and is potentially intoxicating if deliberately inhaled.
How it’s misused
Butane is commonly misused by being inhaled directly through the mouth either from cigarette lighter refills, canisters or aerosol sprays.
Butane and the body
Butane is a central nervous system depressant which slows down the activity of the brain, affecting physical
and mental responses. When butane is inhaled the fumes are absorbed rapidly through the lungs into the
bloodstream. The chemicals are soluble in body fat and pass rapidly to the brain and organs, so they take
effect quickly. Although the initial high will last only a few minutes, the effects can continue for up to
40 minutes. Users may maintain the high by continuing to inhale the fumes.
Short-term effects
It is difficult to calculate the dosage of butane being consumed by users so effects can vary between
individuals. The immediate effects that users describe as desirable are a ‘drunk-like intoxication’ and a
‘euphoria’ or a ‘sense of well-being’.
Immediate side effects that may occur include:
- Aggression
- Sedation
- Possible loss of consciousness
- Loss of short term memory
- Slurred speech,
- Loss of coordination
- Confusion
- Convulsions & fits
- Hallucinations
- Blackouts
Long-term effects that may occur include:
- Chronic headache
- Sinusitis
- Ataxia (lack of muscle coordination)
- Dizziness
- Shortness of breath
- Nosebleeds
- Chronic or frequent cough
- Depression
- Anxiety
- Tinnitus (noise in ears or head)
Dependence
Dependence is usually psychological rather than physical. However physical withdrawal has been reported among some users. Tolerance to butane can develop quickly meaning that more of the substance is required to get the same effect. Chronic users may become addicted to butane and experience withdrawal symptoms or a hangover effect if they don’t use regularly. Withdrawal symptoms can continue for a number of days
when use ceases.
Withdrawal symptoms include:
- Headache
- Anxiety
- Nausea
- Vomiting
- Fatigue
- Tremor
- Sleep disturbances
- Depression
- Delirium/ illusions
- Mild abdominal pain
- Sweating
- Muscular cramps
- Irritability
- Loss of appetite
- Slurred speech
Dangers
Deliberate inhalation of butane can instantly kill and there is no way to avoid this.
Sudden Sniffing Death Syndrome
Sudden Sniffing Death Syndrome (SSDS) is a cardiac condition where the person experiences ‘cardiac arrhythmia’ where the heart starts beating irregularly. Most deaths attributed to butane use are caused by SSDS. If the person gets excited, startled or participates in any sudden physical activity after inhaling butane, the heart can fail to pump blood.
People who deliberately inhale butane are also at risk of death due to:
- Choking on their own vomit
- Suffocating
- The back of their throat swelling, putting them at risk of choking
- Fatal accidents and explosions if exposed to flames
Butane can also cause long-term health implications such as:
- Chemical burns on the skin
- Kidney damage
- Liver damage
- Brain damage
- Seizures
- Tremors
- Visual impairment (may become permanent)
Treatment
Butane users should receive the same support as individuals using stimulants. Motivational Interviewing, Solution Focused Brief Therapy and Cognitive Behavioural Therapy are effective for this group. Psychosocial supports should be provided by key workers or counsellors. Butane users generally function well in stimulant support groups.
Harm reduction information
It’s is safest not to inhale butane, but if you are going to use it, please consider the following:
- Do not use near busy roads or other hazardous environments
- Do not use butane alone, in isolated locations or in conned spaces
- Do not use plastic bags of masks to inhale butane
- Keep the can upright and do not tilt the can
- Do not use near a naked flame or lit cigarette
- Do not mix with alcohol, prescription medications or illegal drugs
- Do not sleep with a canister cropped against your nose or a blanket over your head
- Secure a piece of gauze on top of the nozzle to ensure that if the can is titled the liquefied gas would hit the fabric and not the back of the throat
What should you do in an emergency if someone is unconscious?
