Intentional use of gasoline as an intoxicant has been frequently reported in diverse clinical literature. Recent investigations have described a high prevalence of this behavior in certain ethnic groups such as American and Canadian Indians living in isolated areas. Encephalopathy due to tetraethyl lead has become a well-accepted complication of gasoline sniffing within the last decade, but other adverse effects are less well known. This report discusses gasoline sniffing as a specific substance abuse behavior, and reviews some of the known or potential medical complications. Treatment is primarily limited to chelation therapy for organic lead intoxication, although other interventions may be effective on an individual basis.