Nitrous oxide is both a long-lived greenhouse gas and a substance used in medicine, industry, and recreation. The figures below show its climate significance, market scale, reported use, and documented harm indicators, with the measurement period and geography kept explicit.
Contents
- Climate and emissions
- Market and industrial use
- How common is use?
- Age, sex, and student patterns
- Patterns of repeated use and disorder
- Deaths, poisonings, and clinical signals
Climate and emissions
The EPA nitrous oxide emissions page reports that nitrous oxide represented 6% of all United States greenhouse gas emissions from human activities in 2022. Across the country, total nitrous oxide emissions were 3% lower in 2022 than in 1990. That overall change conceals major differences by source: emissions from mobile combustion fell 56% over the same period, while agricultural soils were about the same in 2022 as in 1990.
Nitrous oxide is persistent in the atmosphere. The EPA gives an atmospheric lifetime of 114 years and also says molecules remain for an average of 121 years before removal. One pound of nitrous oxide has 265 times the warming impact of one pound of carbon dioxide over a 100-year period. Globally, 40% of total nitrous oxide emissions come from human activities.
The EPA’s 2024 source breakdown identifies agricultural soil management as the largest United States source, at 75% of nitrous oxide emissions. The other listed shares are much smaller:
| U.S. source, EPA 2024 breakdown | Share |
|---|---|
| Agricultural soil management | 75% |
| Stationary combustion | 6% |
| Wastewater treatment | 6% |
| Manure management | 4% |
| Transportation | 4% |
| Land use, land-use change, and forestry | 2% |
| Other sources | 2% |
The application of nitrogen fertilizers accounts for the majority of United States nitrous oxide emissions, according to the EPA. Other named industrial or commercial sources include nitric acid production, adipic acid production, anesthesia applications, and semiconductor manufacturing. Naturally occurring emissions are mainly associated with bacteria breaking down nitrogen in soils and oceans. Certain bacteria and ultraviolet radiation remove nitrous oxide from the atmosphere.
The EPA identifies several mitigation approaches. Reducing nitrogen fertilizer applications is a key option. Catalytic converters can reduce nitrous oxide from passenger cars, while technological upgrades and fuel switching can reduce industrial emissions. Abatement equipment can also reduce emissions from nitric acid and adipic acid production.
Market and industrial use
The WHO 46th ECDD nitrous oxide review estimates that the global nitrous oxide market was worth US$805 million in 2016 and had reached US$1.2 billion in 2022. Medical use represented about 85% of the market in 2016.
The same review describes a geographically concentrated market. North America accounted for almost half, while Europe and Asia each accounted for about one-quarter. These are market-share descriptions from the review, not a measurement of emissions or recreational consumption.
Industrial demand is also measurable. The electronics industry used an estimated 10,000 tonnes of nitrous oxide in 2022. The review says effects begin 15 to 30 seconds after inhalation and wear off in 10 to 15 minutes. Those timing figures describe reported effects, not a guarantee of safety or a recommended use pattern.
The WHO review says nitrous oxide is legal in all countries, but it also records restrictions in some countries. Examples include sales restrictions for minors, limits on sales during certain hours such as 22:00 to 05:00, and restrictions on sales from locations that sell alcohol or tobacco.
How common is use?
Across four national surveys summarized in the WHO review, lifetime prevalence ranged from 0.6% to 7.6%, while past-year prevalence ranged from 0.8% to 3.2%. Survey methods and populations differed, so these figures should be read as a range across surveys rather than as one global estimate.
The Office for National Statistics drug misuse report for the year ending March 2020 estimated past-year nitrous oxide use at 2.4% among people aged 16 to 59 in England and Wales, or about 796,000 people. Among those aged 16 to 24, prevalence was 8.7%, or about 549,000 people. ONS described nitrous oxide as the second most prevalent drug among 16- to 24-year-olds after cannabis and the third most prevalent among 16- to 59-year-olds after cannabis and powder cocaine.
In the ONS report for the year ending June 2022, past-year use was 1.3% among 16- to 59-year-olds and 3.9% among 16- to 24-year-olds. ONS said those rates represented about 444,000 and 230,000 people, respectively, and that use had fallen to around half the level reported for the year ending March 2020.
The 2020-2021 Global Drug Survey, summarized by WHO, found 21% past-year use among more than 147,000 respondents in 35 countries, compared with 7.2% in the 2014-2016 surveys. This is a survey comparison, not a population prevalence estimate for all 35 countries. In the same survey, 57% of nitrous oxide users reported clubbing at least once.
Age, sex, and student patterns
The WHO review reports several country-specific differences. In New Zealand, men reported 6.0% lifetime use versus 3.3% for women, and 1.2% past-year use versus 0.6% for women. In the Netherlands in 2020, past-year use was 2.3% for men and 1.9% for women.
