Recreational use of Nitrous Oxide
Is it really harmless?
How does it work?
N2O is a colourless non-flammable gas with a slightly sweet odour. When used recreationally, N2O is referred to as ‘nangs’, ‘nos’, ‘bulbs’ or ‘balloons’, and is most commonly sourced from diverted food industry products, like whipped cream canisters. When inhaled, users experience an extremely brief, yet intense feeling of euphoria, often accompanied by feelings of dissociation and mild changes in perception of body image, or mild hallucinations. Due to the short-lived nature of the effects, users return to normal functioning within a few minutes, making it desirable for those chasing a quick high or as an enhancer to the effects of other drugs.
Global N2O Use
The low cost and easy, legal, availability of nitrous oxide may explain its popularity – especially among young adults. For example, N2O canisters, sold as ‘whipped cream chargers’ are easily available from online shopping sites like Amazon and Ebay, or readily sourced from everyday catering stores. A quick Google search shows thousands of results for canisters that are available to buy online for next-day, or even 30-minute delivery.
The popularity of N2O is confirmed by data from the Global Drug Survey (GDS), the world’s largest anonymous drug survey. Across three years of the survey (2014-2016), 17 per cent of respondents reported ever using N2O, with 42 per cent of these people reporting use within the past year. N2O is particularly popular among respondents from the UK and USA, with 38.6 per cent and 29.4 per cent of these countries’ respondents reporting lifetime use of N2O.
N2O also seems to be growing in popularity among Australians. In the 2014 GDS, 21 per cent of Australian N2O users had used N2O in the last 12 months, with this increasing to 40 per cent in 2016.
Where’s the harm?
A recently-published study, co-lead by UQ’s A/Prof Jason Ferris, analysed survey responses from 16,239 Global Drug Survey respondents who reported recent use of N2O, representing the world’s biggest ever study of N2O users.
Despite N2O being reported as a safe drug, a number of the study’s participants reported persistent numbness or tingling (paraesthesia) in their hands or feet, particular as their ‘hits’ per session increased. This is concerning because this may suggest peripheral neuropathy, or permanently damaged nerves. This happens because prolonged heavy use of N2O can lead to a depletion of vitamin B12, which results in nerve damage if untreated. This can leave people with difficulty walking or balancing, falling and associated injuries.
How many nangs are too many?
The study’s authors also found a dose-response relationship between N2O use and experiencing paraesthesia, meaning that the greater the dose, the greater the chance of experiencing paraesthesia (shown in graph). While the median number of doses per session was five, 130 participants reported using 100 or more doses per session. A media article describes an Australian student who was left with nerve damage to her spinal cord after inhaling up to 360 doses per week.
Additionally, users put themselves at the risk of a number of other side effects based on how it is consumed. When inhaled through a balloon or canister (the most popular method), side effects can include gagging, coughing, vomiting, hypertension, induced asthma attacks, tracheal spams, tinnitus, or seizures. Moreover, when the gas is decanted into a balloon before consumption, people ‘rebreathe’ into the balloon, increasing carbon dioxide intake and reducing oxygen volume in the body, thus increasing the risk of fainting and falls.
Other acute harms associated with N2O include freezing of the lips, or a collapsed lung (pneumothorax), and a few deaths have been reported following accidental asphyxiation. In the UK, 25 fatalities involving N2O were reported between 2010 and 2016. In 2018, an Australian teenager allegedly died whilst using N2O during Schoolies celebrations at the Gold Coast.
Is it legal?
Yes. Under the Australian Consumer Law, the legitimate sale of the small gas canisters relate to whipping cream or medicinal effects, and so Fair Trading does not ban these products that are then misused.
Current New South Wales laws state that it is an offence for someone to supply or sell N2O to another knowing it is to be used for human consumption, however enforcing these laws has proven difficult due to the lack of legislation.
As with any drug there is no safe level, and use of them always carries a risk. For free and confidential advice about N2O, call the 24/7 National Alcohol and Other Drugs Hotline on 1800 250 015.
The 2020 Global Drug Survey is now open; add your response to help researchers to improve our understanding of drugs and related harms. http://www.globaldrugsurvey.com/GDS2020
Associate Professor Jason Ferris is an expert on drug epidemiology from the Centre for Health Services Research at The University of Queensland.
Dr Cheneal Puljević is a Research Fellow in the area of substance use harm reduction at the Centre for Health Services Research at The University of Queensland.
Ms Harriet Wilson is a PhD student at the Centre for Health Services Research at The University of Queensland.