What is Nitrous Oxide? Effects, Risks & Use
Also known as: Nitrous | Nitro | Whippets | Laughing gas | NOS | Bulbs | Nangs | Balloons
If someone is experiencing numbness or tingling in hands or feet when not intoxicated/under influence SEEK MEDICAL ATTENTION.
If you are concerned about another person’s mental health issues and/or alcohol and other drug use, contact 1800here4u (1800 437 348).
"Nangs" is a slang word used to describe the canisters Nitrous Oxide comes in.
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What is nitrous oxide?
Nitrous oxide, commonly known as laughing gas or nitrous, is classified as a depressant, which means it slows down the functioning of the brain and the body. Nitrous oxide is a colourless, odourless gas used in medical and dental settings for anaesthesia, as a propellant for whipped cream and in the automotive industry to enhance engine performance. It is considered an inhalant.
Use in Australia
According to the Australian Institute of Health and Welfare, use of inhalants in the previous 12 months has been gradually increasing from 0.4% in 2001 to 1.0% in 2016 and 1.7% in 2019. One third of those who reported using inhalants, use at least monthly. The most common form of inhalants used in 2019 was nitrous oxide, amyl nitrite and other nitrates.
How long do the effects last?
After nitrous is inhaled, it is absorbed quickly into the bloodstream through the lungs, then travels to the brain and the rest of the body. The effects typically last a few minutes.
Effects of nitrous oxide
The effects of nitrous oxide depend on a range of factors including but not limited to how much is used, how it is used and whether other drugs are used around the same time.
Short term effects include
- Initial ‘rush’ or ‘high’
- Euphoria
- Giggling and laughing
- Altered mood
- Numbness and tingling sensation
- Dizziness and/or light headedness
- Drowsiness/sedation
- Reduced inhibitions
- Impaired judgment
- Headaches
- Blurred vision
- Confusion
- Sweating
- Muscular weakness
- Nausea
- Drop in blood pressure
- Fainting
Effects associated with high volume and/or high frequency use include:
- Numbness and tingling in the hands or feet when not using ,
- Memory loss
- Brain and spinal cord damage (reversible if identified and treated early)
- Poor balance and coordination
- Weakened immune system
- Incontinence
- Limb spasms
- Disruption to reproductive systems
- Potential birth defects (if consumed during pregnancy)
- Psychological disturbances
How it affects your body
Inhaling nitrous oxide affects your body and can have damaging effects such as:
Your Brain
- Vitamin B12 depletion which can cause damage to the nervous system and to the brain.
- Impaired memory and cognition1
- Depression
- Psychosis
Your Lungs
- Ruptures in lung tissue.
Your Heart
- Vitamin B12 depletion can lead to increased amino acid (homocysteine) levels in the body which can cause clots and hardening of the arteries and may lead to a heart attack.
Your Nose, Lips and Throat
- When inhaling directly from cannisters (bulb, cylinder or tank), the gas is extremely cold and can cause frostbite to the nose, lips and throat.
Your Hands and Feet
- Numbness in hands and feet can occur.
Skin
- When inhaling directly from cannisters (bulb, cylinder or tank), the cannister can become extremely cold and can burn skin on the face, hands or body.
Use with other drugs
Use of nitrous oxide with other drugs should be avoided as it increases the risk of harm. Combining nitrous oxide with stimulants increases blood pressure and may disrupt heart rate.
Mixing nitrous oxide with alcohol can cause confusion, a heavy or sluggish feeling, reduced concentration and loss of body control.
Anecdotal evidence suggests that combining nitrous oxide with hallucinogenic drugs and /or cannabis, can cause intense dissociation.
Overdose and bad reactions
Canisters of nitrous oxide contain 100% nitrous oxide, which means during inhalation you don’t breathe in any oxygen. This can starve the brain of oxygen (hypoxia) and be fatal.
Signs of overdose include:
- Asphyxia (when the body is deprived of oxygen)
- Headache
- Dizziness
- Confusion
- Temporary loss of consciousness caused by a fall in blood pressure
- Irregular heartbeat
- Seizures
If someone is experiencing any of the above symptoms, do not leave them on their own. If someone is experiencing confusion, chest pain, breathlessness, or blackouts when using nitrous oxide, call an ambulance immediately – dial Triple Zero (000). If they have stopped breathing commence CPR.
