Poppers, nitrous, and beyond: Patterns of inhalant use across sexual identity groups in the U.S., 2021–2023

• Gay and bisexual males reported the highest rates of lifetime inhalant use. • Bisexual males and females were most likely to initiate inhalant use before age 18. • Past-year inhalant use persists into midlife for gay and bisexual males. • Bisexual females show elevated inhalant use in young adulthood. • For gay and bisexual males inhalant use is linked with stimulants and higher income. • For bisexual females inhalant use is associated with young age and polysubstance use. Inhalant use, including “poppers” (e.g., alkyl nitrites), remains disproportionately common among sexual minority adults, yet national data on recent use patterns and behavioral health correlates are limited. We analyzed nationally representative 2021–2023 National Survey on Drug Use and Health data, estimating prevalence of lifetime, past-year, and past-month inhalant use by sexual identity, sex, and age. Among sexual minority adults, we examined age-specific patterns and identified correlates of past-year use among gay males, bisexual males, and bisexual females (lesbian/gay female users excluded due to small sample size). Lifetime inhalant use was highest among gay males (39.4%) and bisexual males (28.9%), compared to 10.8% of heterosexual males and 5.8% of heterosexual females. Past-year inhalant use was reported by 10.8% of gay males, 5.1% of bisexual males, and 2.1% of bisexual females (<1% among heterosexual adults). Among sexual minority adults, age patterns of use diverged: prevalence was highest among middle-aged gay and bisexual males but was concentrated among younger bisexual females. Among past-year users, bisexual females were disproportionately young, socioeconomically disadvantaged, and had higher polysubstance use relative to gay and bisexual males. Multivariable models confirmed subgroup-specific correlates: cocaine and methamphetamine use and higher income among gay males; prescription stimulants and higher income among bisexual males; and polysubstance use and younger ages among bisexual females. While inhalant use remains concentrated among sexual minority males, bisexual females represent an understudied group with elevated use and distinct risk profiles, including polysubstance use.