Rise of supersized ‘nangs’ linked to deaths, paralysis and brain injuries

A spate of deaths has been linked to nitrous oxide use as rising numbers of Victorians suffer permanent spinal and neurological injuries after inhaling the gas from supersized canisters.

Doctors across Melbourne warn rampant recreational use of the substance, inhaled from metal canisters known as “nangs”, has triggered a sharp rise in emergency department cases and led to devastating consequences including paralysis, severe burns and life-threatening complications.

New Coroner’s Court data also reveals a cluster of accidental deaths linked to nitrous oxide, including five people who died last year.

The data also showed a rise in deaths following increased use in 2020 during the coronavirus pandemic. To date, there have been 16 deaths linked to nitrous oxide between 2020 and 2025, following coronial investigations, compared with just four in the preceding two decades.

Dr Brendan Morrissey, deputy director of emergency medicine at St Vincent’s Hospital in Melbourne, said he had treated young people who had arrived in cardiac arrest after inhaling the gas, while others were being left with irreversible brain and spinal damage and loss of bodily function including incontinence.

“We’re definitely seeing a significant increase in presentations with complications from nitrous oxide use,” Morrissey said.

“We’ve had tragic cases. It really sets off a chain of events. People are getting permanent neurological changes and permanent loss of lower limb function. This is irreversible nerve damage, where they can’t feel their legs or walk because of it.”

Nitrous oxide, commonly known as laughing gas, is a short-acting anaesthetic and analgesic which has been used for sedation in medical settings for more than 180 years.

Recreational use has soared around Australia due to its low cost and accessibility.

In Victoria, sale of nitrous oxide for culinary or medical purposes is legal. However, it is illegal to sell or supply it if the retailer knows or has reasonable cause to believe the buyer intends to inhale it.

But the substance remains readily available at some convenience stores. Advertisements online show large canisters marketed as “cream chargers filled with certified pure nitrous oxide” available for fast, doorstep delivery. Online shops are also selling supersized canisters, containing more than three litres of the gas, with names like “SupremeMax tank”.

Morrissey said doctors were also treating increasing numbers of people who had burns after inhaling the gas from oversized metal canisters.

“They are coming into the hospital with horrible burns. It is like freeze burn on their lips, fingers, their nose, in their airways,” he said. “They can end up with nasty burns to their inner thighs as well.”

Royal Melbourne Hospital’s director of emergency medicine, Dr Mark Putland, has also observed the worrying trend.

“The consequences are catastrophic,” he said. “It has become a huge problem. It is causing permanent spinal damage, brain damage, psychosis. People are becoming paraplegic because of it.”

Putland said while people going to hospital because of nitrous oxide use were once overwhelmingly university students, often from overseas, healthcare workers were now seeing people of all ages.

“We’re seeing everybody, the 50-year-old Anglo blokes to young, really young people,” he said. “People are using vast amounts of it. They are buying five-litre tanks of the stuff. These are industrial-sized tanks.”

Putland said a growing number of the people who were being harmed or overdosing appeared to be in the grips of addiction.

‘The consequences are catastrophic. It has become a huge problem. People are becoming paraplegic because of it.’

Royal Melbourne Hospital director of emergency medicine Dr Mark Putland

“It can be a really addictive drug, and it’s a really tragic thing to see someone who has just lost their way,” he said.

Nitrous oxide can cause severe vitamin B12 deficiency by altering and inactivating the crucial vitamin within the body. Heavy use of the gas can also destroy the protective coating around nerves, causing muscle weakness, loss of balance, walking difficulties and permanent paralysis.

Morrissey said people were arriving at hospital with a broad range of symptoms from nausea and vomiting to limb weakness, tingling in their hands and feet and serious psychiatric issues such as psychosis and sensory hallucinations.

“The problem is that you can now get it in massive amounts and people are taking huge amounts consistently to maintain that high, so they are running into complications much more quickly,” Morrissey said.

He said that five years ago there were relatively few hospital cases related to nitrous oxide abuse, but now they had become routine.

“It’s cheap, very available, and in vogue,” he said. “I worry that because it is used in medicine and commercially, it is so readily available people don’t appreciate the terrible risks of it.”

Dr Jacqueline Maplesden, a St Vincent’s Hospital emergency physician with a special interest in toxicology, said many of the complications caused by nitrous oxide were reversible if treated early.

She said treatment typically involved Vitamin B12 supplementation, which included high-dose oral or intramuscular injections of the vitamin to rapidly correct the deficiency caused by inhaling nitrous oxide.

“It often involves injections over a long period of time,” she said.

Some people required intensive rehabilitation and had to relearn how to walk.

Maplesden said many people had shifted from using small “nangs” with about eight grams of nitrous oxide, such as those used as an aerosol propellant to whip cream, to larger canisters containing up to 200 times that amount of gas in them.

Maplesden said that in medical settings, nitrous oxide was always mixed with oxygen to prevent hypoxia (low oxygen).

However, commercial-sized canisters contain no oxygen, so when they are inhaled in an enclosed space people are at heightened risk of asphyxiating and seizures.

“People need to know about the potential harm and the complications from using this agent and the importance of seeking help early,” she said.

Morrissey said emergency doctors across Melbourne were gathering data on the rise in hospital cases and on patients’ symptoms.

“Every hospital is experiencing the same thing,” he said. “We are all getting our heads around understanding early treatment and early screening for it.”

Pennington Institute chief executive John Ryan said tighter regulation and a national campaign warning Australians of the dangers of nitrous oxide were urgently needed.

“The deaths linked to nitrous oxide are just the tip of the iceberg,” Ryan said. “The permanent harm it is causing is mind-boggling. This really is a new frontier of harm from substances, and it is readily available, and people don’t realise how dangerous it is.”

In her findings over the death of a 26-year-old man who died by suffocation after using a mask to inhale nitrous oxide in his home alone in 2023, Victorian Coroner Audrey Jamieson said last year that the growing number of unintended deaths linked to the gas was particularly concerning.

In 2021, Australia’s medicines watchdog, the Therapeutic Goods Administration, decided the risks of nitrous oxide could be managed through warning-based controls, despite calls for the substance to be deemed a Schedule 10 poison. Schedule 10 poison classifications are given to substances identified as a danger to human health, meaning sale, supply and use are generally prohibited.

But the TGA said such a classification would be disproportionate given the substance’s legitimate uses.

A TGA spokesman said the watchdog was now working with states and territories on potential responses to the risks associated with the misuse of nitrous oxide.

“The TGA continues to monitor nitrous oxide misuse,” he said. ” Of particular concern is the increased availability of large single-use canisters since the original scheduling decision was made.”

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