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Yet it often flies under the radar in public health programs and education settings. For example, it’s not included in the drug education curriculum in .

In , we spoke to young people (aged 18 to 25) who have used nitrous oxide. We found they were are unaware of its risks – even when they reported symptoms such as “brain fog” and seizures.

What is nitrous oxide?

Nitrous oxide is regularly used for sedation and pain relief in dentistry and childbirth.

The gas, which has no colour or flavour, is also used recreationally and is known as nangs, nos, whippits and balloons.

In fact, nitrous oxide has been used to since its creation in 1722, and wasn’t used in surgery . It can create a feeling of dissociation from the body, changes in perception and euphoria. This lasts about one minute.

In Australia, nitrous oxide is cheap and accessible. This is because the gas is also used , for example to whip cream.

So, while it’s not legal to sell nitrous oxide for recreational use, the canisters or “bulbs” are widely available via 24-hour delivery services.

People usually discharge the gas into a balloon or a whipped cream dispenser and then inhale. Nitrous oxide – minus 40 degrees Celsius.

How common is it?

We still don’t have much data about who uses nitrous oxide and how often. Compared to , there is minimal research on its recreational use.

However researchers believe it is becoming more common globally, especially among young people.

For example, in 2022, nitrous oxide was the second-most used controlled substance among 16–24 year olds in the United Kingdom after .

In January 2023, the Netherlands after 1,800 road accidents, including 63 fatal crashes, were linked to the drug in a three-year period.

The reported a doubling in nitrous oxide use between 2015 and 2021, from 10% of respondents to 20%. But this voluntary survey is not representative of all people who use drugs. While it is an indication of people’s nitrous oxide use, the picture remains patchy.

What are the health risks?

Nitrous oxide is not the most harmful drug people can use but that .

Inhaling nitrous oxide has short-term health risks, :

• cold burns from the gas

• injuries from falling over

• nausea and dizziness.

Using a lot of nitrous oxide at one time can result in passing out (from lack of oxygen) and seizures. Calling an ambulance is necessary if this happens.

Longer-term health problems may include:

• vitamin B12 loss (causing numbness of hands and feet and eventually paralysis)

• urinary incontinence

• strokes

• memory loss

• mental health conditions, including depression and psychosis.

The availability of much larger canisters () is also linked to an . These can deliver roughly 70 times the amount of nitrous oxide as traditional small canisters.

Larger bulbs allow people to consume more of the gas at one time and they often experience health problems more .

However, there is still about nitrous oxide in the health system. This means its health risks are often compounded because it is overlooked by those assessing medical conditions and because people deny using it.

Our research

During the first stage of our , we interviewed seven young people (aged 18 to 25) who had used nitrous oxide at least ten times.

While the number of interviewees was small, the stories they told were very similar.

They were either unaware of, or unconcerned about, the drug’s potential risks. This is despite their own experiences of psychological and physical problems.

They reported becoming unconscious, getting burns from the gas on their hands and faces, sores around the mouth and even having seizures.

Of particular concern to us was use before driving because people did not recognise the lingering effects of the gas on concentration.

Our study participants also spoke about “memory zaps” or “brain fog”. Regular use of nitrous oxide affected people’s ability to participate in work and study, with some saying it was also bad for their mental health.

These thinking problems are a concerning side effect. Yet it’s one that has not been adequately investigated.

The role of social media

Videos of young people using nitrous oxide can easily be found on social media. This not only points to its popularity but suggests social media could be a good place to reach young people with and harm reduction.

In the second stage of our research we worked with 30 young people who used nitrous oxide to co-create harm reduction resources.

As a group, we developed videos, photos and text for our on Tik Tok and Instagram and for posts on various .

These describe ways to use the drug more safely. For example the “” messaging suggests breathing the nitrous oxide in for only ten seconds at a time to ensure enough oxygen. “” advises sitting down while using nangs, to avoid injuries from falling.

, Professor, Mental Health and Addiction, Rural Health Research Institute, ; , Lecturer Criminology, Justice & Social Policy, ; , Associate Professor, School of Health and Society, , and , Senior Lecturer, Social Work,

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