Insufflation (medicine)
Encyclopedia
Insufflation is the practice of inhaling
a substance. Insufflation has limited medical use, but is a common route of administration
with many respiratory
drugs used to treat conditions in the lung
s (asthma
or emphysema
) and paranasal sinus
(allergy
).
The technique is common for many recreational drugs
and is also used for some entheogen
s. Nasal insufflation (snorting) is commonly used for many psychoactive drug
s because it causes a much faster onset than orally and bioavailability
is usually, but not always, higher than orally. This bioavailability occurs due to the quick absorption of molecules into the bloodstream
through the soft tissue in the mucous membrane
of the sinus cavity
. Some drugs have a higher rate of absorption, and are thus more effective in smaller doses, through this route. Prodrugs, drugs that are metabolized or activated by the liver (such as hydrocodone), should not be insufflated, because they need to be metabolized by the liver to break down into the compounds that are active (drugs absorbed through the GI tract pass through the liver before entering the systemic circulation, where drugs which are insufflated are absorbed directly into the systemic circulation).
The intranasal route (administration through the nose) may allow certain drugs and other molecules to bypass the blood-brain barrier
via diffusion
through the olfactory epithelium and the perineural sheet or via retrograde axonal transport along olfactory
and trigeminal nerve
s. This latter process probably implies endocytosis of the molecules. Using this route to the brain allows high concentrations of products in the olfactory bulb shortly after exposition and by diffusion to the entire brain. Therefore using this pathway allows a better biodisponibility the drug in the central nervous system
, assuming that the molecule has the right physico-chemical characteristics to get through the nose and the epithelial defenses.
, are often insufflated into a body cavity, in order to expand workroom, or reduce obstruction during minimally invasive or laparoscopic surgery
.
In the 18th century, the tobacco smoke enema
, an insufflation of tobacco smoke into the rectum, was a common method of reviving drowning victims.
Intranasal (IN) administration of various lipid soluble medications is increasing in popularity. It is often used for treatment of pediatric patients or patients who are otherwise alarmed or frightened by needles, or where intravenous (IV) access is unavailable. In addition to a variety of nasal spray
s readily available from pharmacies, some common medications delivered via IN include fentanyl, midazolam
and naloxone
. The time of onset for drugs delivered intranasally is generally only marginally slower than if given via IV.
, which is often more rapid, or more complete, than gastrointestinal
absorption. For a substance to be effective when insufflated, it must be water soluble so it can be absorbed into the mucous membranes. This practice is commonly referred to as snorting, bumping, railing, or doozing.
Although the majority of a dose of insufflated drug is taken up through the mucous membranes, some enters other parts of the gastrointestinal tract where it may also be absorbed. This is because some of the dose drips down the throat and into the stomach. This effect is commonly referred to as the 'drip'
and is often unpleasant to taste.
Commonly insufflated psychoactive substances (for non-medical use) include:
Various other drugs can be taken in intranasally for research purposes such as the neuropeptide
s MSH
/ACTH, vasopressin
and insulin
.
Note: Some psychoactive substances such as benzodiazepine
s (valium, oxazepam, clonazepam) are water soluble to a small degree (about 350ml/1000 mg). Though this means they will be somewhat effective when insufflated, they will not be as readily absorbed into the mucous membrane as highly soluble substances such as amphetamines and opiates. Typically sublingual
administration is preferred for this class of drugs.
. Any damage to the inside of the nose is either because some insufflation highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area, or because the substance is physically caustic. A famous case where the septum was completely destroyed by cocaine was of Eastenders
star Danniella Westbrook
.
Inhalation
Inhalation is the movement of air from the external environment, through the air ways, and into the alveoli....
a substance. Insufflation has limited medical use, but is a common route of administration
Route of administration
A route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body.-Classification:Routes of administration are usually classified by application location...
with many respiratory
Respiration (physiology)
'In physiology, respiration is defined as the transport of oxygen from the outside air to the cells within tissues, and the transport of carbon dioxide in the opposite direction...
drugs used to treat conditions in the lung
Lung
The lung is the essential respiration organ in many air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located near the backbone on either side of the heart...
s (asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
or emphysema
Emphysema
Emphysema is a long-term, progressive disease of the lungs that primarily causes shortness of breath. In people with emphysema, the tissues necessary to support the physical shape and function of the lungs are destroyed. It is included in a group of diseases called chronic obstructive pulmonary...
