Has there been an increase in nitrous oxide use and associated harms in Australia? An analysis of triangulated data sources, 2003-2020

Rachel Sutherland; Nicola Man; Jared Brown; Rose Cairns; Jacques Raubenheimer; Jodie Grigg; Andrew Dawson; Nazila Jamshidi; Amy Peacock

doi:10.1016/j.drugpo.2023.104178

Has there been an increase in nitrous oxide use and associated harms in Australia? An analysis of triangulated data sources, 2003-2020

Int J Drug Policy. 2023 Nov:121:104178. doi: 10.1016/j.drugpo.2023.104178. Epub 2023 Sep 28.

Authors

Rachel Sutherland¹, Nicola Man², Jared Brown³, Rose Cairns³, Jacques Raubenheimer⁴, Jodie Grigg⁵, Andrew Dawson⁶, Nazila Jamshidi⁷, Amy Peacock⁸

Affiliations

¹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. Electronic address: rachels@unsw.edu.au.
² National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
³ School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia.
⁴ The University of Sydney, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia.
⁵ National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia.
⁶ School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia; Drug Health Services, Sydney Local Health District, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia.
⁷ The University of Sydney, Sydney, Australia; Drug Health Services, Sydney Local Health District, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia.
⁸ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia.

PMID: 37776604
DOI: 10.1016/j.drugpo.2023.104178

Abstract

Background: There is growing concern, globally, regarding use of nitrous oxide (N₂O) for intoxication purposes. This paper aims to examine trends in: (i) past six month N₂O use among a sample of people who use regularly use ecstasy and/or other illicit stimulants (2003-2020); (ii) volume of N₂O-related Google searches and social media posts (2009-2020); and (iii) N₂O-related calls to Poisons Information Centres (PIC) (2004-2020).

Methods: Data were obtained from annual interviews with sentinel samples of Australians aged ≥16 years who used ecstasy and/or other illicit stimulants ≥monthly and resided in a capital city (∼800 each year); Google search activity; social media posts; and exposure calls to four PIC.

Results: Among samples of people who regularly use ecstasy and/or other illicit stimulants, past six-month N₂O use increased 10% each year from 2009 to 2020, with the sharpest increase observed between 2015 and 2018 (25.4% p/year; 95% CI: 14.6-37.1). Frequency and quantity of N₂O use remained stable and low. Google search probabilities increased by 1.8% each month from January 2009 and December 2019 (95% CI: 1.5-2.2), with the sharpest increase observed between July 2016 to December 2017 (6.0% p/month; 95% CI: 4.4-7.5). Social media posts increased 2.0% per month from January 2009 and December 2019 (95% CI: 1.1-3.0), with the sharpest increase observed between March and October 2017 (19.2% p/month; 95% CI: 1.7-39.7). The number of N₂O-related calls to Australian PIC increased sixfold between 2016 (16) and 2020 (111).

Conclusions: Triangulation of various data sources indicate significant shifts in N₂O use and harms in Australia. This includes increases in use, Google searches and social media posts, although these have plateaued in recent years, coupled with increased rates of harm. These findings correspond with evidence of a global increase in N₂O use and harm, highlighting the need for education of both people who use N₂O and health professionals.

Keywords: Google trends; Nangs; Nitrous oxide; Poisonings; Social media; harms.

MeSH terms

Australia / epidemiology
Central Nervous System Stimulants*
Humans
Information Sources
N-Methyl-3,4-methylenedioxyamphetamine*
Nitrous Oxide / adverse effects

Substances

Nitrous Oxide
Central Nervous System Stimulants
N-Methyl-3,4-methylenedioxyamphetamine