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

Volatile substance abuse (VSA) continues to cause preventable deaths worldwide. In Australia, petrol sniffing has historically been the main form of misuse in remote Indigenous communities. However, coronial and surveillance data suggest an increasing role of gas fuels and aerosol propellants. Twenty-five VSA-related deaths reported to the Northern Territory (NT) coroner over a 21-year period (2002-2022) were reviewed. In the 22 cases where acute volatile substance inhalation was the direct cause of death, the decedents were all male, and predominantly young Aboriginal individuals aged between 12 and 29 years. Furthermore, petrol vapor inhalation was responsible for most fatalities up to 2018, after which no further petrol sniffing-related deaths occurred. Deaths that occurred after 2018 were associated with the use of propane or butane from aerosol cans, such as those used for deodorants. A public health initiative that resulted from this was the keeping of aerosol deodorants in supermarkets within locked cabinets. In conclusion, public health interventions, such as the introduction of Opal fuel in remote communities in the NT, have been effective, with a sharp decrease in petrol sniffing-related fatalities. However, this seemed to have led to a shift towards the use of other inhalants, most commonly butane and/or propane inhaled from aerosol canisters. Forensic practitioners should be alert to non-petrol volatiles, and public health strategies need to broaden beyond petrol substitution to include regulatory and community-level measures addressing gas fuels and aerosols.