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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 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
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
Duration 2021-2023
Topics MDMA
Keywords Vitamin b12 deficiency Drug monitoring Harm reduction Neurologic symptoms Nitrous oxide
Key findings 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.

Comparable studies

Other cross-sectional and survey studies on MDMA, most cited first.

Study Year Design Participants
Recreational MDMA use in Sydney: a profile of ‘Ecstasy’ users and their experiences with the drug Recreational Ecstasy users recruited via snowball peer network 1992 Cross-sectional survey n = 100
Reducedin vivobinding to the serotonin transporter in the cerebral cortex of MDMA (‘ecstasy’) users Male regular ecstasy users and well-matched controls 1999 Cross-sectional association study n = 20
Patterns of simultaneous polysubstance use in drug using university students Drug-using university students 2006 Cross-sectional survey n = 149
Patterns of recreational drug use at dance events in Edinburgh, Scotland Drug users at dance events in Edinburgh, Scotland, UK, aged 16-47, 80% between 18 and... 2001 Cross-sectional survey n = 122
Acute, sub‐acute and long‐term subjective consequences of ‘ecstasy’ (MDMA) consumption in 430 regular users Regular MDMA users 2003 Cross-sectional study n = 466

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