- Keep calm
- Ensure the area immediately around the person is clear of unsafe objects, including volatile substances
- Call an ambulance yourself or get someone else to
- Check if the person is breathing, and check if they respond to gentle shaking or loud talking
- If the person is breathing, put them in the recovery position and lift their chin to ensure their airway remains clear
- If the person is not breathing, begin CPR if you know how
- Don’t crowd the person or excite them
- Try to find out what the person has used so you can tell the medics
Recreational inhalation of butane and propane in adolescents: Two forensic cases of accidental death
Highlights
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The recreational use of inhalants is a fairly widespread habit among adolescents.
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Two cases of accidental death after sniffing of a mixture of propane and butane are presented.
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The role of propane and butane in causing death was demonstrated with toxicological analyses.
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The importance of correct sampling procedures and surveys was highlighted.
Abstract
The recreational use of inhalants is a fairly widespread habit among adolescents because of the ease of availability and methods of assumption. Their use is however not free of risks, both for direct toxicity on several target organs and for a mechanism of gas replacement with lack of oxygen. The first case concerns a 12-year-old boy who died suddenly after sniffing a mix of butane and propane contained in a can of air freshener. The second case concerns a 14-year-old boy who died by acute poisoning by the same mixture contained in a refill for lighters. High concentrations of the compounds were found in the tissues by analysis with gas chromatography–mass spectrometry. The compounds found in tissues and biological fluids were perfectly compatible with those contained in the containers used for the inhalation. The mechanisms of death were therefore assessed in a combination of the direct toxicity of the compound and oxygen replacement, thus highlighting the crucial help that toxicological analyses can provide in such cases.
Introduction
The recreational use of volatile compounds, the so-called “sniffing”, is determined by the inhalation of aerosols, usually contained in spray cans, for their intoxicating and disinhibiting effects.
It is a fairly widespread phenomenon among teenagers because of their easy availability and low costs, but it represents a part of addiction habits and therefore one of the major causes of mortality and morbidity among young people. The most common substances consist in glues and adhesives for plastics, lacquers, solvents for dyes, fuel (gasoline, naphtha, kerosene), fuel for lighters, aerosol propellants. The latter were composed until the end of the 70s by chlorofluorocarbons that were later banned because of their potential harmful effect toward ozone and thus replaced with aliphatic hydrocarbons such as propane, n-butane, isobutane, n-pentane: the products containing such hydrocarbons have a widespread use, low costs, its easy availability make them accessible as substances of abuse among young people and adults of all social classes [1], [2], [3], [4], [5], [6], [7]. Although these compounds are considered safe as aerosol propellants, harmful events may occur in an accidental or suicidal manner [8], [9], [10], [11], [12], [13], [14], [15], [16]. Inhalation may in fact be found especially among detained people to commit suicide [17]. Although the chemicals of inhalants may produce different pharmacological effects, most of them produce rapid euphoria resembling alcohol intoxication, with disinhibition, lightheadedness and agitation. With prolonged inhalations, a decrease of perceptual sensitivity and even unconsciousness may occur. A variety of additional effects may include aggression, apathy, cognitive impairment. The toxic effects on the organism are clearly determined by the asphyxiating effect in case of prolonged inhalation, but acute inhalation as well (especially with butane) can potentially lead to life-threatening effects. As chronic effect, an extensive and long-lasting damage to the whole nervous system may occur (similar to neurological diseases such as multiple sclerosis). Moreover, cognitive, motor, visual and auditory areas may undergo severe impairment. Other effects may involve coordination, spasticity and sensory loss of hearing and sight [18], [19], [20], [21], [22]. Moreover, chronic exposure can produce significant damage to the heart, lungs, liver and kidneys.
