In recent years the recreational use of inhaled nitrous oxide gas (N₂O) is becoming increasingly popular, yet little is known about the characteristics of its users or the effects they experience. This paper presents original research from the 2014 Global Drug Survey (GDS) ( n=74,864). GDS runs the largest survey of recreational drug use in the world. The findings confirm N₂O as a very common drug of use, in particular in the UK and US (38.6% and 29.4% lifetime prevalence). In the UK N₂O was reported to be the eighth most commonly used substance. N₂O was generally consumed via gas-filled balloons, at festivals and clubs where use of other substances was common. The vast majority of users use infrequently, and their use is not associated with significant harm. However, there appears to be a subpopulation of heavy users who may be using in a dependent pattern. Analysis of last year N₂O users ( n=4883), confirms that N₂O is associated with hallucinations and confusion (which may be the desired effects) and persistent numbness and accidental injury (27.8%, 23.9%, 4.3% and 1.2% of last year users, respectively). Accidental injury is associated with the highest number of ‘hits’ per session, suggesting a dose–response relationship. The presence of significant harm is discussed in the light of public education on the risks of N₂O use and harm-reduction strategies appropriate to N₂O use. Further work needs to be completed to confirm the presence of persistent neurological symptoms in recreational users.

Online purposive samples have unknown biases and may not strictly be used to make inferences about wider populations, yet such inferences continue to occur. We compared the demographic and drug use characteristics of Australian ecstasy users from a probability (National Drug Strategy Household Survey, n = 726) and purposive sample (online survey conducted as part of a mixed-methods study of online drug discussion, n = 753) using nonparametric (bootstrap) and meta-analysis techniques. We found significant differences in demographics and drug use prevalence. Ideally, online purposive samples of hidden populations should be interpreted in conjunction with probability samples and ethnographic fieldwork.

Cannabis and tobacco are common drugs of abuse worldwide and are often used in combination through a variety of routes of administration. Here we aimed to provide an overview of how cannabis and tobacco routes varied across countries and assess the impact of tobacco based routes of administration on motivation to use less cannabis, and less tobacco, in separate models. A cross-sectional online survey (Global Drugs Survey 2014) was completed by 33687 respondents (mean age = 27.9; %female = 25.9) who smoked cannabis at least once in the last 12 months. Most common route of administration, frequency of cannabis/tobacco use, and questions about motivation to use less cannabis/tobacco were recorded. Tobacco based routes of administration were used by 65.6% of respondents. These were most common in Europe (77.2-90.9%) and Australasia (20.7-51.6%) and uncommon in the Americas (4.4-16.0%). Vaporizer use was most common in Canada (13.2%) and the United States (11.2%). Non-tobacco based routes of administration were associated with a 10.7% increase in odds for ‘desire to use less’ tobacco (OR: 1.107, 95% CI: 1.003, 1.221), 80.6% increase in odds for ‘like help to use less tobacco’ (OR: 1.806, 95% CI: 1.556, 2.095) and a 103.9% increase in the odds for ‘planning to seek help to use less tobacco’ (OR: 2.039, 95% CI: 1.638, 2.539) in comparison to tobacco based routes of administration. Associations between route of administration and intentions to use less cannabis were inconsistent. Results support considerable global variation in cannabis and tobacco routes of administration. Tobacco routes are common, especially ‘joints with tobacco’, especially in Europe, but not in the Americas. Non-tobacco based routes are associated with increased motivation to change tobacco use. Interventions addressing tobacco and cannabis need to accommodate this finding and encourage non-tobacco routes.

Cryptomarkets are digital platforms that use anonymising software (e.g. Tor) and cryptocurrencies (e.g. Bitcoin) to facilitate trade of goods and services, most notably illicit drugs. Cryptomarkets may reduce systemic violence compared with in-person drug trading because no face-to-face contact is required and disputes can be resolved through a neutral third party. In this paper, we describe the purchasing behaviour of cryptomarket users and then compare the self-reported experiences of threats, violence and other drug-market concerns when obtaining drugs from cryptomarkets with obtaining drugs through friends, known dealers and strangers. The Global Drug Survey was completed in late 2014 by a self-selected sample who reported accessing drugs through cryptomarkets in the last 12 months (N=3794). Their median age was 22 years and 82% were male. The drug types most commonly obtained through cryptomarkets were MDMA/Ecstasy (55%), cannabis (43%) and LSD (35%). Cryptomarket users reported using a median of 2 sources in addition to cryptomarkets to access drugs, the most common being in-person friendships (74%), in-person dealers (57%) and open markets/strangers (26%). When asked to nominate the main source they would use if cryptomarkets were unavailable, 49% nominated friends, 34% known dealers and 4% strangers. 'Threats to personal safety' (3%) and 'experiencing physical violence' (1%) were less often reported when using cryptomarkets compared with sourcing through friends (14%; 6%), known dealers (24%; 10%) or strangers (35%; 15%). Concerns about drug impurities and law enforcement were reported more often when using the alternative source, while loss of money, waiting too long and not receiving the product were more often reported when using cryptomarkets. Cryptomarkets are associated with substantially less threats and violence than alternative market types used by cryptomarket customers, even though a large majority of these alternatives were closed networks where violence should be relatively less common.