WA’s war on nangs

The WA Government will bring in the toughest regulations in the country to protect young people from the misuse of nitrous oxide gas, commonly known as nangs.

An amendment will be made to the Medicines and Poisons Regulations 2016 to ban the sale of nitrous oxide cannisters to consumers, amid growing concerns over misuse by young people. 

From the second half of this year, small 10-gram nitrous oxide cannisters will only be accessible to: 

  • registered food businesses; 
  • select businesses with a liquor licence; and 
  • other persons approved by the Department of Health. 

The amendment will also prohibit the sale of large nitrous oxide gas cannisters, but will not impact medical use of nitrous oxide, which is already heavily regulated under WA law. 

Buyers will need to show evidence of their registered food or beverage business when purchasing nitrous oxide gas cannisters, and suppliers will need to present evidence to authorities on request, to prove compliance with the new regulations. 

WA Health Minister Amber-Jade Sanderson said the government was listening to parents and clinicians and would do everything possible to protect young people from the dangers of nitrous oxide gas. 

“The changes strike a balance, allowing registered food and beverage businesses to purchase small amounts of nitrous oxide, while making it harder to purchase for recreational misuse,” she said. 

“Parents and community members have also raised significant concerns about the increase in used cannisters left littering our parks and playground.” 

Concerningly, the WA Poisons Information Centre identified an upward trend in community calls regarding nitrous oxide, with 50 calls in 2023, and in 2020 there were 22 presentations to WA EDs related to nitrous oxide – including eight patients with degeneration of the spinal cord. 

A review last year found that low costs and ready availability may play a role in nitrous oxide being the most used inhalant in adults, with research showing that even though the use of inhalants in general peaks around ages 13–14 years, the use of nitrous oxide is highest during early adulthood. 

Using a whipped cream dispenser or a simple opening device, users release aliquots of gas into a balloon, which is then used to deliver ‘hits’ of the drug by inhalation. 

Users experience euphoria, analgesia, and disinhibition and while the effects last only a few minutes, repeated use is common when sustained effects are desired. Unlike therapeutic use, in which nitrous oxide mixed with oxygen is delivered in a monitored setting, recreational use of pure nitrous oxide carries the risk of alveolar hypoxia, when users attempt to achieve and sustain concentrations needed to produce euphoria. 

Regular users commonly use dozens of cartridges daily, with case reports describing use of more than 500 cartridges per day. 

According to the review, the toxic effects of nitrous oxide result primarily from a functional deficiency of vitamin B12 (cobalamin) and are therefore chiefly neurologic and hematologic in nature. Other explanations for the neurotoxicity of nitrous oxide include N-methyl-D-aspartate (NMDA) antagonism, dysregulation of cytokines and growth factors that regulate myelin integrity, and hypoxia resulting from prolonged, heavy nitrous oxide use. 

Neurologic abnormalities are the most prominent features of chronic nitrous oxide exposure, with three well-described presentations: myelopathy, generally in the form of subacute combined degeneration of the cervical spine; a peripheral sensorimotor neuropathy that predominantly affects the motor nerves; and encephalopathy, which appears to be less common and is easily overlooked and often presents with new-onset psychiatric symptoms. 

Prognosis is variable, with most patients displaying at least partial improvement, but more than one-third of those admitted to hospital have residual neurologic symptoms even after months of treatment.