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• W1548104628 abstract "We have become concerned that misuse of salbutamol metered dose inhalers (MDIs) may be more widespread than previously thought. Dependency upon salbutamol inhalers has been previously described 1. The precise substance of dependence was difficult to establish at this time as it was unclear whether salbutamol, or the associated propellant, was the responsible trigger for the misuse of the medicine. It has been argued that since salbutamol does not distribute well in animal brains 2, and addictive effects have also been produced by other drugs delivered by aerosol, that the propellant was the most likely responsible agent of abuse 3. After the adoption and steady implementation of the Montreal protocol by the UK and other countries in 1989 4, most MDIs now use HFA 134a (a hydrofluorocarbon less damaging to ozone) as a propellant. Our clinical experience with a group of homeless people in the UK has drawn us to consider that salbutamol MDI misuse may continue despite this change. Collectively, alongside other volunteers, we provide healthcare services to a leading UK homeless charity at Christmas time over an eight day period, offering voluntary clinical services to homeless people in need. Following our 2006 service, anecdotally we noted that homeless individuals who had substance misuse problems appeared to be frequently requesting salbutamol MDIs, although clinicians did not always feel they were necessary. Requests were often made without any clear complaint and were typically accompanied by requests for drugs with commonly recognised abuse potential, such as benzodiazepines and opiates. Furthermore, one of the authors found a discarded blue MDI with a charred mouthpiece in one of the clinical areas. The appearance of the apparently modified MDI was reminiscent of other homemade apparatus used for inhaling volatile substances. The charity provides clinical services across eight separate centres in London. One centre is co-ordinated to particularly serve the needs of individuals with alcohol and drug problems. Following our 2007 episode we noted that salbutamol MDIs were prescribed much more frequently at the alcohol and drug centre (13 prescriptions) than at each of the other centres (a mean of five prescriptions per centre). Although we acknowledge that there are many potential confounders of this recent observation, including varying clinical need and clinical practices, we believe that it could in part be related to salbutamol MDI misuse. The potential articles of interest may include the plastic MDI casing (to manufacture apparatus to inhale volatile chemicals), the propellants or alternative aspects of the medicine. We are of the opinion that clinicians should be vigilant when prescribing MDIs to individuals known or suspected to misuse volatile substances, and consider further research on salbutamol MDI misuse is required. Stewart Glaspole has acted as a consultant to a number of pharmaceutical companies. His association with these companies is in no way connected to the content of this paper." @default.
• W1548104628 created "2016-06-24" @default.
• W1548104628 date "2008-11-01" @default.
• W1548104628 modified "2023-10-05" @default.
• W1548104628 title "SALBUTAMOL INHALER MISUSE: A PERSISTING PROBLEM?" @default.
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• W1548104628 doi "https://doi.org/10.1111/j.1360-0443.2008.02351.x" @default.
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