Nitrous oxide, commonly known as ‘laughing gas’ is a colourless gas administered by inhalation. It has been used as an anaesthetic particularly in obstetric and dental settings since the 18th century, and it is also used in the catering industry as a propellant to whip cream.
Nitrous oxide is not currently a controlled substance under Ireland’s Misuse of Drugs Act (1977) and can be legally sold for catering, medical and industrial purposes. The Criminal Justice (Psychoactive Substances) Act 2010 prohibits the sale, importation, or exportation of psychoactive substances and under this legislation it is illegal to sell nitrous oxide for its psychoactive properties. However, the canisters are easily accessible for purchase, with no requirement to show any proof of legitimate reason. Marketing of these cannisters targets young adults and adolescents with fruit flavours such as apple, banana, grape and strawberry and with colourful packaging mimicking the strategies used with vapes.
Nitrous oxide comes in two main sizes: the smaller cartridges known colloquially as ‘whippets’ contain 8g of nitrous oxide; and the larger canisters can range from 1.2kg to 2kg of the gas in a pressurised container. By way of comparison, one kilogram of nitrous oxide is the approximate amount used in a normal labour and would be enough to whip over 60 litres of cream. Recreational users typically inflate a balloon from the cannister and inhale this directly. This is in contrast to controlled use in anaesthesia where nitrous oxide is administered as a 50 per cent mix with air.
Easy availability and low cost have led to a perception of low risk of harm from the short-lived desired effects of laughter, euphoria, relaxation, and distorted perception. However, along with these short-lived effects comes a range of acute and chronic adverse effects. The acute adverse effects range from hypoxia, frostbite injury (as the highly pressurised container releases the gas it becomes extremely cold) and pneumothorax. The chronic adverse effects range from peripheral neuropathy, anaemia, thrombosis, rashes and neuropsychiatric problems. These effects depend on how much nitrous oxide was inhaled and under what conditions the nitrous oxide is inhaled.
More specific research conducted by the neurology department of Beaumont Hospital highlighted increased detection of spinal cord damage from the recreational use of nitrous oxide, and the demographics of the patients were similar to those from the national study, including the finding that the problem appears to be becoming more frequent. Finally, the recently updated bulletin from the National Drug Treatment Reporting System (NDTRS) on cases of treated problem drug use in Ireland has highlighted a rapid increase in the number of people seeking treatment for abuse of volatile inhalants since 2021. Specifically, 66 people commenced treatment for problem use of nitrous oxide in 2025. More than half were aged 17 years or under. The majority of this group reported using it alongside other drugs.
It remains to be seen how this increase in use will impact future patterns of recreational drug use, and nitrous oxide could potentially be a starting point for some users who subsequently use it concurrently with other substances. Figures seem to indicate that there are a number of people seeking treatment for polysubstance misuse, including nitrous oxide, although currently the overall numbers are low.
Image 1: HSE information leaflet
Source: drugs.ie
Nitrous oxide canisters discarded in public spaces and the waste associated with the use of nitrous oxide (such as balloons) are a visible indicator of the growing use of the drug. A recent cross-sectional study carried out by ATU with the assistance of voluntary Tidy Towns committees provided an insight into the patterns of use across the country. All groups who responded reported finding nitrous oxide related litter. This highlights the penetration of recreational use of the drug through urban and rural areas in Ireland, although litter was more likely to be found in urban areas. Our research also highlighted a shift in usage patterns as the majority of the waste consisted of large cannisters rather than the small cartridges. The most common location that nitrous oxide-related litter was found was streets and footpaths, followed by parks especially in urban areas. These findings indicate that nitrous oxide is being used openly in urban areas.
Images 2 and 3: Nitrous oxide canisters
Nitrous oxide is a potent contributor to greenhouse gas emissions, trapping 273 times more heat in the atmosphere than carbon dioxide. It has an atmospheric life of 109 years. It has been estimated that over 90 per cent of nitrous oxide purchased by healthcare facilities may not reach patients due to be lost via leaks and wastage. The College of Anaesthesiologists of Ireland is supporting the transition to reduce the use of nitrous oxide and introduce solutions that reduce leakage. There is also pressure on the catering industry to find alternative gases for whipping cream.
There is currently a lack of clear guidance available to the public on the correct way to deal with nitrous oxide waste. It has been estimated that ‘empty’ cannisters may contain up to 10-15 per cent of the original amount of nitrous oxide, and they need to be emptied in a specialised facility prior to recycling of the metal cannister. In Ireland, damage to waste management infrastructure caused by exploding canisters has resulted in repair costs of up to €30,000 per incident and the possibility of serious injuries to staff. The increase in such incidents in recent years is another marker of the increasing recreational use of large cannisters of nitrous oxide. There have been calls for safety features on the canisters such as a pressure relief valve to prevent explosions during waste processing and a requirement that the canisters to be included in the extended producer responsibility (EPR) schemes, which would require manufacturers of the canisters to fund their collection, recycling and safe disposal, as well as a deposit and return system to ensure the safe returns of the canisters in a separate controlled stream. However, the majority of cannisters being used recreationally are being entering Ireland through unregulated channels so these changes are unlikely to be enforceable.
In the United Kingdom, dedicated nitrous oxide waste collection bins have been introduced, allowing canisters to be processed safely by waste management companies In Ireland, Veolia has established Ireland’s first treatment facility for nitrous oxide canisters; however, information to the public on how to dispose of these canisters correctly remains limited. The improvement in disposal of single use vapes demonstrates that improvements can be made in waste management through structured approaches and a similar approach would be beneficial regarding nitrous oxide waste disposal.
It is clear that recreational use of nitrous oxide has increased substantially in years, particularly since the pandemic. Users are predominantly male teenagers. The legitimate use of nitrous oxide in medical and catering settings has made legislating to control availability challenging. The deliberate marketing towards young people has led to an impression of lack of harm from the drug however evidence of problem use and neurological damage is accumulating. It is important for community pharmacists to familiarise themselves with harm reduction supports and resources available in their area. Further information can be found at drugs.ie > Resources > Factsheets and posters. This site carries a range of factsheets on different drug types, including nitrous oxide.
Indirect evidence from litter collection highlights that use is increasing, spreading to rural areas and the quantity being inhaled by individual users is higher. This is borne out by estimates of neurological harms seen in research in medical settings. The long-term sequelae of the widespread use of volatile inhalants by teenagers on patterns of illicit drug use in adulthood remains to be seen. The efforts being made by catering and medical users of nitrous oxide to reduce legitimate nitrous oxide use are to be welcomed, however updated legislation which reflects the harms of nitrous oxide is required. Incorrect disposal of nitrous oxide cannisters is a significant hazard for our waste management streams.
References available on request.
Note on the authors: Áine Dalton is an undergraduate student in the Department of Life Sciences and Patricia Ging is a lecturer in the Department of Pharmacy and Pharmaceutical Sciences, Atlantic Technological University Sligo.
Áine Dalton, undergraduate student at the Department of Life Science; and Patricia Ging MPSI, Department of Pharmacy and Pharmaceutical Sciences; both of Atlantic Technological University, Sligo
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