Changing patterns in volatile substance abuse fatalities: A retrospective case series from Northern Australia

Introduction

The deliberate inhalation of volatile substances is an enduring public health and forensic concern.^1,2 These substances—ranging from fuels such as petrol, butane, and propane to solvents, aerosols, and gases—are inexpensive and widely available. Their appeal lies in their accessibility and their capacity to produce rapid intoxication. On occasion, inhalation may augment sexual asphyxia. ³ Unfortunately, the physiological effects of volatile substances can be unpredictable and often fatal. Mechanisms of death may include, but are not limited to, oxygen displacement leading to asphyxia, aspiration of gastric contents, and the arrhythmogenic effects of hydrocarbons on the myocardium, a phenomenon sometimes described as “sudden sniffing death.” Sporadically, deaths may be due to accidental asphyxiation from nose and mouth occlusion if petrol is inhaled from a metal can. ⁴

The current study examined Volatile substance abuse (VSA)-related deaths in the Northern Territory (NT) of Australia over a 21-year period to determine whether there had been any changes in methods used over time.

Methods

A retrospective review of coronial cases in the NT between 2002 and 2022 was undertaken, where VSA was identified as the direct or contributory cause of death, as per the standardized coronial framework. Cases were identified using coronial cause-of-death coding and keyword searches (“volatile substance abuse,” “volatile substance misuse,” “volatile substance inhalation,” “petrol,” “butane,” “propane,” and “organic vapour”) of coronial databases. Each case file typically included police reports, autopsy findings, toxicology results, and coronial findings. Data were extracted on demographic characteristics, location and circumstances, substances involved, co-intoxicants, mechanisms of death, and autopsy features.

The local findings were compared with larger datasets: (i) national NCIS data covering 2000–2021, (ii) a South Australian autopsy study (1983–2002), (iii) Office for National Statistics mortality data from England and Wales, (iv) poison center surveillance in the United States, and (v) reviews of volatile substance use in Indigenous communities.^1,5–10 Relevant forensic case reports were also considered to highlight specific mechanistic risks.

Ethics approval was obtained from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC 2025–5228), and permission for this research was granted by the NT coroners’ office.

Results

Demographic profile

Twenty-five deaths were identified where volatile substance inhalation caused or contributed to death. Acute volatile substance inhalation was the direct cause of death in 22 of the identified cases (see Table 1). In these 22 cases, the individuals were all male, the majority were Aboriginal (20, 91%), with most deaths occurring at rural locations (20, 91%). The age range was 12–37 years, with a median age of 22.5 years and an average age of 22.7 years. The age distribution was heavily weighted towards teenagers and young adults. The highest number of cases in one year was recorded in 2004, when six deaths were recorded (see Figure 1).

OPEN IN VIEWER

Figure 1.

Distribution of cases over the study period.

OPEN IN VIEWER

Table 1.

Demographic information of study population—deaths associated with acute volatile substance inhalation (n = 22).

Case characteristics	No. (%) of cases
Sex Male Female Age, years  12–19  20–29  30–39 Ethnicity  Aboriginal  White Location of incident  Rural  Urban Involved volatile substance  Petrol  Butane  Butane and propane	22 (100) 0 (0) 8 (36) 9 (41) 5 (23) 20 (91) 2 (9) 20 (91) 2 (9) 18 (82) 2 (9) 2 (9)

Chronic volatile substance abuse was listed as a contributing factor in death in three cases, involving one female and two male Aboriginal individuals (see Table 2).

OPEN IN VIEWER

Table 2.

Deaths related to chronic volatile substance abuse (VSA) (n = 3).

Type of death	Short description
Suicidal hanging Natural death	17-year-old female with a longstanding history of volatile substance abuse and associated behavioral issues. 39-year-old male; died from the combined effects of hyponatremia, severe chronic obstructive pulmonary disease, acquired brain injury from VSA and lupus nephritis. 47-year-old male died from acquired brain damage from chronic petrol sniffing.

Substances, environments, and toxicological analyses

Toxicological analyses, including screening for volatile organic compounds (VOCs), were performed in all but two cases (n = 20, 91%) at the Forensic Science South Australia toxicology laboratory. Headspace analysis for the detection of VOCs is not included in the standard scope of analysis and is usually undertaken on request from the pathologist when there are suggestive circumstantial findings or a relevant history indicating possible exposure. The analyses were most commonly performed on post-mortem blood samples (n = 18); in some cases, body cavity fluid, urine, lung, liver, and/or brain tissue were also submitted. The presence of volatile substances was confirmed in 18 of these 20 analyses. In two cases, toxicological analyses were not performed, and in another two cases, toxicological analyses failed to confirm the presence of volatile organic compounds. In these four cases, the cause of death was determined by strong circumstantial evidence and the absence of any other organic or traumatic death at autopsy (see Table 3).

OPEN IN VIEWER

Table 3.

Deaths related to acute volatile substance inhalation—relevant circumstantial information, autopsy findings and toxicology results.

