Intended for healthcare professionals


Recreational use of nitrous oxide

BMJ 2022; 378 doi: (Published 27 September 2022) Cite this as: BMJ 2022;378:o2297
  1. Harry Sumnall, professor in substance use
  1. Public Health Institute, Liverpool John Moores University, Liverpool, UK
  1. h.sumnall{at}

Smart legislation, prevention, and harm reduction are required to reduce the risks

Nitrous oxide (N2O) has been used non-medically since the early 19th century, but only over the past 20 years has it become established in the recreational pharmacopeia.1 It is not regularly included in national substance use surveys, so assessing global prevalence of recreational use is difficult. In England and Wales, 9% of 16-24 year olds reported use in 2019-20, which makes N2O the second most popular controlled substance after cannabis.2 In Australia, N2O is grouped with other inhalants, and use by those older than 14 increased from 0.4% in 2001 to 1.7% in 2019.3 In the US, 4.5% of the population older than 12 reported in 2020 that they had used N2O at least once in their lifetime; this has been relatively stable over the past 20 years.4

N2O is typically consumed through inhalation from small balloons containing around 10 ml of gas. It produces short lasting euphoria and mild perceptual changes (lasting 0.5-1 minute). Occasional use is considered less harmful than for many other types of recreational substance,5 but there is a …

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