# Presentation: 242094

## Summary of Regional Data on Inhalants

- Leningrad Region, Russia

- E.Zvartau
- Pavlov Medical University, St.Petersburg

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## Basics of Russian addiction-related terminology

**Narcology**  =  addiction medicine
**Narcologist** = physician trained and certified in treatment of addicted patients
**Narcology service** = federal and municipal system of specialized narcological out- and in-patient facilities (narcological dispensaries, units, departments, etc)
- Separate state statistics for:
-  ***Alcohol dependence*** (alcoholism) and ***alcohol abuse***
-  ***Narcomania*** = (narcotic) drug dependence. Narcotic drugs = scheduled drugs (Lists of narcotic drugs and psychotropic substances approved by the Government). ***Drug abuse*** = narcotic drug abuse.
-  ***Toxicomania*** = non-narcotic (not scheduled) psychoactive substances (=toxic substances) dependence. Substances include volatile solvents (inhalants), prescription drugs, etc. ***Toxic substances abuse***. No separate registration for inhalants.

## Classification of psychoactive substance use disorders: DSM-IY and ICD-10

_*DSM-IY: ABUSE (A.) AND DEPENDENCE (D.)*_
- Alcohol: D. (303.90) and A. (305.00)
- Opioids: D. (304.00) and A.(305.50)
- Cannabis: D. (304.30) and A. (305.20)
- Sedative-, hypnotic-, or anxiolytics: D. (304.10) and A. (305.40)
- Cocaine: D. (304.20)  and A. (305.60)
- Amphetamine and sympathomimetics: D. (304.40) and A. (305.70)
- Hallucinogens: D. (304.50) and A. (305.30)
- Nicotine: D. (305.10)
**Inhalants: D. (304.60) and A. (305.90)**
- РСР and PCP-like substances: D. (304.50) and A. (305.90)
- Polysubstance: D. (304.80)
- Other or unknown substance: D. (304.90) and A. (305.90)

_*ICD-10:HARMFUL USE (F1x.1) AND DEPENDENCE  (F1x.2)*_
- Alcohol : F10
- Opioids : F11
- Cannabinoids : F12
- Sedative, Hypnotisc : F13
- Cocaine : F14
- Other simulants including caffeine: F15
- Hallucinogens : F16
- Tobacco: F17
**Volatile solvents: F18**
- Polydrug use or other psychoactive substances use: F19

## F18. Mental and behavioural disorders resulting from the use of volatile solvents (inhalants)

- Inhalants are the large group of organic volatile liquids and gases, which are used for deliberate inhalation to bring about the state of euphoria.

## Inhalants problem: importance

- Non-narcotic psychoactive substances use, including most frequently used volatile solvents (about 90%), is widespread in the Russian Federation *(Koshkina, Kirzhanova, 2003).* Recent decades volatile solvents are used by under age population as major non-narcotic psychoactive substance *(Churkin, Tvorogova, 2002)*
- Non-narcotic psychoactive substances use is considered as one of the teenagers’ forms of the deviant behavior, which is characterized by social adaptation failure: poor progress in school, vagrancy, and criminal behaviors
- Early use combined with toxic effects of volatile organic compounds, inhaled by adolescents, result in continued personal problems typical for psychoorganic syndrome (Nadezhdin, 2002)

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## Absolute number of patients with mental and behavioral disorders (MBD), related to psychoactive substances (PAS) use in Russian Federation, 2002 

|  | Total | Adolescents |
| --- | --- | --- |
| MBD, related to PAS use (alcohol excluded) | 482202 | 26962 |
| Drug dependence (narcomania) | 322930 | 3945 |
| Drug abuse (harmful use) | 125771 | 10100 |
| Non narcotic PAS dependence (toxicomania) | 12669 (3,7%)* | 3346 (45,8%)* |
| Non narcotic PAS abuse (harmful use) | 20832 (14,2%)** | 9571 (48,6%)** |

**** - percent of total values for narcotic drugs and non-narcotic PAS dependence;       ** - percent of total values for narcotic drug and non-narcotic PAS abuse/harmful use***

## Absolute number of patients with mental and behavioral disorders (MBDs), related to psychoactive substances use in Russian Federation, 2002 (first time registered)

|  | Total | Adolescents |
| --- | --- | --- |
| MBD, related to PAS use (alcohol excluded) | 71548 | 12047 |
| Drug dependence (narcomania) | 27307 | 1305 |
| Drug abuse (harmful use) | 32615 | 5199 |
| Non narcotic PAS dependence (toxicomania) | 2227 
(7,5%)* | 938   (41,8%)* |
| Non narcotic PAS abuse (harmful use) | 9389 (22,3%)** | 4605 (46,9%)** |

**** - percent of total values for narcotic drugs and non-narcotic PAS dependence;                ** - percent of total values for narcotic drug and non-narcotic PAS abuse/harmful use***

