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Insufflation (Latin insufflation "blowing on" or "into") is the act of inhaling something (such as a gas, powder, or vapor) into a body cavity.^[1] Insufflation has medical use as a route of administration for many respiratory drugs used to treat conditions in the lungs (e.g., asthma or emphysema) and paranasal sinus (e.g., allergy).

The technique is common for many recreational drugs and is also used for some entheogens. Nasal insufflation (snorting) is commonly used for many psychoactive drugs 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 and portal circulation bypass. 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 codeine), 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 sheath or via retrograde axonal transport along olfactory and trigeminal nerves. 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 bioavailability, assuming that the molecule has the right physico-chemical characteristics to get through the nose and the epithelial defences.^[2]

Medical uses

Medical procedure

Inert, nontoxic gases, such as carbon dioxide, 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.^[3]

Intranasal (IN) administration of various lipid soluble medications is increasing in popularity. It is often used for treatment of children or patients who are otherwise alarmed or frightened by needles, or where intravenous (IV) access is unavailable. In addition to a variety of nasal sprays 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.

Administering drugs

Psychoactive substances are often insufflated nasally for the purpose of intranasal absorption through the mucous membrane, 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. The verb "snort" is synonymous with insufflate in this context, as are several slang words.

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.

Commonly insufflated psychoactive substances (for non-medical use) include:

Cocaine (benzoylmethylecgonine) - a strong stimulant that is highly addictive; most commonly associated with drug insufflation
Opioids - a class of analgesic drugs (including heroin, morphine, oxycodone, buprenorphine, hydromorphone, oxymorphone and the synthetic meperidine and fentanyl).
Amphetamines - another class of strong stimulants (including amphetamine, dextroamphetamine and methamphetamine) that are also highly addictive.
Ritalin (methylphenidate) - another stimulant somewhat pharmacologically similar to cocaine; sometimes claimed to have effects similar to that of cocaine when insufflated^{[citation needed]}
Ketamine - a dissociative anaesthetic, used recreationally for its euphoric, anaesthetic and hallucinatory effects
Phencyclidine - a dissociative anaesthetic, commonly known as PCP or angel dust; no longer in common use because of reports of intensely negative experiences
MDMA/Ecstasy - an entactogen that also possesses stimulant effects
Zolpidem (Ambien) - a sedative hypnotic that can have various hallucinogenic effects with certain people and/or at high doses
Tobacco snuff - contains nicotine, a mild stimulant that is highly addictive.

Various other drugs can be taken in intranasally for research purposes such as the neuropeptides MSH/ACTH, vasopressin and insulin.^[4]

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 septum.^[5] 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 corrosive. A famous case where the septum was completely destroyed by cocaine was of EastEnders star Danniella Westbrook.^[6]

It may be possible to contract Hepatitis C by sharing contaminated insufflation implements.^[7]

References

^ http://www.merriam-webster.com/medical/insufflation
^ William H. Frey. "Bypassing the Blood-Brain Barrier to Deliver Therapeutic Agents to the Brain and Spinal Cord." Drug Delivery Technology.
^ Lawrence, Ghislaine (20 April 2002). "Tobacco smoke enemas". The Lancet 359 (9315): 1442. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08339-3/fulltext. Retrieved 2008-11-27.
^ Born J, Lange T, Kern W, McGregor GP, Bickel U, Fehm HL. (2002). Sniffing neuropeptides: a transnasal approach to the human brain. Nat Neurosci.5(6):514-6. doi:10.1038/nn849 PMID 11992114
^ http://www.thesite.org/drinkanddrugs/drugsafety/drugsandyourbody/cokeandyournose
^ Westbrook, Danniella (2006). The Other Side of Nowhere. Hodder. ISBN 0-340-89887-9.
^ Aaron S, McMahon JM, Milano D, Torres L, Clatts M, Tortu S, Mildvan D, Simm M. (2008). "Intranasal Transmission of Hepatitis C Virus: Virological and Clinical Evidence". Clinical Infectious Diseases 47 (7): 931–934. doi:10.1086/591699.

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Sun Z, Gong X, Zhu H, Wang C, Xu X, Cui D, Qian W, Han X.SourceImmunology and Reproductive Biology Laboratory, Medical College of Nanjing University, Nanjing, PR China; Jiangsu Key Laboratory of Molecular Medicine, Nanjing, PR China; State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, PR China.
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No exacerbation but impaired anti-viral mechanisms in a rhinovirus-chronic allergic asthma mouse model.

Rochlitzer S, Hoymann HG, Müller M, Braun A; U-BIOPRED consortium.AbstractSevere asthma and viral-induced asthma exacerbations represent a high unmet medical need as no therapy is currently available for these patients. HRV (human rhinovirus) is prominently associated with asthma exacerbations in humans. The aim of the present study was to establish a mouse model of severe asthma with additional rhinovirus infection to investigate the interplay between chronic allergic airway inflammation and acute respiratory viral infection. Balb/c mice were sensitized with HDM (house dust mite) extract (25 μg in 50 μl of saline) by i.n. (intranasal) delivery to the lung over 7 weeks. HRV1B (HRV serotype 1B) inoculation was performed i.n. on the last 3 days. Therapeutic treatment with FP (fluticasone propionate) was performed to assess steroid efficacy. Lung resistance was measured invasively to assess AHR (airway hyper-responsiveness). BAL (bronchoalveolar lavage) differential cell count, cytokines, lung histology and the proliferative and cytokine response of MLN (mediastinal lymph node) cells upon in vitro restimulation were analysed. Chronic HDM application induced a strong Th2-skewed eosinophilic airway inflammation and AHR, which was not exacerbated by superimposed HRV1B infection. Therapeutic steroid intervention in the chronic HDM model reduced BAL eosinophil cell counts, cytokine levels and AHR, while neutrophil numbers were unaffected. Steroid efficacy against inflammatory readouts was maintained during additional HRV1B infection. Animals with chronic allergic airway inflammation exhibited a diminished immune response towards superimposed HRV1B infection compared with HRV1B alone, as induction of the anti-viral and pro-inflammatory cytokines IFN (interferon)-α, IFN-γ and IL (interleukin)-12 were suppressed. Although superimposed HRV1B infection did not provoke asthma exacerbation in this severe model, a deficient anti-viral immune response to HRV1B was present under chronic allergic airway inflammatory conditions. Thus, this model is able to reflect some aspects of the complex interplay of respiratory virus infection in chronic allergic asthma.
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Japanese Journal

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