Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users

Background: Prevalence of nitrous oxide (N₂O) use appears to be increasing in numerous countries worldwide, and excessive use has been associated with physical and mental problems. Because there currently is no consensus whether N₂O has addictive potential, we aimed to evaluate the evidence for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in N₂O users.
Analysis: A literature search was conducted to assess the evidence for the presence of any of the 11 DSM-5 SUD symptoms in N₂O users and the prevalence experiencing those symptoms. A substantial part of the studied N 2 O users use more than intended (i.e. 46% to 98%) and spend a substantial amount of time using N 2 O. At least some of the studied N₂O users experience interpersonal problems (i.e. 13% to 80%) and use N2O in risky situations, such as driving under the influence. Evidence for the other criteria is either insufficient or inconclusive. Conclusions: The literature base for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in nitrous oxide (N₂O) users is limited and largely consists of qualitative studies and case studies, but it provides consistent evidence for the presence of at least four SUD criteria in heavy N₂O users. N₂O could well be addictive and should be treated as a potentially addictive substance until systematic assessments can provide evidence-based guidance to users, healthcare professionals and legislators.