No.	Age (years)	Circumstantial information	Autopsy findings	Toxicology results
				Sample	Results
1	24	Found deceased in a prone position in his vehicle; a jerry can that contained petrol was found near his head, with his face resting on a cut 1.125 mL soft drink bottle that contained petrol	Mark on the decedent's face around the mouth consistent with the outline of the cut soft drink bottle Signs of decomposition Strong smell of petrol emanated from the viscera, particularly the lungs, and the decedent's clothing	Not collected	N/A
2	33	Found deceased lying in the rear of his vehicle after he was seen driving around sniffing petrol; a can containing a small amount of petrol was found near his head	Signs of decomposition No organic disease identified	No suitable specimens available	N/A
3	14	Found deceased at his residence with a petrol container close to his face	Signs of decomposition No organic disease identified	Decomposition fluid	0.13% alcohol
4	21	Found deceased at his residence with a petrol container close to his face	No organic disease identified	Blood	0.013% alcohol Cannabis metabolites
5	36	Found deceased in a prone position in his vehicle with a tin containing liquid, suspected to be petrol, located near his face	No organic disease identified	Blood	Volatile organic compounds consistent with petrol
6	14	Found deceased with a clear bottle containing petrol covering his nose, with a blanket covering the bottle, pressed up against his face	No organic disease identified	Blood	Volatile organic compounds consistent with petrol
7	21	Found deceased lying on his right side holding a tin against his face with a blanket over the top of his body	No organic disease identified	Blood	Volatile organic compounds consistent with petrol
8	37	Found deceased inside an abandoned car covered in blankets with a tin of petrol near his head	No organic disease identified	Blood	Volatile organic compounds consistent with petrol
9	32	Found deceased at his residence after being observed to inhale petrol	Chronic myocarditis	Blood	i. Volatile organic compounds consistent with petrol
10	32	Found deceased after being observed to sniff petrol	Chronic myocarditis	Blood	Volatile organic compounds consistent with petrol
11	18	One of two persons found deceased inside a storage container, which held a quantity of petrol	Stomach contents in the airways with evidence of terminal aspiration Pulmonary edema and congestion	Blood	Volatile organic compounds consistent with petrol Cannabis metabolites
12	15	One of two persons found deceased inside a storage container, which held a quantity of petrol	Frothy white fluid in the lower airways Pulmonary edema and congestion	Blood	Volatile organic compounds consistent with petrol Cannabis metabolites
13	22	Found deceased at his residence, surrounded by numerous petrol containers	Noticeable smell of petrol fumes, both externally over the body and on internal examination Pulmonary edema	Blood	Volatile organic compounds consistent with petrol
14	12	Found deceased with a container of automotive fuel adjacent to the body	No organic disease identified	Body cavity fluid and liver tissue	Volatile aliphatic hydrocarbons consistent with Opal fuel were detected in both samples
15	19	Known for butane abuse Found deceased at his residence with a container of butane gas adjacent to the body	Frothy white fluid in the lower airways Pulmonary congestion and edema	Blood	Butane detected
16	26	Driver of a motor vehicle involved in a rollover collision; was observed to inhale petrol prior to the collision	Multiple blunt force injuries	Blood and urine	0.090% alcohol in the blood. Volatile organic compounds consistent with petrol in the blood sample Cannabis metabolites in the blood sample Alcohol present in the urine (not quantified)
17	27	Found deceased at his residence with a container of liquid suspected to be petrol adjacent to the body	Early decomposition No organic disease identified	Blood	Volatile organic compounds consistent with petrol 0.026% alcohol
18	24	Found unresponsive in his room with a bottle of petrol nearby; resuscitation attempted	No organic disease identified	Blood	Volatile organic compounds consistent with petrol
19	12	Found in the rear cargo area of a sport utility vehicle with his head positioned directly above the open spout of a plastic jerry can containing fuel	Pulmonary edema	Blood, lung tissue, and brain tissue	Volatile organic compounds consistent with petrol were detected in all the samples
20	23	Found deceased on his bed with a rubbish bag over his head and genitalia exposed; a butane container was present inside the rubbish bag	Brown-red fluid in the nose Pulmonary edema with a “chemical smell” emanating from the lung tissue	Blood and lung tissue	Butane detected
21	13	Known solvent abuser Found collapsed with a “strong smell of deodorant emanating from the body” and two deodorant aerosol containers adjacent to the body	Bloody fluid and stomach contents in the airways Pulmonary edema and terminal aspiration	Blood and lung tissue	Butane and propane detected
22	24	Known solvent abuser with associated psychiatric illness Found collapsed in a hospital bathroom with a deodorant aerosol container adjacent to the body	Decedent's t-shirt had an overpowering smell of deodorant and showed multiple white patches in keeping with sprayed deodorant White frothy fluid in the lower airways Pulmonary edema	Blood and lung tissue	Butane and propane detected Therapeutic drugs (paliperidone, lorazepam, and zuclopenthixol) are present at non-toxic concentrations in the blood

Petrol was implicated in 82% (n = 18) of deaths, with the last petrol-sniffing-related death recorded in 2018. One fatality in 2007 was related to the inhalation of Opal fuel. Gas fuels (primarily butane and propane) accounted for 18% (n = 4), with deodorant canisters found in close proximity to the bodies in two cases, and butane gas containers in the other two cases.

