Canisters of the potentially deadly gas nitrous oxide — linked to the death of a Queensland man on Monday — are widely available across Australia, including at many service stations.
While some health workers are calling for a crackdown on the sale of the canisters, known as 'nangs' among teenagers, a leading drug authority says banning their sale is not the way to curb deaths caused by the drug and will only fuel black market sales.
On Monday, police in Queensland revealed a 30-year-old man had drowned in a spa after inhaling the drug.
Police say the man became unconscious while in a spa at a Surfers Paradise premises and was unable to be revived by paramedics.
Nitrous oxide, or "laughing gas", is commonly used in the medical industry, as well as by cafes and restaurants in devices that instantly whip cream.
However, health professionals fear the gas is increasingly being used by young people as an inhalant drug.
In regional Victoria, the ABC has seen aluminium cartridges of the gas for sale in a variety of places, including service stations.
In some metropolitan areas, nangs can even be delivered to your home through ordering on websites.
Drug, alcohol and mental health counsellor Jess Lawrence, who works at Head to Health in eastern Victoria, said there was widespread use of nangs among young people, and authorities needed to take action.
"For my son's 18th birthday, we hired a football shed and before the party started and we could use it, we had to clean up a heap of nangs from the bathroom floor," she said.
"They need to be cracked down upon because it's a public health issue that's gone unaddressed until now.
"They're so accessible, they're not being sold for the reason they're made, they're only being sold for substance use."
A federal Department of Health and Aged Care spokesperson said while the Therapeutic Goods Association (TGA) had reclassified nitrous oxide cartridges as a schedule 6 poison, it was up to states and territories to make and enforce laws around them.
"Some states and territories may also impose further restrictions on storage and availability of nitrous oxide, including in relation to its sale and access by young people."
Nicole Lee, adjunct professor at the National Drug Research Institute, said drugs like nangs were relatively low on the "harm scale", but cracking down on them would only make them more enticing to young people.
"It makes it more available because they can get it on the black market," Dr Lee said.
"And it's pretty easy to import and buy from overseas."
Dr Lee says the best way to control the sale of nangs, as well as illegal vapes and e-cigarettes, is to regulate the market and gain control of it.
While there's no isolated data collected on nitrous oxide use in Australia, recent use of inhalants, including nangs, has been steadily increasing — and the 2021 Global Drug Survey lists it as the 13th most popular recreational drug in the world.
How toxic are 'nangs'?
When bulbs of nitrous oxide are discharged into the mouth — or into a balloon from which they are then inhaled — they produce a short burst of euphoria, excitement, a sense of floating or, when mixed with other drugs, hallucinations.
Historically, the bulbs were plain, aluminium vessels.
But some canisters seen by the ABC in regional service stations look like pocket torches and come in flashy, colourful packaging that is clearly designed to attract young people.
According to the Alcohol and Drug Foundation, regular use of nitrous oxide can result in memory loss, depression, ringing in the ears, incontinence, limb spasms and a weakened immune system.
However, Dr Lee said she did not believe nang use — which first gained popularity in the 1970s — had long-term negative impacts on the brain.
"There have been records [of] people who have used [nangs] constantly, for a very long time, and have some indications or some brain impairment," she said.
"But generally people don't use them like that, they just use a few at a time and usually at a party or at a festival."
Buying vapes on the go
But it's not only the widespread availability of nangs that have health advocates concerned.
If you walk into some service stations in regional Victoria you can find an e-cigarette — or "vape" — menu alongside nitrous oxide canisters.
The menu is replete with numerous flavours and sizes, including vessels with enough vapour for 3,500 puffs, selling for around $45.
After a ruling by the Therapeutic Goods Administration (TGA), it has been illegal since October 1, 2021, for consumers to buy and import vaping products containing nicotine unless they have a prescription.
And it is illegal for retailers (other than pharmacies) to sell e-cigarettes or vapes that contain nicotine, including via online sales.
However, the ABC believes numerous service stations are selling vapes and other e-cigarettes that contain nicotine, despite labels suggesting they don't.
Both the Cancer Council and VicHealth have spoken about the need for regulation of vapes and stopping them from being imported.
Vaping is 'exploding'
VicHealth CEO Dr Sandro Demaio says vaping use has "exploded" and is calling for the devices to be stopped at the border.
"The federal government really is the one that needs to fundamentally step up," he said.
"They need to put much tighter border controls, much tighter protections, and expand the laws around advertising and promotion of e-cigarettes, and normal cigarettes, to include new media including social media.
"But fundamentally, they need to turn off the tap at the border."
Dr Demaio said he was highly sceptical of the marketing around e-cigarettes, which have been touted as a healthier alternative for people trying to quit regular cigarettes.
"There is a reason that the tobacco industry is investing so much money in e-cigarettes, in the marketing of e-cigarettes, and in research around e-cigarettes — they wouldn't be doing that out of the goodness of their heart," he said.
"The industry is using every loophole possible to dump a huge quantity of highly addictive cheap products onto the market."
However, Dr Lee disagreed and told the ABC she believed tighter regulations and a border crackdown would make vapes and nangs even more attractive to young people and would fuel a black market.
She said e-cigarettes were "95 per cent safer than cigarettes", but, like the Cancer Council and VicHealth, is concerned young people who had no intention of smoking cigarettes are taking up vaping.
"The best way to stop the black market and to stop access, particularly by teens and underage kids, is to actually regulate the market and have control over it," she said.
"At the moment, like with illicit drugs, we have no control over that market. They're imported and sold by criminals.
"What we do know is that when you start clamping down on a particular drug, all that happens is that those kids who wanted to try that drug will just try something else, and that something else is probably going to be more dangerous.
"So we need to be really careful about unintended consequences of regulating these kinds of things."
Federal Health Minister Mark Butler said the government and state health ministers had agreed vaping was a priority area needing "strong action".
"As a first step the Therapeutic Goods Administration has held a public consultation process on nicotine vaping products," he said.
"We need to understand where the current regulatory framework falls short, and what action governments can take to move the dial.
"We're determined to see Australia reclaim its position as a world leader on tobacco control."