Dependence and withdrawal
There is little evidence of dependence or withdrawal associated with the use of nitrous oxide, aside from cravings to use more nitrous oxide. Regular high volume use increases the risk of long-term harm. If you need help to reduce or cut back on use, see ‘getting help’ section below.
People at higher risk of harm
Use of nitrous oxide, can be particularly damaging for young brains that are still developing.
People with heart and lung issues are at a greater risk of health-related harm and should avoid inhaling nitrous oxide.
If you are pregnant or breastfeeding, it is recommended that you do not use nitrous oxide unless under medical supervision.
People with a predisposition to vitamin B12 deficiency (such as vegans and vegetarians) and people with pre-existing low vitamin B12 levels from other causes (e.g. pernicious anaemia, coeliac disease, Crohn’s disease etc) are at a greater risk of health-related harm. Nitrous oxide causes the inactivation of vitamin B12 which is where the body is unable to use vitamin B12. This can cause clots and hardening of the arteries and may lead to a heart attack. It is important to note that this is not prevented by oral vitamin B12 supplementation.
Drug use and mental health
The relationship between drug use and mental health is complex. Individuals may experience co-occurring mental health and substance use problems. A mental health condition may make a person more likely to use drugs, for short-term relief from their symptoms, while for others with a predisposition to mental health conditions, drug use can trigger initial symptoms. The use of drugs can interact with mental health conditions in ways that create serious adverse effects.
Legislation
Non-medical use of nitrous oxide is regulated under the Medicines and Poisons Act 2014, which means that wholesale and retail suppliers are only able to legally sell nitrous oxide if:
- the purchaser is aged 16 years or older;
- products are labelled and packaged as a ‘poison’ with warning statements, “Do not intentionally inhale contents” and “WARNING – May cause irreversible nerve damage if inhaled”.
Western Australia has introduced further regulatory supply controls. For more information, visit the Nitrous oxide supply restrictions webpage on the Department of Health website.
Reducing harm
The most effective way to reduce the risk of harm is to not use nitrous oxide. If you do choose to use nitrous oxide, it’s important to know ways to reduce the risk of harm.
Avoid direct contact with skin
When nitrous oxide releases from its cannister (a bulb, cylinder, tank or nang), the cannister is freezing cold and can burn the skin. As nitrous oxide intoxication may cause numbness in the body, the cold burn may not be felt immediately, which may result in a more severe burn.
Avoid direct inhalation from cannister
Nitrous oxide is stored under extreme pressure in canisters. When released, the gas is freezing cold. Inhaling directly into the mouth can cause frostbite to the mouth, nose, lips and throat (including vocal cords), and can cause a rupture in lung tissue due to the pressure. Additionally, canisters may also release grease and metal fragments which could be inhaled.
Avoid repeated or prolonged use
Because the effects do not last long you may be tempted to repeat use. Frequent use increases your risk of harm as nitrous oxide can cause the inactivation of vitamin B12 which is where the body is unable to use vitamin B12. This can cause clots and hardening of the arteries and may lead to a heart attack. It is important to note that this is not prevented by oral vitamin B12 supplements.
Have a friend with you
Nitrous oxide intoxication can cause disorientation and a lack of awareness of surroundings, and even unconsciousness, making you more vulnerable to your environment. Avoid using alone or inform someone you are going to use and where you will be in case you have a negative experience or need medical assistance.
Ensure someone who is not using knows what signs to look for regarding overdose e.g., blue lips, pale skin, no response, shallow breathing or no breathing, seizures, chest pain.
Ensure this person knows how to respond with DRSABCD – Danger, Response, Send for help, Airways, Breathing, CPR, Defibrillator.
Avoid spraying near flammable substances and naked flames (including cigarettes)
Nitrous oxide is not considered flammable; however, it can act as an oxidizer and can make a fire burn hotter, faster and more intensely. Throwing nitrous oxide canisters in fire can also cause explosions.
Don’t mix with alcohol and other drugs
Using with alcohol or other drugs can increase risk of harmful effects.
Avoid risky methods of use
- Do not put plastic bags over the head or obstruct breathing in any way.
- Do not drive or operate machinery if intoxicated.
Avoid using in high-risk environments
- Avoid using in enclosed spaces, near water, traffic or at heights.
References
- National Drug & Research Centre. Nitrous Oxide Australia: University of New South Wales; 2022 [Available from: https://ndarc.med.unsw.edu.au/resource/nitrous-oxide-0.
