Nitrous oxide, frequently referred to as “nangs,” has triggered a surge in emergency hospitalizations across Victoria, with medical professionals reporting a rise in permanent spinal injuries, neurological damage, and accidental deaths. Between 2020 and 2025, coronial investigations linked 16 deaths to the gas, a sharp increase compared to only four deaths recorded over the preceding two decades.
Why Is Nitrous Oxide Causing Permanent Neurological Damage?
Recreational inhalation of nitrous oxide causes severe, functional Vitamin B12 deficiency by chemically inactivating the vitamin within the body. According to Dr. Brendan Morrissey, deputy director of emergency medicine at St Vincent’s Hospital in Melbourne, this process destroys the protective coating around nerves. The clinical result is often irreversible, leaving patients with permanent loss of lower limb function, incontinence, and an inability to walk.
Dr. Mark Putland, director of emergency medicine at Royal Melbourne Hospital, notes that the consequences are “catastrophic,” ranging from paraplegia to psychosis and brain damage. Beyond neurological harm, patients are increasingly presenting with severe “freeze burns” on their lips, fingers, and airways caused by the gas being released from pressurized metal canisters.
Unlike medical-grade nitrous oxide, which is always mixed with oxygen to prevent hypoxia, commercial-grade canisters contain no oxygen. Inhaling the gas in an enclosed space significantly increases the risk of asphyxiation and seizures.
How Have Consumption Patterns Changed?
The nature of nitrous oxide misuse has shifted significantly in recent years. Dr. Jacqueline Maplesden, an emergency physician at St Vincent’s Hospital, explains that users have moved from small eight-gram “nangs” to industrial-sized canisters containing up to 200 times that amount of gas.
While hospital presentations were once primarily confined to university students, doctors now report that people of all ages are seeking treatment, including teenagers and adults in their 30s and 50s. Dr. Putland observed that many of these individuals appear to be struggling with addiction, often purchasing five-litre tanks to maintain a consistent high, which accelerates the onset of severe health complications.
What Are the Regulatory Challenges?
While selling nitrous oxide for culinary or medical purposes remains legal in Victoria, it is illegal to supply the gas if a retailer believes the purchaser intends to inhale it. Despite this, the substance remains readily available at convenience stores and through online retailers offering doorstep delivery of large-capacity tanks.
In 2021, the Therapeutic Goods Administration (TGA) opted against classifying nitrous oxide as a Schedule 10 poison—which would have prohibited its sale and use—arguing such a move would be disproportionate to its legitimate uses. However, a TGA spokesman stated the agency is currently working with state and territory governments to address the risks posed by the increased availability of large, single-use canisters.
John Ryan, chief executive of the Pennington Institute, argues that current regulations are insufficient. He describes the 16 deaths linked to the gas as “the tip of the iceberg” and has called for a national campaign to warn the public about the dangers of the substance.
Frequently Asked Questions
- Are the neurological injuries caused by nitrous oxide reversible?
Many complications are reversible if caught and treated early. Dr. Jacqueline Maplesden notes that treatment typically involves high-dose Vitamin B12 supplementation, though some patients require intensive rehabilitation to relearn basic motor functions. - Why is the death rate increasing?
Coronial data indicates a spike in deaths following the 2020 pandemic. Experts attribute this to the increased availability of large, industrial-sized canisters and the tendency for users to inhale larger quantities more frequently, leading to faster health deterioration. - Is it illegal to buy nitrous oxide in Victoria?
It is legal to purchase the gas for legitimate culinary or medical purposes. However, it is unlawful for a retailer to sell or supply it if they have reasonable cause to believe the buyer intends to inhale it.
Have you or someone you know been affected by the misuse of substances? For support, contact your local health service or speak with a medical professional. Stay informed by subscribing to our newsletter for the latest updates on public health trends.
