Nitrous Oxide Harm Reduction

First written: 2021-04
Last nontrivial update: 2021-08
Author: Andromeda ✨

Note: because little research has been conducted on the recreational consumption of nitrous oxide, a lot of the information contained on this page comes from educated guesses about what practices are more or less safe. If you think I’ve missed anything out or got something wrong, please contact me via the homepage submission form and let me know your reasoning. I care a lot about harm reduction and want this page to be as comprehensive as possible!

Equipment

I strongly discourage the use of nitrous crackers. Not only are they more cumbersome to operate, they also drastically increase many of the risks associated with recreational nitrous oxide consumption. For example, nitrous crackers can easily cause frostbite when handled incorrectly, they are less durable and more prone to malfunction, and are more difficult to modify for harm reduction purposes. Instead, buy a food-grade whipped cream dispenser with a metal body and plastic accessories (i.e., nozzle and charger holder). While this is the more expensive option, it is considerably safer – especially while inebriated – and will last a lot longer if you look after it, so don’t skimp out. Remember: you’re handling a highly-compressed gas that has the potential to inflict serious injury if something goes wrong.

When deciding which nitrous dispenser to purchase, be sure to read product reviews for quality assurance, and avoid products that come with metal accessories (even if they seem the most ‘premium’). This is important due to the build-up of metallic dust resulting from friction where they screw onto the head of the cannister – choose a product with plastic accessories instead. Over time, the plastic charger holder will begin to deteriorate due to constant pressure changes and friction from rubbing against the metal threading on the head of the cannister. This is normal wear and tear, but keep an eye out for possible cracks that might form inside the charger holder or plastic threads that stick out. If you notice signs of damage, its easy and cheap to replace the component. Continuing to use a damaged cannister can cause an explosion resulting in serious injury or death, so it is better to be safe than sorry.

It is important to note that nitrous oxide chargers often contain small amounts of industrial lubricant that might be unsafe to inhale. This is usually not present in nitrous oxide produced for medicinal purposes (e.g., what you’d receive at the dentists), but since most chargers are considered ‘food-grade’ (i.e., intended for whipping cream) their quality can vary between different manufacturers. While I cannot find any reports of harm being caused from inhaling this lubricant, its probably not good for you, so here are a few things you can do to minimize risk:

Place a few folded squares of paper towel inside the cannister body (you may have to cut it down to fit), replacing them and cleaning the cannister’s interior with soapy water every 50-100 chargers consumed. Make sure that the paper is thick enough not to get pulled through the nozzle when discharging the gas into a balloon.
Wrap a layer of cotton (e.g., cheese cloth) around the nozzle of your nitrous dispenser to filter out any excess lubricant present in the gas, using rubber bands to hold it in place (see 1 and 2 for instructions on this).
Upon discharging the gas, leave the balloon for a minimum of 10 seconds so that any excess lubricant coats the inside of the balloon, and also so that the gas has a change to warm up to room temperature.
If possible, purchase higher quality chargers that are reported to contain smaller concentrations of this lubricant.

You can also purchase helium-grade balloons which are more elastic and therefore less likely to pop. While this does not appear to have any direct benefits in terms of harm reduction, it probably reduces plastic waste given that you can reuse them on multiple occasions.

Dispensing Technique

When operating a nitrous oxide canister, NEVER inhale directly from its nozzle, ALWAYS use a balloon or some other inflatable container (e.g., a condom) to dispense the gas. This is extremely important because of the physical conditions of the captured gas (e.g., highly-pressurized and extremely cold) and the fact that nitrous oxide is often used recreationally in conjunction with other substances (meaning that the user is often already inebriated and has reduced bodily autonomy). Failure to depressurize the gas before inhalation risks the following:

Over-inflating your lungs due to the difference in pressure between your lungs and the cannister.
Puncturing your lungs due to the presence of metal shards / dust from puncturing the charger.
Frostbite on your mouth and throat due to the cold temperature of the pressurized gas. In the worst case scenario this could obstruct regular breathing and cause death.

