Solvent Abuse and Toxicity: the Philippine Experience

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Solvent Abuse and Toxicity the Philippine
Experience

• Irma R. Makalinao, MD DPPSAssociate Professor
• Department of Pharmacology and Toxicology
• University of the Philippines Manila

INHALANT ABUSE AMONG CHILDREN AND
ADOLESCENTS National Institute on Drug
Abuse/Fogarty Center 7-9 November 2005
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There is no comprehensive epidemiologic data on
the magnitude on inhalant abuse among children
and adolescents in the Philippines
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The Integrated Central Case Registry and
Monitoring System (ICCRMS)

• 2004 Report from 53 residential and outpatient
  facilities revealed 5,787 cases of drug abuse
• 4,680 cases were new admissions while 887 were
  readmissions and 220 were outpatient cases

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Case Distribution According to Drugs Used/Abused
(DDB Annual Report 2004)
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Data from the UP Poison Control Unit January to
December 2003

• 108 drug related cases
• Most commonly abused drugs include
  methamphetamine, alcohol, marijuana and volatile
  organic solvents particularly toluene from glue
  sniffing

MARIJUANA
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Chronic Solvent abuse among Filipino street
children in Manila

• Preliminary results revealed
• Cognitive dysfunction particularly memory
  impairment
• Hyperactivity
• Performed poorly on the groove peg board test
• On physical examination they were malnourished

Unfinished study from the UP POISON CONTROL
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Toluene Abuse in the Philippines

• Rugby sniffing is one of the most common ways
  by which toluene is abused
• A rugby sniffer often puts the chemical in a
  plastic bag and inhales the vapors directly from
  the bag to achieve a state of euphoria

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Factors that contribute to popularity of Rugby
sniffing

• The relative ease of procuring this substance due
  to its low cost and relatively accessibility
  contributed significantly to its widespread abuse
  among Filipino street children

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Solvent Abuse among Filipino street children

• UNICEF estimates the number of street children in
  the Philippines to range from 75,000 to 80,000
• Data from DSWD show that the number increases by
  6,365 annually
• HALF of the Philippines street children have at
  one time or another snorted "rugby" and other
  aromatic solvents to assuage hunger pangs
• ( Source Kanlungan sa
  Er-Ma Ministry)

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Over the last 10 years several NGOs tried to
determine the profile of the street children who
abused solvents

• These include
• Unang Hakbang Foundation
• Development Endeavors for Organized
  Sustainability Foundation
• Kuya Center for Street Children
• Sarnelli Center for Street Children
• Tahanan Outreach Projects and Services
• Virlanie Foundation

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Background information of Filipino street children

• Began to be visible by the late 1970s
• Pick up children since they were being picked
  up by the police for violating the anti-vagrancy
  law

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Who are the Filipino street children?

• In the Philippines, there are three different
  categories of street children
• children on the streets
• children of the streets
• completely abandoned children

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The Filipino street child

• Children on the streets - work on the street but
  do not live there
• Children of the street - who live and work on
  the streets
• Completely abandoned and neglected children -
  entirely on their own for physical and
  psychological survival

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Solvent Toxicity
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Pharmacokinetics of Toluene

• Aromatic hydrocarbon methylbenzene
• Liquid with high volatility and low viscosity
• 40-60 absorbed via the respiratory tract
• Dermal absorption is rapid while GI absorption is
  slow
• Widely distributed once absorbed with the highest
  concentration in adipose tissue, followed by the
  bone marrow, adrenals, kidneys, liver, brain and
  blood

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Biologic marker for exposure and toxicity

• The mixed function oxidase system metabolizes
  60-75 of the absorbed toluene to benzoic acid
• Toluene is hydroxylated to form benzylalcohol
• Benzylacohol is conjugated with glycine to form
  hippuric acid
• Hippuric acid can easily be measured from the
  urine

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Elimination of toluene

• 20-40 of absorbed toluene is eliminated
  unchanged in the expired air
• Following a single acute exposure elimination is
  complete within 24 hours

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Clinical Manifestations

• Toluene abusers are exposed to levels above 1000
  ppm. Levels of exposure greater thatn 600 ppm
  cause confusion and delirium
• Data on the toxic effects of toluene among
  patients seen at the Poison Center were from
  inhalational exposure with chest tightness, chest
  pain and altered mental status as the most common
  presenting symptom at the emergency room

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Biphasic response among toluene sniffers

• Initial excitatory phase followed by depression
• The excitatory phase is characterized by
  euphoria, delusions, less commonly visual and
  auditory hallucinations
• With prolonged exposure- confusion,
  disorientation, muscular incoordination ataxia,

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Treatment Protocol from the UP National Poison
Control Center

• History
• Examination
• Changes in sensorium
• MSE and complete neurologic exam
• Check for arrhythmias and chemical pneumonitis
• General Measures
• Laboratory Exam
• Treatment of Specific Problems

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GAPS in the knowledge of solvent abuse among
Filipino children and adolescents definitely
exists
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POLITICAL
SOCIAL
CHILDRENS ENVIRONMENTAL HEALTH ISSUES
ECONOMIC
SPIRITUAL
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We were born to protect LIFE