Misusing Asthma Inhalers to Get Intoxicated: An Unrecognized Problem Among Delinquent Youth

Background and purpose. Nearly 40 million prescriptions for asthma inhalers were dispensed in 2006 in the U.S. Although the pervasive use of asthma inhalers among youth and adults warrants increased attention to the possible misuse of these products, only one prior study has examined misuse of asthma inhalers for the purposes of intoxication. Thus, the aim of this investigation was to examine the prevalence, correlates and consequences of asthma inhaler misuse in a large sample of youth in residential care for antisocial behavior.

Methods. A cross-sectional survey of 723 youth (participation rate = 97.7 %) in 32 residential treatment facilities comprising the Missouri Division of Youth Services was conducted over a three-month period. Youth completed psychometrically validated measures of mental health symptoms, substance use, and antisocial behavior and attitudes in face-to-face interviews with trained graduate MSW students.

Results. Asthma diagnoses were common, with more than 26 % (N = 193) of youth reportedly receiving a lifetime asthma diagnosis; 91.2 % of youth diagnosed with asthma were prescribed an asthma inhaler. Nearly one-quarter (23.6 %, n = 88) of respondents who had used a prescribed or non-prescribed asthma inhaler (N = 373), reported using the inhaler to get high. Youth in this group were termed “inhaler misusers.” Compared to nonusers of asthma inhalers or to youth who used their inhalers only as prescribed, inhaler misusers had greater current psychiatric distress, suicidality, more substance use problems, and higher levels of temperamental low fear and impulsivity. In multivariate logistic regression analyses, Caucasian racial status, lifetime use of volatile solvent inhalants, and current level of psychiatric distress distinguished inhaler users and misusers. Asthma inhaler misusers also reported significantly greater euphoria, blurred vision, confusion, dizziness, memory problems, slurred speech, and other acute effects of asthma inhaler inhalation compared to youth who used inhalers only as prescribed.

Conclusions and Implications. Misuse of asthma inhaler medications for the purpose of becoming intoxicated was prevalent in this state population of antisocial youth. Youth who used prescribed and nonprescribed asthma inhalers to get high were characterized by high levels of polydrug use, comorbid psychiatric problems, antisocial behavior, and temperamental profiles that place them at substantial risk for various adverse short-, intermediate-, and long-term outcomes. Acute reactions to asthma inhaler use were common and occurred more frequently among youth who were asthma inhaler misusers than among inhaler users. Our findings indicate that asthma inhaler misuse may legitimately be considered a form of substance abuse among some youth. Additional studies of the prevalence, phenomenology, and consequences of asthma inhaler use among children, adolescents, and adults in various treatment populations and the general population are needed. If such studies provide noteworthy reasons for concern, vigorous prevention and treatment efforts in this area should be initiated. The findings of this study clearly suggest that additional research and practice efforts are needed examining asthma inhaler misuse in juvenile justice populations.