Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users
Sammie Back, Emese Kroon, Karis Colyer-Patel, Janna Cousijn
Addiction April 1, 2024 DOI: 10.1111/add.16380 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Qualitative Peer reviewed |
|---|---|
| Population | Nitrous oxide users |
| Measures | DSM-5 substance use disorder criteria |
| Topics | Addiction |
| Key findings | The authors report consistent evidence that heavy nitrous oxide users meet at least four DSM-5 substance use disorder criteria: using more than intended (46% to 98%), spending substantial time using, interpersonal problems (13% to 80%), and use in risky situations such as driving under the influence. Evidence for other criteria is insufficient or inconclusive. They argue N2O could well be addictive and should be treated as potentially addictive until systematic assessments provide evidence-based guidance. |
Abstract
AbstractBackgroundPrevalence of nitrous oxide (N2O) use appears to be increasing in numerous countries worldwide, and excessive use has been associated with physical and mental problems. Because there currently is no consensus whether N2O has addictive potential, we aimed to evaluate the evidence for the presence and prevalence of DSM‐5 substance use disorder (SUD) symptoms in N2O users.AnalysisA literature search was conducted to assess the evidence for the presence of any of the 11 DSM‐5 SUD symptoms in N2O users and the prevalence experiencing those symptoms. A substantial part of the studied N2O users use more than intended (i.e. 46% to 98%) and spend a substantial amount of time using N2O. At least some of the studied N2O users experience interpersonal problems (i.e. 13% to 80%) and use N2O in risky situations, such as driving under the influence. Evidence for the other criteria is either insufficient or inconclusive.ConclusionsThe literature base for the presence and prevalence of DSM‐5 substance use disorder (SUD) symptoms in nitrous oxide (N2O) users is limited and largely consists of qualitative studies and case studies, but it provides consistent evidence for the presence of at least four SUD criteria in heavy N2O users. N2O could well be addictive and should be treated as a potentially addictive substance until systematic assessments can provide evidence‐based guidance to users, healthcare professionals and legislators.
Comparable studies
Other systematic reviews and meta-analyses on addiction, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Ketamine use: a review Ketamine users | 2011 | Systematic review | |
| Mindfulness Meditation for Substance Use Disorders: A Systematic Review Individuals with substance use disorders | 2009 | Systematic review | |
| Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review | 2018 | Systematic review | |
| Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review | 2021 | Systematic review | |
| Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials Patients with psychiatric disorders, primarily alcoholism | 2020 | Systematic review | n = 567 |
Citations in the library
Cited by 9
- Rapid antidepressant potential of nitrous oxide: current state and major questions. Molecular Psychiatry June 1, 2026
- Recreational Nitrous Oxide Dosing and Administration and Its Use in Traffic: An Online Survey Journal of Drug Issues February 24, 2024
- Nitrous oxide for the treatment of depression: a systematic review and meta-analysis. EBioMedicine December 1, 2025
- The boon and bane of nitrous oxide. European Archives of Psychiatry and Clinical Neuroscience September 1, 2025
- Addressing the Global Challenge of Nitrous Oxide Misuse Through a Multidisciplinary Approach: Example of the PROTOSIDE Network Toxics May 31, 2025
and 4 more in the library
Cites 12
- Nitrous oxide-induced neurotoxicity: Clinical characteristics and impacts on overall neurological impairments Frontiers in Neurology February 23, 2023
- Nitrous oxide–induced reproductive risks: Should recreational nitrous oxide users worry? Journal of Psychopharmacology August 1, 2022
- Review article: Clinical manifestations and outcomes of chronic nitrous oxide misuse: A systematic review Emergency Medicine Australasia June 13, 2022
- Problematic Use of Nitrous Oxide by Young Moroccan-Dutch Adults. International Journal of Environmental Research and Public Health May 23, 2021
- Ketamine and nitrous oxide: The evolution of NMDA receptor antagonists as antidepressant agents. Journal of the Neurological Sciences May 15, 2020
and 7 more in the library