Not for stress relief: Experts warn against using muscle spray to get ‘high’

SINGAPORE — The label reads “skin anaesthesia” and “for external use only”. But some people here are inhaling muscle sprays to get high – and putting themselves in danger of poisoning and death.

The muscle sprays in question are those that contain ethyl chloride. Used to relieve pain, they are easily available online and off-the counter in pharmacies.

Each 100ml bottle costs around S$14, TODAY found during a check at retail pharmacy here.

But therein lies the risk. Awareness among the public and healthcare professionals of this form of solvent abuse is poor, as it is not perceived to be a “serious” form of drug abuse, said Dr Navin Kuthiah of the Woodlands Health Campus’ department of internal medicine via email.

“The harms of volatile substance abuse addiction and adverse effects of ethyl chloride (are) often underappreciated due to the poor knowledge… and the general perception that (it) is not a ‘true form’ of drug abuse,” wrote Dr Kuthiah and his co-author in an article published last month in the journal Annals by the Academy of Medicine, Singapore.

The article highlighted a recent case of muscle-spray abuse.

UNSTEADY AND VOMITTING

Late last year, a 24-year-old Singaporean man was diagnosed with ethyl chloride poisoning after he turned up at a local hospital with a two-day history of nausea, vomitting and abdominal cramps. He had an unsteady gait and tremors.

The patient admitted to abusing muscle spray several times a week over two months, the authors reported.

The total number of cases seen in Singapore is not known, but news reports on abuse among students and other youths date back to 2009.

Some hospitals contacted declined to comment on whether they have encountered cases in recent years, but Changi General Hospital said it has not.

“This may be because most cases have effects that are mild and short-lived, and hence would not require medical treatment at hospitals,” said Dr Mong Rupeng, a consultant in emergency medicine at Changi General Hospital.

In Britain, there have been 834 deaths related to volatile substance abuse since 2001, and 64 deaths were recorded in 2016 alone, wrote Dr Kuthiah and his co-author, Dr Er Chaozer.

Ethyl chloride – which is also used as a solvent and refrigerant – is not a controlled drug under the Misuse of Drugs Act or the Intoxicating Substances Act.

HARMFUL WAY TO COPE WITH STRESS

Abusers may use the substance to relieve stress or a negative mood, and this is especially for youths who may have poorer skills to cope with stress, said Dr Guo Song, a senior consultant at the Institute of Mental Health’s National Addictions Management Service (Nams).

Nams has seen such cases of addiction involving muscle spray but they are “very rare”, he said.

The youths “typically abuse it by usually spreading it on cloth to inhale until they get intoxicated”, said Dr Guo.

Like other forms of inhalant abuse, such as glue-sniffing, the predominant effects of muscle-spray abuse are on the neurological system, said Dr Mong.

Short-term exposure to ethyl chloride inhalation may cause the person to appear intoxicated and have poor coordination, he said.

Topical exposure to consumer products containing the substance, or occupational exposure, rarely lead to significant poisoning, he said.

To curb abuse, the dangers of volatile substance abuse must be highlighted and the public and healthcare professionals need to be more aware of the issue, the report’s authors said.

It may also be useful to put additional warning labels on products containing ethyl chloride, to indicate that misuse or abuse of such products can be harmful to health, Dr Guo added.