Inclusive approaches to research and healthcare for nitrous oxide users: lessons from a longitudinal study.

Abstract

BackgroundRecreational use of nitrous oxide (N2O) has risen markedly over the past decade; typically, users are young adults, often from ethnic minority backgrounds and not in full-time employment. Prolonged or intense N2O use can inactivate vitamin B12, leading to subacute combined degeneration of the spinal cord, which may result in significant neurological disability. Understanding N2O-related health and social harms remains challenging due to limited patient engagement with research and healthcare.MethodsDrawing on our experience of conducting a longitudinal study and existing literature, we offer practical recommendations for researchers and clinicians.ResultsInclusive research practices that incorporate lived experience perspectives are essential to enhance relevance and accessibility. Offering compensation, psychological support resources and flexible delivery models may improve recruitment and retention. Confidentiality limits must be clearly communicated, particularly when illegal activity may be disclosed.ConclusionsStrengthening engagement in research will inform evidence-based practice within healthcare systems. Additionally, we advocate for better training on N2O-related harms and multidisciplinary collaboration to enhance healthcare provision. Trial registration number NCT05714917. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.