A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals.

Background: Nitrous oxide (NO) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of NO use is difficult to quantify but appears to be increasing. Research on NO harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people.

Methods: To identify publications reporting the recreational use of NO, a search of public health, psychology and social science databases was conducted. Databases included . Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of NO, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool.

Results: The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational NO use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of NO-related harms.

Conclusion: The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with NO use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for NO use which also includes further consultation and research with both groups. Future research could explore young people's experience of NO use including benefits and problems to inform contextually relevant harm reduction strategies.