Drug screens can be used to determine substance use and are common in circumstances such as employment checks, treatment adherence, and legal proceedings. However, checking for the use of inhalants is complicated, and there are no tests that can definitively determine inhalant use. As such, professionals rely on thorough history taking and other indications of use during examination.
- Standard drug tests typically do not detect inhalants. Specialized laboratory testing and clinical assessments are often required to identify inhalant use.
- Inhalants have short detection windows and testing limitations. Many inhalants leave the body quickly, making detection difficult and increasing the likelihood of false negatives.
- Recognizing signs of inhalant use is important for early intervention. Symptoms such as chemical odors, dizziness, cognitive impairment, and stained clothing may indicate inhalant misuse.
Inhalant drug testing and limitations
Inhalants are not screened for in standard drug tests. Typically, in order to test for inhalant use, professionals need to perform verbal assessments and screening questions while conducting their examinations. However, some laboratory tests can provide suspicion of inhalant use. For example, elevated liver enzymes might be indicative of use and can be further investigated. [1][2]
Inhalants are some of the least researched and understood substances, despite the prevalence of their use. They are cheap, easy to access - as they are often legal - and widely used by children, adolescents, and adults. Inhalants cause a rapid onset of physical and cognitive effects, and high concentrations especially impact brain and lung health. Long-term use can result in significant impairments in interpersonal and social functioning, a high risk of substance abuse, and poor mental health outcomes. [2]
Testing for inhalant use is not yet widely available, although research to improve inhalant abuse diagnosis is increasing. [1][2]
Why standard drug tests miss inhalants
Standard drug tests miss inhalants because they have short detection windows and are not metabolized by the body in the same way as other substances of abuse.
A large proportion of the substance is released by the exhaled breath, while the rest is excreted in urine within a matter of hours. As such, the detection window is very small. Inhalants tend to be legal products, and the substances within them can only be detected with specialized testing. [3]
Need for laboratory and clinical assessment
Inhalants include a range of components. For example, testing for toluene requires checking hippuric acid and o-cresol in the individual’s blood or urine. This requires specialist tests that are not commonplace and, thus, can be expensive and difficult to access. [2]
Often, when attempting to determine inhalant abuse, medical professionals rely only on comprehensive questionnaires and history taking, along with a high index of suspicion, which may be obtained through answers and physical presentation. The development of specific inhalant use testing is necessary to help in the diagnosis of inhalant abuse. [1][2]
Specialized tests for inhalant abuse
Urine tests may be used to check for specific inhalant agents. For example, toluene may be detected as urinary hippuric acid, although this is likely to be detected with chronic abuse. [2]
Additional tests that can be used to help determine inhalant use include: [2][4]
- Full blood count
- Electrolyte levels
- Phosphorus levels
- Calcium levels
- Urinalysis to help determine renal function
It can also be useful to include scans of the chest and head, as damage to these areas can occur with inhalant use and may help to determine use. [1]
Limitations
Limitations of these tests include: [2][3][4]
- Hippuric acid can be found in people who do not use inhalants, as it may occur as a metabolite from the ingestion of certain food and drink preservatives, thus causing false positives.
- Urine and serum toxicology screens for specific agents could take days or weeks to complete and would be very costly due to the need for specialized testing.
- No tests can provide definitive confirmation of inhalant use.
How long do inhalants stay in your system?
Studies indicate that between 25-40% of toluene is exhaled, with the remaining proportion being metabolized by the body through various pathways. Mostly, it is excreted via the kidneys in urine, which means that the majority of the remaining metabolites have been removed from the body within 24 hours. [2]
Factors influencing inhalant duration
Factors that can influence the duration of inhalants in the body include: [2]
- Physical health conditions that impact metabolism, such as impaired liver function.
- Level of hydration.
- General physical well-being.
- Age and weight.
- Amount and frequency of inhalant use.
Additionally, the type of test used by a laboratory can influence the duration of detection.
Importance of knowing the signs of inhalant use
Some signs of inhalant use can overlap with signs of other substance use or various mental and physical health conditions. However, it is important to be aware of potential signs, as inhalant use can often go unrecognized. This can include: [1][2]
- Frequent dizziness
- Tiredness
- Irritability
- Headache
- Sensitivity to light and noise
- Coughing
- Bloodshot eyes
- Chemical smells on the breath
- Sores around the mouth
- Impaired memory and cognition
- Changes in speech, such as slurring
- Impaired coordination or movement
- Impaired visual acuity or abnormal eye movements
- Stained clothes (if inhalants such as paints or oils are spilled or mishandled)
What to do if inhalant use is suspected
Inhalant use is common among adolescents. If a parent suspects their teenager is using inhalants, they may wish to seek professional support. Education can be beneficial to ensure that young people are aware of the potential dangers of inhalant use and how to seek support. [1]
Seeking professional help
Professional help can benefit people who use inhalants, as inhalants can become addictive and may have severe health consequences. Professional support can include therapies and rehabilitative services that assist individuals in reducing and stopping use, addressing underlying mental health symptoms, and developing positive coping strategies and recovery plans.
A primary care physician can advise on appropriate care and may make a referral to specialist services.
When to seek emergency care
Inhalant use can result in serious effects that may require urgent medical attention, such as: [1]
- Delusions or hallucinations.
- Serious impairments in heart, kidney, or liver functioning.
- Significant cognitive impairments.
- Loss of consciousness.
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