) and paranasal sinus
Paranasal sinus
Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity , above and between the eyes , and behind the ethmoids...
(allergy
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
).
The technique is common for many recreational drugs
Recreational drug use
Recreational drug use is the use of a drug, usually psychoactive, with the intention of creating or enhancing recreational experience. Such use is controversial, however, often being considered to be also drug abuse, and it is often illegal...
and is also used for some entheogen
Entheogen
An entheogen , in the strict sense, is a psychoactive substance used in a religious, shamanic, or spiritual context. Historically, entheogens were mostly derived from plant sources and have been used in a variety of traditional religious contexts...
s. Nasal insufflation (snorting) is commonly used for many psychoactive drug
Psychoactive drug
A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...
s because it causes a much faster onset than orally and bioavailability
Bioavailability
In pharmacology, bioavailability is a subcategory of absorption and is used to describe the fraction of an administered dose of unchanged drug that reaches the systemic circulation, one of the principal pharmacokinetic properties of drugs. By definition, when a medication is administered...
is usually, but not always, higher than orally. This bioavailability occurs due to the quick absorption of molecules into the bloodstream
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
through the soft tissue in the mucous membrane
Mucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
of the sinus cavity
Paranasal sinus
Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity , above and between the eyes , and behind the ethmoids...
. Some drugs have a higher rate of absorption, and are thus more effective in smaller doses, through this route. Prodrugs, drugs that are metabolized or activated by the liver (such as hydrocodone), should not be insufflated, because they need to be metabolized by the liver to break down into the compounds that are active (drugs absorbed through the GI tract pass through the liver before entering the systemic circulation, where drugs which are insufflated are absorbed directly into the systemic circulation).
The intranasal route (administration through the nose) may allow certain drugs and other molecules to bypass the blood-brain barrier
Blood-brain barrier
The blood–brain barrier is a separation of circulating blood and the brain extracellular fluid in the central nervous system . It occurs along all capillaries and consists of tight junctions around the capillaries that do not exist in normal circulation. Endothelial cells restrict the diffusion...
via diffusion
Diffusion
Molecular diffusion, often called simply diffusion, is the thermal motion of all particles at temperatures above absolute zero. The rate of this movement is a function of temperature, viscosity of the fluid and the size of the particles...
through the olfactory epithelium and the perineural sheet or via retrograde axonal transport along olfactory
Olfactory nerve
The olfactory nerve, or cranial nerve I, is the first of twelve cranial nerves. It is instrumental in the sense of smell. Derived from the embryonic nasal placode, the olfactory nerve is capable of regeneration.-Anatomy:...
and trigeminal nerve
Trigeminal nerve
The trigeminal nerve contains both sensory and motor fibres. It is responsible for sensation in the face and certain motor functions such as biting, chewing, and swallowing. Sensory information from the face and body is processed by parallel pathways in the central nervous system...
s. This latter process probably implies endocytosis of the molecules. Using this route to the brain allows high concentrations of products in the olfactory bulb shortly after exposition and by diffusion to the entire brain. Therefore using this pathway allows a better biodisponibility the drug in the central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...
, assuming that the molecule has the right physico-chemical characteristics to get through the nose and the epithelial defenses.
Medical procedure
Inert, nontoxic gases, such as carbon dioxideCarbon dioxide
Carbon dioxide is a naturally occurring chemical compound composed of two oxygen atoms covalently bonded to a single carbon atom...
, are often insufflated into a body cavity, in order to expand workroom, or reduce obstruction during minimally invasive or laparoscopic surgery
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
.
In the 18th century, the tobacco smoke enema
Tobacco smoke enema
The tobacco smoke enema, an insufflation of tobacco smoke into the rectum by enema, was a medical treatment employed by European physicians for a range of ailments....