## Toxicomania incidence and morbidity among under age population: Russian Federation

| Years | 1999 |  | 2000 |  | 2001 |  | 2002 |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  | Children | Adole-scents | Children | Adoles-cents | Children | Adoles-cents | Children | Adoles-cents |
| Incidence | 1.36 | 9.18 | 1.27 | 6.9 | 2.09 | 8.3 | 2.85 | 12.8 |
| Morbidity | 7.88 | 60.1 | 6.71 | 47.6 | 6.22 | 43.1 | 6.95 | 45.7 |

- Difficulties in getting proper statistics (A.Nadezhdin, 2005):
- Category “toxicomania” does not allow to differentiate particular types of abuse/dependencies (obviously inhalant abuse/dependence is predominant)
- Service for persons under 14 is often provided in psychiatric, not narcological, units whith primary psychiatric diagnosis
- Homeless and neglected children are still often out of statistics (Government decree on addictional measures of prevention..., 2002)

## Percentage of teenagers and youth (11-24 y.o.) experimenting with or using non-narcotic psychoactive substances (data of the Sociological Center, Ministry of Education, 2003)

| Narcotic and Psychoactive substances (PAS) | Frequency of usage |  |  |
| --- | --- | --- | --- |
|  | 1-3 lifetime | 2-5/month | 2-3/week |
| Inhalants | 4.4 | 2.2 | 15.9 |
| Medications | 2.9 | 10.3 | 9.7 |
| Other PAS | 4.6 | 3.5 | 3.1 |

- Biased data: underestimation due to absence of homeless and neglected children data and inclusion of above 18 y.o. subjects
- Those who started from inhalants switched to cannabis (50%), prescription drugs (20%), opiates (10%)

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## Leningrad Region (Oblast). One of 89 administrative subjects of Russian Federation. Area  84,500 sq.km. Population – near 2 mln

## Collaboration agreements: Medical Academy of Postgraduate Education/ Department of Narcology, City Narcology Hospital, City Hospital # 31/Narcology Unit

*Collaboration agreements: Medical Academy of Postgraduate Education/ Department of Narcology, City Narcology Hospital, City Hospital # 31/Narcology Unit*

## Specific properties of inhalants making them widely used

- Low cost
- Absence of mandatory records (with exception of some substances)
- Various forms of commercial products containing volatile substances
- No necessity to use specific equipment or make preparations for their use
- Prompt setting in of inhalation intoxication
- Quickly attained effect
- Quick disappearance of symptoms of the use of inhalants

## Inhalant properties mentioned above make them very popular among:

- Teenagers and young people, who for the first time in their life use substances causing intoxication
- People having no means to acquire other preparations because of their high cost (poverty-stricken strata of society)
- People isolated from society (inmates of prisons)
- People having access to inhalants (personnel of medical establishments, industrial workers)

## Adolescents’ narcological service report: Leningrad region

- 39.2% of registered patients suffering toxicomania use volatile organic compounds, _evaporating from varnish and paints_
- In 55.4% of cases users inhale _gasoline and glue vapors_
- 5.4% use _different toxic substances alternately_

## Acute and chronic effects of inhalant’s intoxication

- Acute and chronic effects of inhalant’s intoxication

- Acute and chronic effects of inhalant’s intoxication

**Notes:**
Notes for a slide

- Acute and chronic effects of inhalant’s intoxication

## Inhalants-related deaths

- Sudden death in the result of respiratory depression or asphyxia
- Sudden death resulting from arrhythmia and cardiac arrest (potentiation of the  effect of endogenous catecholamines)

**Notes:**
Notes for a slide

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## Official statistics recorded by Adolescents Narcological Service of the Leningrad Regional Public Health Committee is based on 4 types of registers:

- _Register for dependent subjects_
- Morbidity: ***absolute number and percentage*** referred to 100.000 population ***of under age patients registered*** in the Regional and Provincial Narcological Dispensaries/Units according to the following diagnostic categories: 1. Alcoholism, 2. Narcomania, 3. Toxicomania
- Incidence: ***absolute number and percentage*** referred to 100.000 population ***of newly registered cases*** in the Regional and Provincial Narcological Dispensaries/Units according to the following diagnostic categories: 1. Alcoholism, 2. Narcomania, 3. Toxicomania
- _Register for abusing subjects_
- Overall registered: ***absolute number and percentage*** referred to 100.000 population ***of*** ***under age subjects registered*** in the Regional and Provincial Narcological Dispensaries/Units according to the following categories: 1. Alcohol abuse, 2. Drug abuse, 3. Toxic substances abuse
- Newly registered: ***absolute number and percentage*** referred to 100.000 population ***of newly registered cases*** in the Regional and Provincial Narcological Dispensaries/Units according to the following categories: 1. Alcohol abuse, 2. Drug abuse, 3. Toxic substances abuse

