Nangs in Australia: Investigating nitrous oxide use among people who regularly use MDMA and/or other illicit stimulants
Background: In response to increasing neurological harms associated with nitrous oxide use, multiple countries (including Australia) are considering, or have implemented, regulatory action to restrict non-therapeutic access. However, the need for caution (to avoid iatrogenic effects) and strategies beyond regulation is increasingly recognised. To help inform responses, this presentation investigates how nitrous oxide is being sourced, products being used, awareness of risks, protective behaviours, experience of early neurological symptoms, awareness/retention of new product warning statements, and difficulty accessing nitrous oxide post regulatory changes.
Methods: Data were collected annually in 2021-23 from samples of Australians who regularly used ecstasy/MDMA and/or other illicit stimulants (n=2182). Descriptive statistics were conducted, alongside binary and multinomial logistic regressions to investigate correlates of higher-risk patterns of nitrous oxide use (more frequent use; greater amounts used per session).
Results: In 2021-23, past six-month use of nitrous oxide was reported by 49%, 45%, and 40%, respectively. Across years, the most commonly reported source of nitrous oxide was corner stores, followed by 24/7 delivery services. The percentage reporting use of larger cylinders (>8g bulbs) increased from 6% in 2021 and 26% in 2023, while the percentage reporting persistent neurological symptoms post-use increased from 5% in 2021 to 14% in 2023. Sourcing via corner stores and delivery services was found to be associated with higher-risk patterns of use. Most identified at least one neurological risk (e.g. nerve damage), but only one-fifth identified risk of vitamin b12 depletion, and 17% were not aware of any risks. Almost one-third (30%) reported limiting amounts used per session, 36% limited frequency and 36% reported taking no precautions. In 2023, 28% reported seeing product warning statements, but few recalled warnings relating to nerve damage, while most (96%) who tried to purchase nitrous oxide in the past 6 months reported no difficulties.
Conclusions: There were indications of increasing use of larger cylinders, alongside increasing reports of early neurological symptoms. While the Therapeutic Goods Administration mandated changes only came into effect in October 2022, and additional regulatory measures are still being initiated across Australia, the vast majority reported no difficulties accessing nitrous oxide, while a minority recalled product warnings. These findings have implications for additional education measures directed at consumers, clinicians, and retailers, addressing both mechanisms of harm and early neurological symptoms. They also highlight the need for balanced regulatory controls on availability, which consider the recent flooding of larger cylinders into the market, linked with increasing harm. Finally, given the shifting regulatory/risk environment, ongoing surveillance of use and market trends is warranted.
