The Advisory Council for the Misuse of Drugs has provided an updated harms assessment of nitrous oxide, concluding that the Psychoactive Substances Act 2016 remains the appropriate drug legislation to tackle supply of nitrous oxide for non-legitimate use, and that nitrous oxide should not be subjected to control under the Misuse of Drugs Act 1971.

Instead, the report makes a number of recomendations, stating 'no single recommendation on its own is likely to be sufficient to successfully reduce the harms associated with nitrous oxide use.'

Recommendation 1

Nitrous oxide should remain under the Psychoactive Substances Act 2016. Enforcement under the Psychoactive Substances Act 2016 should be supported by interventions in the following recommendations on tackling non- legitimate supply, monitoring and reducing health and social harms associated with nitrous oxide. Police forces should share examples of good practice in enforcement using the Psychoactive Substances Act 2016.

Recommendation 2

The Home Office should work with other Government departments (and agencies) to understand and adopt successful approaches to tackling non- legitimate routes of supply, for example, in the regulation of food and medicines. Approaches should include:

• Restrictions on direct-to-consumer sales
• Restrictions on canister sizes that are not found to have legitimate uses
• Restrictions on the volume of sales that customers can purchase
• Restrictions on online sales including associated paraphernalia (for example ‘crackers’)
• Increased health warning information on packaging
• Closing down of websites selling nitrous oxide for non-legitimate uses Lead– Home Office.

Recommendation 3

The ACMD recommends:

• Universal prevention activity focused on nitrous oxide. This should include education and harm reduction interventions aimed at the public, including young people and schools, around the immediate and long- term health effects associated with repeated and heavy nitrous oxide use. For example, there could be a national campaign which could utilise appropriate platforms such as social media.
• Information and advice should be made available to the public and in places where nitrous oxide use is more common (for example festivals). Organisations that already provide advice to the public should review this information to ensure it takes into account the most recently published information.
• Local authority public health teams should ensure they are connected to local policing, community safety and wider community concerns about the availability, prevalence and use of nitrous oxide in their areas, and ensure commissioned treatment services have the necessary information and resources to support individuals to reduce the risks and harms of nitrous oxide use.
• Dissemination of information and guidance to healthcare staff to increase awareness of harmful nitrous oxide use, its clinical consequences and appropriate treatment protocols. Organisations that already provide advice to health professionals should review this information to ensure it takes into account the most recently published information.

Recommendation 4

The ACMD recommends:

• Government, Police, Trading Standards and local authorities should explore further partnership working and use of existing powers under legislation other than the Psychoactive Substances Act 2016. These include, for example, Public Space Protection Orders (in England and Wales), Dispersal Notices and Community Protection Notices.
• Government undertake a review of local authorities that have introduced Public Space Protection Orders to take lessons from evaluations of different local approaches.
• Home Office and other Government departments to consider (including unintended consequences of) providing additional powers for Police to remove, confiscate and dispose of nitrous oxide canisters and paraphernalia from people using, or are intending to use nitrous oxide for non-legitimate purposes, including in a vehicle.
• Home Office and Department for Transport to explore how nitrous oxide could be added to existing drug/driving protocols, noting difficulties with roadside and forensic testing.

Recommendation 5

The ACMD recommends there should be enhanced long term data collection to better understand the health and social harms of nitrous oxide. This includes additional UK monitoring of:

• Type, prevalence and severity of neurological, neuropsychiatric, and psychological harms attributable to nitrous oxide.
• Number and type of anti-social behaviour incidents associated with nitrous oxide.
• Number of road traffic accidents associated with nitrous oxide use.
• Number of deaths in the UK associated with nitrous oxide use
• Mechanism to monitor the environmental impact of littering associated with nitrous oxide use.

Recommendation 6

The Home Office should work with other Government departments (and agencies) and stakeholders to undertake a comprehensive consultation to develop an evidence base to fully understand the scope of legitimate uses for nitrous oxide. This consultation will also enable Government to identify non- legitimate routes of supply.

Such a consultation should fully determine:

• the potential impact(s) of any proposed legislative changes
• the full range of Government departments that could support action on other recommendations in this report
• legitimate supply routes, which would then identify non-legitimate routes of supply

Recommendation 7

The Home Office should design a framework for the assessment of the impact of any changes and undertake a formal evaluation of actions further to this advice and from the ACMD’s 2015 advice to reduce the health and social harms associated with nitrous oxide use. This review should take place no sooner than three years after any actions are implemented.

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