Age differences were especially pronounced in the Dutch 2020 figures. Past-year prevalence was 14.5% among 18- to 19-year-olds, 12.1% among 20- to 24-year-olds, 4.0% among 25- to 29-year-olds, 1.8% among 30- to 39-year-olds, 0.3% among 40- to 49-year-olds, and 0.2% among 50- to 64-year-olds. The reported rate was 0% among people aged 65 and older. A United States survey cited by WHO found 5.1% lifetime prevalence among people aged 26 and older in 2021.
Among Danish high-school students aged 15 to 18, 17% of men and 10% of women reported lifetime use. Among Danish vocational-school students aged 19 to 25, the corresponding figures were 17% and 8%.
Student surveys from several countries produced higher estimates than broad adult surveys. In a New Zealand sample of 1,360 first-year engineering, law, and health-science students, 11.1% reported lifetime recreational use; 56% of the sample were men and 78% had used at least one other recreational drug. In a United States university survey, 10.3% of medical students and 17.9% of dental students had ever used nitrous oxide recreationally.
An anonymous Paris medical-student survey reported 80.3% lifetime use. Users were more likely to be men, with an odds ratio of 1.63, and more likely to have alcohol use disorder, with an odds ratio of 1.83. The review also reported an odds ratio of 0.90 for age, indicating that users were younger in that sample.
Patterns of repeated use and disorder
The WHO review includes a 10,066-student French university sample in which 26% reported lifetime use and 12% reported past-year use. Half of past-year users used only nitrous oxide; 23.7% also used cannabis, 20.2% used MDMA, and 11.8% used cocaine.
In southwest London, a sample of 140 young adults found that 77% had heard nitrous oxide called “hippy crack,” while 28% were past-year users. Among users, 83% had used it no more than 10 times in the past year, 31% had used it only once, and 10% had used it more than 20 times.
A Dutch secondary-school sample of 555 students found 13.6% lifetime use. Among users, 40.7% had used it once, 34.9% had used it two or three times, and 16.3% had used it four to 10 times. These frequency figures describe that sample and should not be generalized to all Dutch students.
In a sample of 788 Paris medical students who had lifetime use, 24.1% met DSM-5 criteria for nitrous oxide use disorder. Of those cases, 79% were mild, 17% moderate, and 4% severe. Persistent desire or unsuccessful attempts to reduce or stop use appeared in 46%; tolerance in 45%; continued use despite persistent health problems in 44%; and larger amounts or longer use than intended in 18%.
French national addictovigilance data included 525 cases, of which 64.6% met diagnostic criteria for nitrous oxide use disorder. Heavy use was reported in 17.9%, mean duration of use was 16.5 months, and about 23.4% also used alcohol while 23.8% also used cannabis. Reported French cases increased from 40 in 2019 to 344 in 2021, while cases with use disorder rose from 88 in 2020 to 302 in 2021.
Deaths, poisonings, and clinical signals
The ONS volatile-substance deaths article recorded 56 deaths involving nitrous oxide in England and Wales between 2001 and 2020; 45 were registered from 2010 onward. ONS said nitrous oxide was the third most mentioned substance on death certificates after butane and propane. Across all volatile-substance-related deaths, there were 716 deaths over the period, including 25 in 2020. Males accounted for 77.9%, butane was involved in 324 deaths, and propane in 123. The average annual death rate was 0.6 per million people. The North West recorded 100 deaths and the East Midlands 49. Average age at death rose from 27.6 years in 2001 to 46.1 years in 2020.
The UK government’s updated nitrous oxide harms assessment reports that registered nitrous oxide deaths peaked at eight in 2016 and again in 2019. The annual figures were six in 2017, three in 2018, and three in 2020. NPIS enquiries rose from 15 in 2018 to 20 in 2019, 32 in 2020, 38 in 2021, and 85 in 2022.
Guy’s and St Thomas’ recorded presentations for nitrous oxide-related peripheral neuropathy rising from four in 2020 to seven in 2021 and 32 in 2022. In France, 126 poison-centre cases were reported from 2017 onward; 73 involved sensory or motor problems and five involved hospitalization for neurological issues. In the Netherlands, 64 young adults were treated for partial spinal-cord injury attributed to nitrous oxide use between 2018 and 2019.
Traffic-related incidents also appeared in the UK assessment. Manchester city centre recorded 31 incidents in 2020-2021 involving drivers inhaling nitrous oxide balloons, rising to 71 in 2021-2022.
Outside Europe, Michigan reported that calls to its poison centre involving recreational nitrous oxide rose 533% from 2019 to 2024, EMS responses rose 553% from 2019 to 2024, and emergency-department visits rose 757% from 2019 to 2023. In a 2025 consumer warning, the FDA said nitrous oxide products were sold online and at retailers including Amazon, eBay, and Walmart; the warning list was updated on June 4, 2025.