, an insufflation of tobacco smoke into the rectum, was a common method of reviving drowning victims.
Intranasal (IN) administration of various lipid soluble medications is increasing in popularity. It is often used for treatment of pediatric patients or patients who are otherwise alarmed or frightened by needles, or where intravenous (IV) access is unavailable. In addition to a variety of nasal spray
Nasal spray
Nasal sprays come in a variety of forms. Medicated such as Astelin, Afrin and Nasonex and natural such as Sinusoothe and Sterimar. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump mechanism.-Antihistamine nasal...
s readily available from pharmacies, some common medications delivered via IN include fentanyl, midazolam
Midazolam
Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic,...
and naloxone
Naloxone
Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opiate overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory...
. The time of onset for drugs delivered intranasally is generally only marginally slower than if given via IV.
Administering drugs
Psychoactive substances are often insufflated nasally for the purpose of intranasal absorption through the mucous membraneMucous membrane
The mucous membranes are linings of mostly endodermal origin, covered in epithelium, which are involved in absorption and secretion. They line cavities that are exposed to the external environment and internal organs...
, which is often more rapid, or more complete, than gastrointestinal
Gastrointestinal tract
The human gastrointestinal tract refers to the stomach and intestine, and sometimes to all the structures from the mouth to the anus. ....
absorption. For a substance to be effective when insufflated, it must be water soluble so it can be absorbed into the mucous membranes. This practice is commonly referred to as snorting, bumping, railing, or doozing.
Although the majority of a dose of insufflated drug is taken up through the mucous membranes, some enters other parts of the gastrointestinal tract where it may also be absorbed. This is because some of the dose drips down the throat and into the stomach. This effect is commonly referred to as the 'drip'
Drop (liquid)
A drop or droplet is a small column of liquid, bounded completely or almost completely by free surfaces. A drop may form when liquid accumulates at the lower end of a tube or other surface boundary, producing a hanging drop called a pendant drop...
and is often unpleasant to taste.
Commonly insufflated psychoactive substances (for non-medical use) include:
- DimethyltryptamineDimethyltryptamineN,N-Dimethyltryptamine is a naturally occurring psychedelic compound of the tryptamine family. DMT is found in several plants, and also in trace amounts in humans and other mammals, where it is originally derived from the essential amino acid tryptophan, and ultimately produced by the enzyme INMT...
(DMT) - a psychedelic tryptamine, commonly insufflated during south american rituals. - CocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
(benzoylmethylecgonine) - a strong stimulant that is highly addictive; most commonly associated with drug insufflation - Opioids - a class of analgesic drugs (including heroin, morphineMorphineMorphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
, oxycodoneOxycodoneOxycodone is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine , and codeine.Oxycodone oral medications are generally...
, buprenorphine, hydromorphoneHydromorphoneHydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug...
, oxymorphoneOxymorphoneOxymorphone or 14-Hydroxydihydromorphinone is a powerful semi-synthetic opioid analgesic first developed in Germany circa 1914, patented in the USA by Endo Pharmaceuticals in 1955 and introduced to the United States market in January 1959 and other countries around the same time...
, and the synthetic meperidine and fentanyl). - Amphetamines - another class of strong stimulants (including amphetamineAmphetamineAmphetamine or amfetamine is a psychostimulant drug of the phenethylamine class which produces increased wakefulness and focus in association with decreased fatigue and appetite.Brand names of medications that contain, or metabolize into, amphetamine include Adderall, Dexedrine, Dextrostat,...
, dextroamphetamineDextroamphetamineDextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus as well as decreased fatigue and decreased appetite....
and methamphetamineMethamphetamineMethamphetamine is a psychostimulant of the phenethylamine and amphetamine class of psychoactive drugs...
) that are also highly addictive. - Ritalin (methylphenidate) - another stimulant closely related to amphetamine, but often reported to have effects similar to that of cocaine when insufflated
- KetamineKetamineKetamine is a drug used in human and veterinary medicine. Its hydrochloride salt is sold as Ketanest, Ketaset, and Ketalar. Pharmacologically, ketamine is classified as an NMDA receptor antagonist...