At the state of the art, several cases have been reported of fatal suicidal and accidental butane or propane intoxication. In case of sudden death following acute inhalation, it was attributed to suffocation, respiratory depression, cardiac arrhythmia or to a combination of such different mechanisms [23], [24], [25]. However, it is clear that since autopsy is usually completely unremarkable (as in many asphyxial deaths), the assessment of the cause and mechanism of death is mainly based upon circumstantial data or histological and toxicological analyses. The volatile substance abuse (VSA) among adolescents is a widespread phenomenon [26], [27], [28], [29]. In 2014, according to the “Behavioral health trends in the United States” [30] approximately 546.000 people aged 12 or older were current users of inhalants. Current use of inhalants in 2014 was more common among adolescents aged 12–17 than among people in other age groups. Percentages of people in different age groups who were current users of inhalants in 2014 were 0.6% in adolescents, 0.2% in young adults aged 18–25, and 0.2% in adults aged 26 or older. People who abuse of inhalants belong mostly to rural urban environments. In Europe, according to the survey performed by European School Survey Project on Alcohol and Other Drugs (ESPAD) [31], the highest prevalence of use of inhalants is observed in Cyprus, Greece, Ireland, the Isle of Man, Malta and Slovenia. The consumption of inhalants gradually increases with age, with prevalence of 4% among 15-year-old people and 11% in 19-year-old. This trend can be detected even for other substances such as amphetamines, ecstasy, hallucinogens and opiates. No significant differences between genders were detected.
In Italy, the survey Italian Population Survey on Alcohol and Drugs (IPSAD) [32] aimed at detecting the use of legal and illegal psychoactive substances in the resident population in Italy between the ages of 15 and 64. The survey showed higher prevalence among young people, as individuals below the age of 35 are those reporting more frequently the assumption of these drugs at least once in a lifetime, with prevalence rates between 3% and 4%. The consumption of inhalants in 2008 reached 1% in the age group 15–24 and decreased to 0.2% in other age groups (25–54), without significant differences between genders. The latest report of the Central Executive Anti-Drug Board [33] shows how the sniffing of substances like glues, gases, aerosols and solvents, is alarmingly growing among young people.
Thus, VSA developed in Italy since the early 90s, although it is still rarely observed when compared to other forms of substance abuse. Moreover, the crucial issue of VSA-related deaths among adolescents has never been thoroughly investigated. A previous review of the cases occurred at the Institute of Legal Medicine of Milan until 1985 recorded only two cases and not related to adolescents [34].
The authors report two cases of accidental death due to inhalation of a mixture of butane and propane, hence highlighting crucial aspects involved in a correct diagnosis within a forensic context, which must necessarily rely upon a correct and thorough integration of circumstantial data, clinical evidence, autopsy, histological analysis, and especially toxicological investigations. These cases are of particular interest since they are the only two described in Italian case studies and provide a contribution to this topic, showing how the causal role of the substance can be demonstrated even when a certain survival is present and significant concentrations may be found only in accumulation tissues (i.e. adipose tissue). Different mechanisms responsible for death are therefore discussed.
Section snippets
Case 1
The case concerns a 12-year-old male, found by his mother lying supine on the floor of the bedroom, unconscious and with a plastic bag placed around the face. White foam was dripping from the mouth. The mother immediately alerted the rescue who found him in cardio-circulatory arrest, tried to resuscitate and carry him to hospital but circulation and heartbeat never recovered and he was thus pronounced dead. At the survey of the scene, a can of air freshener was found on the desk of his bedroom,
Materials and methods
In both cases, during autopsy the following samples were taken for further toxicological analyses: cardiac (both cases) and femoral blood (only case 2), urine, bile, portions of tissues (brain, lungs, liver, kidneys) in order to establish the assumption of psychoactive substances. For the search of volatile substances, blood samples (1 ml) and fragments of liver, kidney, brain, lung, iliopsoas muscle and adipose tissue were sampled in vials of 10 ml, previously calibrated, sealed with a septum
Results
The analysis of the biological samples showed the presence of n-butane, isobutane and propane in blood samples and several organs, similar to the gaseous mixture contained in the material found at the decedent’s home (air freshener in the case 1 and cans for lighters recharge in case 2). Fig. 3 shows the gas chromatographic analysis of propane and butane detected in the blood sample of case 1, whilst Fig. 4 shows, in the sample of adipose tissue of case 2, the detection, by GC/MS analysis, of
Discussion
The present cases are very representative of how a correct and thorough forensic investigation should be performed in case of poisoning by butane and propane, especially in accidental cases among people who use to inhale substances for some sort of “trip” [1], [2], [3], [4], [5], [6], [7]. The assessment of the assumption of these substances (a mixture, in both cases) and their role in causing death is based on a thorough evaluation based on circumstances, crime scene investigation, autopsy,
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