Defining and measuring 'inhalant' use in population-based surveys.

Area of Science:

• Drug epidemiology
• Substance use research
• Public health surveys

Background:

• The term 'inhalants' broadly categorizes drugs by administration route, encompassing volatile solvents, alkyl nitrites, and nitrous oxide.
• These distinct drug classes possess unique pharmacological properties, usage patterns, and associated harms.
• Current population-level drug use surveys often group these diverse substances, potentially obscuring specific epidemiological trends.

Purpose of the Study:

• To critically review and comparatively analyze the definitions and measurement of inhalant drug use across various population-level surveys.
• To identify inconsistencies in how volatile solvents, alkyl nitrites, and nitrous oxide are defined and surveyed.
• To evaluate the implications of these inconsistencies for understanding global drug use patterns and informing public health interventions.

Main Methods:

• A case study analysis of population-level drug use surveys, including five youth-specific and six general population surveys.
• Extraction and analysis of inhalant drug types surveyed and their definitions from survey codebooks or methodological documentation.
• Comparative assessment of definitional and measurement approaches across different surveys and geographical contexts.

Main Results:

• Significant inconsistencies were observed in the definitions and measurement of inhalant drug use across surveys, varying by country and target population (youth vs. general).
• General population surveys reported varying coverage of nitrous oxide (5/6), volatile solvents (5/6), and alkyl nitrites (4/6).
• Youth-specific surveys showed lower reporting rates for alkyl nitrites (1/5) and nitrous oxide (1/5) compared to volatile solvents (3/5).

Conclusions:

• There is a lack of standardized methodology for defining and measuring inhalant drug use, impacting international comparisons and population-specific insights.
• The umbrella term 'inhalants' offers limited epidemiological value due to the heterogeneity of the substances it groups.
• Discontinuing the collective term 'inhalants' and focusing on the distinct epidemiology of volatile solvents, alkyl nitrites, and nitrous oxide is recommended for improved harm reduction, treatment, and prevention strategies.