A lack of survey work among young people outwith mainstream education means that it is difficult to fully assess the direct relationship between different forms of social vulnerability and likely use of inhalants. In particular, research with looked after and accommodated children and those in secure accommodation may be needed. The lack of consultation work with young people and older users with solvent abusing histories also makes it difficult to develop a full epidemiological understanding of VSA.
It appears that there is little dedicated evidence that focuses on minority groups, especially in the UK. What is available mostly stems from Australia and the US and suggests that VSA is more prevalent among white people than minority ethnic groups. It remains to be fully explored as to whether cultural differences would affect the findings or transferability of this work to the Scottish context.
Other areas of research could include:
There is a clear message that VSA is not taken as seriously as other drug use. This is because only a minority of those who try VSA go on to become habitual users and, of those who do continue with their use, only a small number will experience serious health problems associated with their use.1 Further, evidence suggests that negative stereotypes associated with solvent abuse may compound problems of hidden use. Lake (2004)2 suggests that sniffing solvents is considered by young people to be 'filthy', something which in itself may be problematic since it encourages users not to disclose their use and the problem therefore, may remain hidden. See also 'Just a Dirty Kind of Drug: Young People's Perceptions of Chroming'.3 This suggests that sensitive approaches may be required to making clear the harm minimisation strategies that can be used (i.e. social using), however, this would need to be handled in a way that did not, as a consequence, increase potential for experimentation.
In achieving a better understanding of the views of professionals in Scotland in relation to VSA, it may prove useful to audit:
Although the survey evidence points towards use of VSA as a gateway drug, there may be potential to further explore the relationship between VSA and other concurrent drug use.
Specifically, it may be useful to explore whether solvents, in particular, are mixed with other drugs and/or alcohol rather than being used independently. Further, whilst there may be some resistance to future allocation of resources aimed specifically at VSA, due to its perceived low prevalence and severity compared to other drugs, a better understanding of VSA as a gateway into illegal drug misuse may warrant further attention. Decreasing participation in VSA at a young age may act as an early prevention of entry into the forms of drug misuse that do currently receive attention and resources.
It seems that despite a large body of guidance material, there is little that evaluates this material or monitors its use. Whilst discussions with stakeholders suggest that evaluative work is undertaken, this is very much hidden in the 'grey literature'. Undertaking formal evaluation of the effectiveness of various VSA awareness raising activities/campaigns seems a sensible next step. Until both process and outcome evaluation has been carried out of these interventions, little information is available with regard to their actual impact.
The lack of consultation work is also highlighted by the 2005 Department for Health VSA Framework, with a commitment by the DoH that such work will be undertaken. Given regional variations in prevalence rates, and the differing socio-demographic and geographical characteristics of Scotland and the rest of the UK, there may be a need for local consultation work to be undertaken as this seems to be the biggest single gap in the evidence to date.