- a dissociative anesthetic, used recreationally for its euphoric, anesthetic, and hallucinatory effects - PhencyclidinePhencyclidinePhencyclidine , commonly initialized as PCP and known colloquially as angel dust, is a recreational dissociative drug...
- a dissociative anesthetic, commonly known as PCP or angel dust; no longer in common use because of reports of intensely negative experiences - MDMAMethylenedioxymethamphetamineMDMA is an entactogenic drug of the phenethylamine and amphetamine class of drugs. In popular culture, MDMA has become widely known as "ecstasy" , usually referring to its street pill form, although this term may also include the presence of possible adulterants...
/Ecstasy - an entactogenEmpathogen-entactogenThe terms empathogen and entactogen are used to describe a class of psychoactive drugs that produce distinctive emotional and social effects similar to those of MDMA. Putative members of this class include 2C-B, 2C-I, MDMA, MDA, MDEA, MBDB, 2C-T-7, and 2C-T-2, among others...
that also possesses stimulant effects - ZolpidemZolpidemZolpidem is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders. It is a short-acting nonbenzodiazepine hypnotic of the imidazopyridine class that potentiates gamma-aminobutyric acid , an inhibitory neurotransmitter, by binding to GABAA...
(Ambien) - a sedative hypnotic that can have various hallucinogenic effects with certain people and/or at high doses - Tobacco snuffSnuffSnuff is a product made from ground or pulverised tobacco leaves. It is an example of smokeless tobacco. It originated in the Americas and was in common use in Europe by the 17th century...
- contains nicotine, a mild stimulant that is highly addictive.
Various other drugs can be taken in intranasally for research purposes such as the neuropeptide
Neuropeptide
Neuropeptides are small protein-like molecules used by neurons to communicate with each other. They are neuronal signaling molecules, influence the activity of the brain in specific ways and are thus involved in particular brain functions, like analgesia, reward, food intake, learning and...
s MSH
Melanocyte-stimulating hormone
The melanocyte-stimulating hormones are a class of peptide hormones that are produced by cells in the intermediate lobe of the pituitary gland...
/ACTH, vasopressin
Vasopressin
Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...
and insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
.
Note: Some psychoactive substances such as benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s (valium, oxazepam, clonazepam) are water soluble to a small degree (about 350ml/1000 mg). Though this means they will be somewhat effective when insufflated, they will not be as readily absorbed into the mucous membrane as highly soluble substances such as amphetamines and opiates. Typically sublingual
Sublingual
Sublingual, literally 'under the tongue', from Latin, refers to the pharmacological route of administration by which drugs diffuse into the blood through tissues under the tongue...
administration is preferred for this class of drugs.
Dangers
Many recreational drugs which are commonly insufflated such as cocaine, can cause damage to the nasal cavity and have even been known to destroy the nasal septumNasal septum
The nasal septum separates the left and right airways in the nose, dividing the two nostrils.It is depressed by the Depressor septi nasi muscle.-Composition:The fleshy external end of the nasal septum is sometimes also called columella....
. Any damage to the inside of the nose is either because some insufflation highly constricts blood vessels – and therefore blood and oxygen/nutrient flow – to that area, or because the substance is physically caustic. A famous case where the septum was completely destroyed by cocaine was of Eastenders
EastEnders
EastEnders is a British television soap opera, first broadcast in the United Kingdom on BBC One on 19 February 1985 and continuing to today. EastEnders storylines examine the domestic and professional lives of the people who live and work in the fictional London Borough of Walford in the East End...
star Danniella Westbrook
Danniella Westbrook
Danniella Westbrook is an English actress and television presenter. She is known for being the original actress to play Samantha Mitchell in the popular BBC soap opera EastEnders from 1990–93, 1995–96, 1999–2000 and 2009–10. Away from EastEnders she has presented various shows, and was also a...
.