Nitrous Oxide Sourcing, Use and Harms: Insights From Australians Who Use Ecstasy/MDMA and Other Illicit Stimulants.
Jodie Grigg, Simon Lenton, Amy Peacock, Jessamine Soderstrom, Cate King, Natalie Thomas, Rachel Sutherland
Drug and alcohol review November 1, 2025 DOI: 10.1111/dar.70032 via PubMed
Summary
From 2021 to 2023, Australians who regularly used ecstasy or other stimulants and also used nitrous oxide showed a rise in use of large cylinders (from 6% to 26%) and a rise in reported neurological symptoms (from 5% to 14%). Most respondents knew about brain or nerve damage risks, but only one in five identified vitamin B12 depletion as a risk, and 17% were unaware of any risks. One-third took no precautions. Sourcing from convenience stores and 24/7 delivery services was common and linked to heavier use. Fewer than five people received treatment for symptoms. The authors call for balanced regulation and education of retailers, clinicians, and consumers.
Study at a glance
| Characteristics | Cross-sectional survey Peer reviewed |
|---|---|
| Sample size | 978 |
| Population | Australians who regularly used ecstasy/MDMA and/or other illicit stimulants and reported past 6-month use of nitrous oxide |
| Keywords | Vitamin b12 deficiency Drug monitoring Harm reduction Neurologic symptoms Nitrous oxide |
| Key finding | Use of larger nitrous oxide cylinders and reports of neurological symptoms increased from 2021 to 2023, while awareness of vitamin B12 depletion risk remained low and few sought treatment. |
Abstract
Increasing harms associated with nitrous oxide use have raised concerns, but limited evidence exists to inform harm reduction. This study aimed to identify how nitrous oxide is sourced, the products/forms used, awareness of health risks, engagement in harm reduction and experience of neurological symptoms. Data were collected via annual interviews (2021-2023) with cross-sectional convenience samples of Australians who regularly used ecstasy/MDMA and/or other illicit stimulants and reported past 6-month use of nitrous oxide (2021 n = 379; 2022 n = 315; 2023 n = 284). The most commonly reported source of nitrous oxide in the past 6 months was convenience stores, followed by 24/7 delivery services. Sourcing from these retailers was also associated with heavier use. Reported use of larger cylinders (> 8 g) increased from 6% in 2021 to 26% in 2023. While most respondents demonstrated awareness of neurological risk (e.g., brain damage 63%; nerve damage 20%), only one-fifth identified the risk of Vitamin B12 depletion and 17% were unaware of any risks. Almost one-third (30%) reported limiting use per session, 36% limited frequency and 36% took no precautions. Reports of neurological symptoms rose from 5% in 2021 to 14% in 2023 among cross-sectional samples, with few (n ≤ 5) receiving treatment. Findings suggest increasing use of larger cylinders, alongside increasing neurological harms. Given the evolving regulatory and risk environment, close surveillance of usage and market trends is needed. The findings reinforce the need for balanced regulation and targeted education of retailers, clinicians and consumers to reduce harmful patterns of use and encourage early intervention.