Physicians: Know the risks and warning signs of huffing

Aaron Carter, an actor and singer who came to fame in the late 90s and early 2000s, died in his bathtub at his Lancaster, California, home on November 5 last year. He was 34. According to the Los Angeles County Medical Examiner-Coroner’s Office, the death was accidental, with drowning listed as the primary cause.^[] 

A secondary cause of death specified “effects of difluoroethane and alprazolam.” Alprazolam is the generic for Xanax; difluoroethane is a gas that can be inhaled (referred to as “huffing”) to induce a high.  

Carter’s public struggle with addiction

At the scene, the Associated Press (AP) says that “investigators found several prescription bottles and multiple scattered cans of an electronic duster that he used for inhaling.”^[] 

Carter publicly struggled with addiction for many years. According to the AP, the coroner’s report stated that he’d had a recent relapse as well as “multiple interactions with local police relating to the substance abuse.” Last fall, however, he spoke on camera to celebrity tabloid news organization TMZ about his outpatient care experience.^[] At that point, he said he’d had “five years clean.” 

However, fans were worried about him relapsing last September, due to unconfirmed claims that he was huffing products off-camera while talking to fans on Instagram Live.^[] 

What is huffing?

Huffing is a colloquial or slang term used to describe “breathing fumes in order to get high,” according to a definition listed on Urban Dictionary. 

The practice, the NLM says, became popular in the 1960s when people—mostly teens or younger children—began sniffing glue to achieve a high. The 90s saw another boom in popularity around huffing. In fact, the 2000 National Household Survey on Drug Abuse found that the number of people (mostly teens ages 12 to 17) using inhalants grew 158% from 1990 to 1999.^[] As a result of the sharp increase in users, huffing awareness campaigns were created.^[]

Is huffing still an issue today?

The short answer: yes. While huffing certainly has a reputation for being a 90s and early 2000s method of substance abuse, people still abuse these substances today. The National Institute on Drug Abuse (NIDA)’s 2021 National Survey on Drug Use and Health found that among people aged 12 or older, 2.2 million people reported using inhalants in the 12 months prior to the survey.^[] 

The survey found that 0.1% (or 335,000 people) had an inhalant use disorder in the 12 months prior to the survey—and many of the users are still children. According to a 2022 survey from Monitoring the Future, high school students (3.6% of 8th graders, 2.4% of 10th graders, and 1.8% of 12th graders) were still huffing within the 12 months prior to the survey.

Risks associated with huffing

According to Kelly Johnson-Arbor, MD, medical toxicologist, co-medical director, and interim executive director at the National Capital Poison Center, people may think that inhalants don’t seem “as risky” as other street drugs—but this is far from the truth. 

“Because inhalants (like spray paint or nail polish) are available over-the-counter and are sold in retail establishments, people may not believe that the products are associated with significant harm,” Dr. Johnson-Arbor says. 

That said, huffing chemicals is dangerous, and can lead to several effects, including dilation of blood vessels, asphyxiation, increased heart rate, seizures, impaired functioning, and unconsciousness. “Physicians should also be aware of ‘sudden sniffing death syndrome,’” Dr. Johnson-Arbor adds. This syndrome can lead to irregular and rapid heart rhythms as well as heart failure. Carter’s secondary cause of death was due, in part, to abuse of difluoroethane (DFE).

While it can cause a desired sensation of euphoria, acute toxicity can lead to “nausea, vomiting, abdominal pain, and altered mental status. Severe complications include loss of consciousness, mucosal frostbite, angioedema, cardiac arrhythmias, and skeletal fluorosis,” according to a 2020 article in Federal Practitioner.^[] 

Beyond the physical risks, she says that inhalant use is associated with psychiatric disorders. According to Drug and Alcohol Dependence, 70% of surveyed inhalant users met criteria for “at least one lifetime mood, anxiety, or personality disorder and 38% experienced a mood or anxiety disorder in the past year.”^[] Inhalants can also induce psychotic disorder, according to Cureus.^[] 

Awareness is key for harm reduction

While people of any age may turn to huffing, certain groups are at higher risk. “Those most likely to engage in inhalant abuse include young people between the ages of 12 to 17 who have access to household products like paint or glue,” says Ian Jackson, LPC-MHSP, LMHC, NCC, clinical director at Recovery Unplugged in Austin, Texas. 

Dr. Johnson-Arbor also underscores the importance of knowing the warning signs of inhalant abuse. “These warning signs include the presence of paint or other stains on the hands or face, the presence of empty aerosol containers or chemical-soaked fabrics, and chemical odors on the breath or clothing,” Dr. Johnson-Arbor says. Jackson says that physicians should openly talk to at-risk patients about huffing and its risks. 

“When doctors detect signs of huffing in a patient, they should refer them to a licensed addiction specialist or mental health professional who has experience treating inhalant abuse. This specialist can help diagnose the individual and create an individualized plan for treatment that includes both behavioral therapy and medication if necessary,” he says. For patients struggling with addiction and other psychiatric issues, “Both psychiatry evaluation and addiction medicine referral may be beneficial for patients who are struggling with addiction and huffing,” Dr. Johnson-Arbor adds.