- 5

- 10

- 15

- 20

- 25

- 0

**1992**

**1993**

**1994**

**1995**

**1996**

**1997**

**1998**

**1999**

**2000**

**2001**

**2002**

**2003**

**2004**

- Morbidity

- Incidence

- For 100,000 under age population

## Toxicomania incidence among under age population: Leningrad region

- Toxicomania **incidence** among under age population: Leningrad region

**1992-1994: a decrease of toxicomania incidence (3.6 times in 1994 *****vs.***** 1992)**
**1994-1998: 20.6 times rate increase**
**1999: the incidence rate became 4.3 times less to compare with 1998.**
**Since 1999 the second wave of increase has been revealed and in 2002 a fourfold increase was recorded. **
**2003-2004: the incidence rate reduced by 34% to compare with year 2002, but in 2004 the incidence rate increased by 79%**
**Thus, toxicomania incidence among non-adults resident in Leningrad Region since 1992 till 2004 occurred in three waves: the first peak took place in 1998, the second one in 2002, and the third one in 2004 **

## Toxicomania morbidity among under age population: Leningrad region

- Toxicomania **morbidity** among under age population: Leningrad region

**1992-1994: morbidity decreased in 4.5 times to compare with 1992 **
**1995-2002: morbidity rate increase in 19 times in 2002**
**2002-2004: morbidity rate stable.**

## Toxic substance abuse by under age population: Leningrad Region

- 0

- 20

- 40

- 60

- 80

- 100

- 120

- 140

- 160

- 180

- 200

**1992**

**1993**

**1994**

**1995**

**1996**

**1997**

**1998**

**199****9**

**2000**

**2001**

**2002**

**2003**

**2004**

- Newly registered

- Registered abusers

- For 100,000 under age population

- 1992-1994: newly registered abuse occurrence without dependence (prevention record group) was declined by 26% in 1994
- 1994-1997: rate increased in 2.9 times, though in 1999 it decreased again in 2.2 times to compare with the incidence rate in 1997.
- 1999-2004: two waves. In 2004 newly registered rate increased by 29% as compared with 2003

## Alcoholism, narcomania and toxicomania incidence among under age population: Leningrad Region

**Total addiction pathology incidence increased in 4.1 times in the period from 1992 till 2002 **
**Remarkable growth of narcomania incidence was observed. Since 1992 till 1996 this rate increased in 14.5 times, but during 1997 it declined by 45%  **
**From 1997 the second wave of narcomania incidence growth was noted (especially heroin use), which resulted in more than six fold increase of this rate by 2000 **
**In 2001 narcomania incidence rate decreased by 34%, and during 2004 it decreased in 7 times to compare with 2000**

## Alcoholism, narcomania and toxicomania incidence among under age population: Leningrad Region

**Thus, narcomania incidence among non-adults of Leningrad Region during the period from 1992 till 2004 had two waves: the peak of the first wave occurred in 1996, and the peak of the second one occurred in 2000. **
**At the same time toxicomania incidence level among non-adults also had wave pattern, when in the period of narcomania incidence increase the decline of toxicomania incidence was noted, and in the period of toxicomania incidence increase among non-adults of Leningrad Region narcomania incidence decrease was reported.**

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## TreatmentIntoxication by VS 

## Treatmentof Withdrawal Syndrome

## TreatmentStabilization of remission

## Summary of Regional Data on Inhalants: overview

- Inrtoduction: terminology and problem importance
- Some federal level statistics
- Features of inhalant use: regional narcological service experience
- Regional prevalence and incidence statistics
- Treatment
- Prevention and rehabilitation

## Prevention and rehabilitation

- Development and implementation of the unified model of street children help
- Participants:
- federal and municipal-based state structures (Committees on education, public health, adolescents, City center on under age homeless and neglected children, etc)
- NGOs (e.g. “For the health generation at the XXI century age”, “Phisicians of the world – USA”, etc)
- Prevention and rehabilitation network include children hospitals, narcological units, police under age departments, children care and trusteeship municipal commissions, schools and boarding schools, children’s homes

## NGO “For the health generation at the XXI century age” example

- Target population: homeless and neglected children and adolescents abusing non-narcotic and toxic substances (40% are HVC, HVB and HIV infected)
- Basic idea: creation of surrogate family environment (therapeutic milieu)  at medical and rehabilitation centers as an alternative to PAS use subculture
- Therapeutic means: contract-based individual and group counselling and training, professional training, development of family and significant others communication (if possible), leasure organization, etc

## Conclusions

- Since diseases caused by volatile organic solvents use have marked social character, their growth results in increasing violations of the law among under age population and predisposes child neglect development among children and adolescents.
- Taking into account nowadays addiction diseases epidemiology trends, short-term toxicomania prognosis appears to be unfavorable:
- the increase of patients, including under age, is expected
- widening the range of the used toxic substances
- growing proportion of different psychiatric and somatic disorders caused by toxic damage of central and peripheral nervous system
- Such prognosis makes it important to develop and implement complex health and social programs aimed at toxicomania prevention and treatment.

## Acknowledgement

- Evgeny Krupitsky, chief narcologist, Leningrad Region
- Dmitry Masalov, chief children narcologist, Leningrad Region
- Alexander Grinenko, head, Public Health Committee, Leningrad Region
- Tatyana Slavina, chief physician, Leningrad Regional Center of Addictions