Insufflation (medicine)

Insufflation (Latin insufflatio "blowing on" or "into") is the practice of inhaling substances into a body orifice. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs (asthma or emphysema) and paranasal sinus (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. Some drugs have a higher rate of absorption, and are thus more effective in smaller doses, through this route.

The intranasal route (administration through the nose) may allow certain drugs and other molecules to bypass the blood-brain barrier via diffusion or axonal transport along olfactory and trigeminal nerves.

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.

Intranasal (IN) administration of various lipid soluble medications is increasing in popularity. It is often used for treatment of paediatric 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 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 lipid 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 include:

Various other drugs can be taken in intranasally for research purposes such as the neuropeptides MSH/ACTH, vasopressin and insulin.
 * 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, hydrocodone, hydromorphone, oxymorphone, and the synthetic meperidine and fentanyl).
 * Amphetamines - another class of strong stimulants (including amphetamine, dextroamphetamine and methamphetamine).
 * Ritalin (methylphenidate) - another stimulant closely related to amphetamine, but often reported to have effects similar to that of cocaine when insufflated
 * Ketamine - a dissociative anesthetic, used recreationally for its euphoric, anesthetic, and hallucinatory effects
 * Phencyclidine - a dissociative anesthetic, commonly known as PCP; no longer in common use because of reports of intensely negative experiences
 * MDMA/Ecstasy - an entactogen
 * 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.

Note: Some psychoactive substances such as benzodiazepines (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.

Dangers
Many recreational drugs which are commonly insufflated such as cocaine, can cause damage to the nasal cavity and has even been known to destroy the nasal septum. 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.