In this issue of American Family Physician, Anderson and Loomis¹ provide a timely review of the prevalence and consequences of inhalant abuse in children and adolescents. Although this form of substance abuse poses serious health risks, it may be overlooked when family physicians discuss drug abuse prevention with young patients and their families. The potential ill effects of inhalant abuse include damage to cardiac, pulmonary, neurologic, gastrointestinal, hematologic, renal, and dermatologic systems.

Fortunately, inhalant use appears to lack some of the cachet that attracts adolescents and young adults to illicit drugs. This factor may explain the relatively low prevalence and frequency of inhalant use. Evidence from the Monitoring the Future survey² indicates that since 1995 there has been a small but steady decline in the one-year prevalence of inhalant use among school-aged children in the United States. The decline in use has been accompanied by an increase in the percentage of young people who disapprove of even occasional use of inhalants. In 2002, the percentage of 10th grade students who disapproved of trying inhalants (88.6 percent) was comparable to the percentages of those who disapproved of trying crack cocaine (88.0 percent), powder cocaine (86.4 percent), or heroin (89.2 percent), and higher than the percentages of those who disapproved of occasional use of marijuana (cannabis; 57.8 percent), LSD (lysergic acid diethylamide; 74.6 percent), or Ecstasy (MDMA; 77.4 percent). Data from this survey also indicate that many young people are aware of the dangers associated with inhalant use.

The article by Anderson and Loomis¹ highlights the possibility that inhalant abuse may act as a gateway to the use of other illicit drugs. This is an intriguing suggestion, given that some of the proposed mechanisms underlying the potential gateway effect of cannabis use relate to the extent to which access to cannabis also may increase access to other drugs.³ However, these proposed explanations for the gateway effect of cannabis use are not easily applied to inhalants, which are widely and freely available. It may be that preexisting factors, such as personality and low income, precede the onset of inhalant use and explain the association between the abuse of inhalants and other substances.

Inhalants also differ from other gateway substances in lifetime prevalence of use, which is typically higher for alcohol and cannabis. As Anderson and Loomis¹ note, the prevalence of inhalant use (and abuse) is relatively low. However, given the serious acute effects of inhalant abuse, intensive efforts should focus on preventing the onset of use and, when indicated, encouraging cessation of use.

Given the myriad factors that are associated with the onset of substance abuse (i.e., the persons most at risk often are exposed to multiple disadvantages and dysfunctions⁴), preventive efforts should be multifaceted and should target multiple risk factors. Such broad preventive efforts must involve a host of institutions. Family physicians have a pivotal role in these preventive efforts: they are often the first point of contact, and they generally have well-established relationships with all family members. Furthermore, brief interventions by family physicians targeting alcohol and other drug problems have been shown to be effective.⁵ Thus, family physicians should be aware of the dangers of inhalant abuse, should assess patients who may be at risk, and should be prepared to intervene to prevent the onset of inhalant use and to support and encourage cessation among abusers.