When cracking a charger, hold the cannister with the charger holder facing AWAY from yourself or others around you (e.g., face the charger holder toward the ceiling). This is important in case the plastic threading of the charger holder breaks and the bulb becomes a live projectile. Additionally, before you puncture the charger, wrap a piece of fabric (e.g., a blanket) around the canister in order to prevent accidental frostbite to your hands or legs. Be aware that due to the anesthetic properties of nitrous oxide, you might have harmed yourself without realizing it. If you think you’ve gotten frostbite, seek medical attention immediately.

NEVER – I repeat NEVER – inhale nitrous oxide from a device that dispenses a continuous supply of it, or otherwise inhibits your ability to breath in regular air (e.g., use of a mask strapped to your face). You will very quickly lose consciousness and are at serious risk of developing hypoxia or even death.

Environment

Before consuming nitrous oxide, make sure that you are sitting / laying in a place where it is safe for you to lose consciousness. Make sure you scan your environment for potential hazards that you might encounter during your trip (e.g., sharp objects, gaps in furniture). While it is possible to do nitrous standing up, I do not recommend it for the reason that it is easy to lose control of your body, fall over, and hit your head.

If you are doing nitrous oxide indoors, make sure that you have at least one source of ventilation to help replenish the air in the room. This point is especially important if you are doing nitrous oxide in a smaller room or a car as each balloon you inflate displaces regular oxygen-rich air from your environment, reducing the rate at which you can absorb oxygen into your bloodstream from regular breathing. It is a good idea to leave your windows open overnight with a fan on in order to completely remove any amount of the gas that might be lingering in the air – especially if you share a living space with others, as breathing in even a small amount of nitrous oxide is sufficient to prevent one from absorbing B12 within their diet for up to four days (see ‘Managing B12’ for more information). Be considerate!

Breathing Technique

“In the last 300 years we’ve discovered how to purify gases which our bodies can’t detect. When we inhale a lungful, the CO2 in our blood diffuses out and is exhaled, and the gas diffuses into our blood to replace it because the lungs can’t tell it’s not oxygen. This means that the body thinks the air quality is great because CO2 is being removed at a normal rate, but there is no oxygen coming in and the brain has no idea. Lack of oxygen to the brain rapidly becomes dangerous as it begins to trigger self destruction of cells. Once or twice this is not noticeable on the outside, but over time this can cause serious nerve damage and noticeable cognitive decline.”/u/borax, ‘Why nitrous might be the most damaging drug you use’

Hopefully this pasted comment alerts you to the real dangers of breathing in a pure gas such as nitrous oxide without taking adequate precautions. While the brain can survive in low-oxygen environments for some time, the real danger here is that you’re inhaling a pure gas for which your body has not evolved an autonomic response regulate its breathing to maintain homeostasis. A few minutes might not seem like much time – especially when some people can hold their breath underwater for several minutes – but it is important to remember that one inhales air into their lungs before attempting to hold their breath whereas they exhale air from their lungs before consuming a balloon of nitrous oxide. To demonstrate the important difference between these two practices, see how long you can hold your breath with and without a lungful of air. It’s a lot more difficult without any oxygen in your lungs!

This point is extremely important and cannot be overstated: just because you might not feel the need to breathe when consuming nitrous oxide, this does not mean that you are not at risk from developing hypoxia (i.e., cell death resulting from oxygen deprivation), which is classified as “a central factor in brain aging and the development of age-related neurological diseases”. Additionally, because the deleterious effects of mild cerebral hypoxia on cognition are nonobvious, it might take years before you notice that you have suffered harm from unsafe practices. These risks increase substantially from repeated exposure to hypoxic conditions within a short time period, such as the common practice of ‘chaining’ nitrous oxide balloons (i.e., inhaling multiple balloons consecutively without taking breaks in-between).

