Abstract
Despite the increasing visibility of recreational nitrous oxide (N₂O) use, little qualitative research exists on its consumption patterns, motivations, harms, and perceptions in Aotearoa New Zealand. This study aimed to explore these aspects by investigating both individuals with and without prior N₂O experience, additionally investigating combination drug use, harm reduction practices and knowledge. Using a qualitative approach, data were collected via semi-structured interviews and focus groups with 19 participants aged 18–65 across the Wairarapa and Pōneke/Wellington regions in Aotearoa. Reflexive thematic analysis resulted in four key themes: (1) The Social Experience of N₂O, highlighting how use is embedded in social settings and peer influence; (2) Cherry on Top: Other Substance Use and N₂O, exploring N₂O use in conjunction with other substances and its role in further enhancing altered states; (3) The Sensory Experience of N₂O Facilitates Change in Preparation and Consumption Patterns, detailing how the unique physical and perceptual effects of N₂O influences rituals and harm reduction behaviours; and (4) Negative Media Portrayal and How This Shapes N₂O Perceptions and Stigma, which examined the impact of media on stigma, misinformation and public perceptions. Findings showed that motivations for use were varied and often rooted in social bonding, curiosity, or the use of other substances. Preferred setting was always social, and often at house parties or home, while use was typically infrequent and at low doses. Harms were reported infrequently and were typically linked to co-use with other substances. Participants described a large scope of harm reduction behaviours, such as setting, safer equipment use, and sitting down. Information and harm reduction techniques were often informally shared through peer networks, and contributed to the low prevalence of harm reported. This study challenges dominant narratives that frame N₂O use as inherently dangerous, and instead calls for balanced, evidence-based public health messaging and policy approaches. These findings contribute novel insights into an under-researched area and support the development of targeted education and harm reduction strategies reflective of real-world use in the Aotearoa context.