Petrol sniffing deaths often occurred in outdoor locations or abandoned dwellings, with several incidents linked to enclosed spaces or the use of plastic bags to concentrate fumes. The manner of death was deemed accidental in all 22 cases.

There was a known history of VSA present in all cases except in the case of possible auto-erotic asphyxia. The single case of possible auto-erotic asphyxia was included for completeness and represents a distinct behavioral category, not considered to influence the observed VSA trends.

Discussion

In Australia, petrol sniffing was entrenched in some remote Aboriginal communities during the latter part of the twentieth century. The devastating impact on individuals, families, and communities has been well-documented and the subject of several coronial inquests.^1,10,11

The introduction of government-subsidized low-aromatic Opal fuel (a variety of low-aromatic 91 RON petrol developed in the mid-2000s by BP Australia as a deterrent to petrol sniffing) and the Volatile Substance Abuse Prevention Act 2005 marked a major policy success, substantially reducing petrol sniffing in targeted regions.^12–14 This temporal association has been demonstrated in the current case series, with a peak in the number of cases reported in 2004, followed by a sharp reduction, and the last recorded petrol sniffing-related death occurring in 2018.

However, reductions in petrol misuse did not eliminate volatile misuse altogether in the NT. With petrol being less accessible or less psychoactive, it seems that users are displaying substitution behavior, turning to butane and propane, products that are inexpensive, highly intoxicating, and widely sold and available. There is no general prohibition on the sale of all aerosols in the NT, but specific products, like aerosol paints, are restricted, and others, such as deodorants, have been moved to locked cabinets in many stores to prevent misuse. ¹²

National and international experience mirrors this trajectory. National NCIS data (n = 164) showed that gas fuels were the most frequent substances in fatal incidents (35%), with petrol and adhesives/paints contributing around 20% each.^14,15 Sudden collapse was frequently described, and pneumonia was uncommon, consistent with very rapid death. Similar to what was seen in a South Australian study on inhalant deaths, there were no deaths in this case series from paint and glue inhalation. ⁶

In the United Kingdom (UK), adhesive inhalation, which had previously dominated mortality figures until the mid-1980s, has been replaced by fuels such as butane and propane, which are now responsible for the majority of deaths.^7,16 Similarly, poison center data from the United States from the 1990s and 2000s reveal high rates of adolescent misuse and particularly lethal outcomes with butane and difluoroethane. ⁸

The mechanisms of death underline the challenges for forensic practice. The syndrome of sudden sniffing death, with fatal arrhythmias occurring within minutes of inhalation, is well described in the toxicological literature and was consistent with several of our witnessed cases. Asphyxial mechanisms were also common, especially in situations involving bags or enclosed spaces. Autopsy findings, by themselves, are rarely diagnostic, although, in some cases, inhaled material may be detected in the lungs if paint has been sniffed. ⁹ Usually, however, the combination of scene investigation, toxicology, and witness evidence is required to reach a reliable conclusion. Chronic VSA is associated with impairments of cognition and neurological damage ¹ ; three cases were identified in the study period where chronic VSA contributed to death, as described earlier.

Sociodemographic themes run through the data. The overwhelming male predominance is consistent across jurisdictions. Indigenous Australians at remote locations bear a disproportionate burden of VSA-related deaths, while data from the UK link mortality to social deprivation. Adolescent vulnerability is universal, with experimentation often beginning in early teenage years.^7,8,15

The introduction of low-aromatic fuel has been a significant success story^13,14; however, the rise of gas fuels and aerosols necessitates a new or revised policy response. Measures that may be introduced include restrictions on the sale of lighter refills, modifications to packaging, community-driven education programs, and enhanced surveillance through coronial databases. Interventions would have to be culturally informed and community-led to have a lasting impact.

Although this study was limited by its modest sample size and the inherent challenges of toxicology (volatiles will only be tested for if suspected), the findings are consistent with those from larger datasets nationally and internationally. They highlight the urgent need for broadened strategies to reduce deaths from VSA.

Conclusions

VSA remains a cause of preventable death in the NT; however, a shift has occurred from historical petrol sniffing to non-petroleum volatiles, typically involving the inhalation of gases from aerosol cans. Forensic practitioners should anticipate involvement of non-petroleum volatiles and consider the possibility of sudden arrhythmic death even when toxicology is limited. Public health efforts that have successfully addressed petrol sniffing must now be adapted to include the realities of butane, propane, and aerosol misuse. Method substitution is an ever-present problem in dealing with substances of abuse.