Anecdotally, some 80% of nitrous oxide users ‘rebreathe’ from the same balloon in order to avoid wasting the drug and induce stronger subjective effects. This is an incredibly dangerous practice given that during the ‘peak’ of the experience it is common to lose conscious control of one’s body, so if you are rebreathing on the ‘come up’ you might be deprived of oxygen for many minutes until the drug wears off. On its own, cerebral hypoxia can induce feelings of euphoria and well-being, which might explain why some people report that rebreathing gives them stronger subjective effects. Additionally, your lungs absorb most of the nitrous oxide you inhale on your first breath, so it is also inefficient. To account for this risk, I would recommend taking the following precautions:

Instead of rebreathing from the same balloon, take one deep breath of nitrous oxide and hold it for around 10-15 seconds (no longer than 20 seconds).
After exhaling the contents of your lungs, remember to take in a few deep breaths of air to reoxygenate your body.
Avoid hyperventilating before inhaling nitrous oxide as this will increase your heart rate, increasing the rate at which your body uses up the levels of oxygen stored in your blood, reducing the period of time before you run out of oxygen and develop hypoxia.
Aim to spent at least 5-10 minutes breathing regular air in-between nitrous oxide balloons – don’t chain them!
When doing double balloons (i.e., two chargers dispensed into a single balloon), take a deep breath of nitrous oxide, hold, exhale, and then take a few deep breaths of regular air before inhaling what is left in the balloon.
Don’t do triples or higher (i.e., more than two chargers dispensed into a single balloon) as this drastically increases your chances of forgetting to breath regular air and developing hypoxia.
Avoid using nitrous oxide consecutively for more than a few hours at a time, roughly equivalent to a maximum of 30-50 chargers per night.
(optional) Blow a small amount of air into each balloon before you inhale it. In principle this should increase the concentration of carbon dioxide within your blood to help ‘trigger’ your body’s autonomic (reflexive) breathing response. If are having a really intense experience and consciously forget to breath, it is a good idea to put your body in a state where it is more likely to instantiate this process on its own accord.

Managing B12

Chronic exposure to nitrous oxide can cause serious (sometimes life-threatening) harm because of how it interferes with your body’s natural metabolism of B12, which is an important vitamin required for the normal functioning of your nervous and circulatory system. Common sources of B12 include animal products, fortified foods, and vitamin supplements. Because of its importance in maintaining homeostasis, most animals have evolved to store large quantities of B12 within their body – mainly in the liver – to avoid becoming deficient. However, through oxidation of the cobolt ion in B12, nitrous oxide renders the vitamin inactive within the body and effectively prevents its dietary absorption for up to four days post-use, causing serious health risks when consumed frequently. This applies to both recreational users and their flatmates, in addition to dentists, anaesthetists, and anybody else who is regularly exposed to the drug. While the exact mechanism through which nitrous oxide interferes with B12 metabolism is unclear, current research suggests the involvement of multiple different pathways which I attempt to summarise in the following paragraph:

B12 is used as a co-factor for an enzyme called methionine synthase, which is essential for the synthesis of DNA and regulation of blood vessels. However, due to the inactivation of B12, exposure to nitrous oxide inhibits this process for up to four days. This also inhibits the production of myelin proteins and the stabilization of myelin sheaths which form a protective layer around nerve cells (e.g., neurons in the brain and nerve fibers in the spinal cord) causing a wide array of serious health effects, such as agranulocytosis, bone marrow suppression, psychosis, subacute combined degeneration of the spinal cord, myeloneuropathy, polyneuropathy, and peripheral neuropathy. It is important to note that exposure to nitrous oxide affects functional concentrations of B12 within the body, which is not always reflected by quantitative measurements (e.g., blood tests). Additionally, while the frequency of exposure to nitrous oxide is probably the most important variable in determining safe usage, the extent to which it inactivates B12 within the body is likely to be dose-dependent.

To minimize risk, I strongly recommend the taking the following precautions:

Regular oral supplementation of vitamin B12 around 4 days after consuming nitrous oxide – preferably methylcobalamin, the specific form of B12 required for methionine synthase.
Unless you are receiving an injection, aim to take small doses of B12 frequently rather than large doses infrequently.
If you are regularly supplementing B12, wait at least 3-6 weeks in-between nitrous oxide exposure events so that your body has sufficient time to replenish its stores. Double this time if you are not supplementing B12.
If practical, open disclosure of nitrous oxide consumption to your doctor (or equivalent medical professional) for more accurate monitoring of functional B12 levels.
As noted in the previous section, avoid consuming any more than 30-50 chargers per exposure event.