- Your Room. Nitrous Oxide Sydney, Australia: NSW Health; 2022 [Available from: https://yourroom.health.nsw.gov.au/a-z-of-drugs/Pages/nitrous-oxide.aspx.
- Australian Institute of Health and Welfare (2020). National Drug Strategy Household Survey 2019. National Drug Strategy Household Survey 2019 (aihw.gov.au)
- Chen T, Zhong N, Jiang H, Zhao M, Chen Z, Sun H. Neuropsychiatric Symptoms Induced by Large Doses of Nitrous Oxide Inhalation: A Case Report. Shanghai Arch Psychiatry. 2018 Feb 25;30(1):56-9. PubMed PMID: 29719360. PMCID: PMC5925601. Epub 2018/05/03.
- Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. 2017;30(2):171-2
- Soderstom J. Brain and body disconnect: The costs of chronic nitrous oxide use and the benefits of triangulation of data in influencing public health policy in Western Australia. The Medical Journal of Australia. 2022.
- Evans EB, Evans MR. Nangs, balloons and crackers: Recreational nitrous oxide neurotoxicity. Aust J Gen Pract. 2021 Nov;50(11):834-8. PubMed PMID: 34713284. Epub 2021/10/30. eng.
- Baran KC, van Munster IG, Vries AM, Gardien KLM, van Trier T, Pijpe A. Severe nitrous-oxide frostbite injuries on the rise in The Netherlands; let's raise awareness. Burns. 2020 Sep;46(6):1477-9. PubMed PMID: 32534889. Epub 2020/06/15.
- Algahtani H, Shirah B, Abdelghaffar N, Abuhawi O, Alqahtani A. Nitrous oxide recreational abuse presenting with myeloneuropathy and mimicking Guillain-Barre syndrome. Intractable Rare Dis Res. 2020 Feb;9(1):54-7. PubMed PMID: 32201677. PMCID: PMC7062599. Epub 2020/03/24.
- Stockton L, Simonsen C, Seago S. Nitrous oxide-induced vitamin B12 deficiency. 2017;30(2):171-2.
- Soderstom J. Brain and body disconnect: The costs of chronic nitrous oxide use and the benefits of triangulation of data in influencing public health policy in Western Australia. The Medical Journal of Australia. 2022.
- Bajaj D, Agrawal A, Gupta S, Bajaj S. Recreational Nitrous Oxide Abuse Causing Ischemic Stroke in a Young Patient: A Rare Case Report. Cureus. 2018 Dec 21;10(12):e3761. PubMed PMID: 30820381. PMCID: PMC6389023. Epub 2019/03/02
- Mancke F, Kaklauskaite G, Kollmer J, Weiler M. Psychiatric comorbidities in a young man with subacute myelopathy induced by abusive nitrous oxide consumption: a case report. Subst Abuse Rehabil. 2016;7:155-9. PubMed PMID: 27729826. PMCID: PMC5047713. Epub 2016/10/13.
- Oomens T, Riezebos RK, Amoroso G, Kuipers RS. Case report of an acute myocardial infarction after high-dose recreational nitrous oxide use: a consequence of hyperhomocysteinaemia? Eur Heart J Case Rep. 2021 Feb;5(2):ytaa557. PubMed PMID: 33598625. PMCID: PMC7873791. Epub 2021/02/19.
- Baran KC, van Munster IG, Vries AM, Gardien KLM, van Trier T, Pijpe A. Severe nitrous-oxide frostbite injuries on the rise in The Netherlands; let's raise awareness. Burns. 2020 Sep;46(6):1477-9. PubMed PMID: 32534889. Epub 2020/06/15.
- Stone MJ, Roberts NM, Anwar MU. Burn injury from filling balloons with nitrous oxide. British Medical Journal. 2021;1(14).
- Australian Drug Foundation (2022). Nitrous Oxide. Nitrous oxide - Alcohol and Drug Foundation (adf.org.au)
- NSW Government and St Vincent's Alcohol and Drug Information Service. (March 2024). Your Room – Nitrous Oxide.
- Alcohol and Drug Foundation. (Feb 2022). Alcohol and other drugs and mental health. Alcohol and other drugs and mental health - Alcohol and Drug Foundation (adf.org.au)
- Australian Institute of Health and Welfare. (2020). National Drug Strategy Household Survey 2019; data table S.29. Retrieved from Canberra