At first glance, it would be easy to mistake for an Uber Eats delivery.

A man drives slowly down a suburban street in Brisbane searching for the right house, before emerging from his car carrying a package in both hands.

He's not there to drop off food, though — it's a 3.3 litre canister of nitrous oxide ordered online less than an hour before.

Abusing the gas, known colloquially as "nangs", can cause irreversible brain and spinal damage, psychosis, incontinence and in some cases, even death.

Despite those serious health concerns, it can be ordered online from companies promising to deliver the gas 24/7.

To demonstrate how easily it can be bought — and without any oversight of a purchaser's age or intended use — the ABC placed an order and had it delivered to a residential address. 

Amid the increasing ease of access to nitrous oxide, health professionals are concerned about misuse and the potential for serious health consequences.

Dr Katherine Isoardi, director of toxicology at Metro South Health, recounts one harrowing tale from a paramedic who had to "wade through thousands of nangs on the ground" to get to a patient who realised they could no longer walk properly. 

"You can DoorDash it and get it straight to you — you can get it at three o'clock in the morning," she says. 

"I've had a patient [who couldn't walk anymore] who's been able to order it up to the hospital and get it delivered onto the floor."

'I woke up that morning with just about complete paralysis'

Possessing and selling the gas is not illegal in Queensland — or many other states across Australia — unless the seller has a reasonable expectation it will be misused.

But when the ABC placed the order, the only correspondence from the company was to confirm an estimated time of arrival.

The 3.3 litre canister was then left on a welcome mat.

The ease of access to nitrous oxide is part of the reason Molly Day developed an addiction that eventually left her unable to walk.

The first time she used "nangs", the now 20-year-old was at a school-leavers party, celebrating the end of year 12 and the beginning of the rest of her life.

"They were so easily accessible — you could get them from smoke shops, corner shops, and get them online 24/7, so it was a very popular thing [with] teenagers especially," she says.

What began with inhaling "little bulbs" of the gas soon escalated when her group of friends realised "really big canisters" had become available.

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It wasn't long before she was abusing "the big canisters, basically on my own just about every day".

"I kept using even when I had small symptoms and it just turned into a really, really big disaster."

Molly recalls the morning she woke up and couldn't feel anything from the waist down.

"I was doing them the night before actually and I woke up that morning with just about complete paralysis," she says.

"By the time I got to the hospital, within a day or two, I couldn't even stand, couldn't walk, couldn't feel anything."

Some people 'simply don't' recover

Nitrous oxide can cause irreversible brain and spinal damage — among other severe health impacts — because it inactivates the vitamin B12, which can damage the spinal cord. 

"We start to replace [B12] and they might get some functional improvement — sometimes these people have to go to rehab to learn how to walk again, if they do get full recovery," Dr Isoardi says.

"It can take many weeks or months to get back to their pre-functioning level … there are some people who simply don't."

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Dr Isoardi says in cases where patients have developed psychosis, a reversal isn't always possible. 

"Certainly some of the patients who we've managed have had recurring issues with it," she says.

"So it doesn't seem like something that's been easily solved."

The National Drug Strategy Household survey suggests about six per cent of the Australian population have used inhalants, about half of which are believed to be nitrous oxide, says Dr Jeremy Hayllar, clinical director of the Alcohol and Drug Service for Metro North Mental Health.

"That's about 600,000 people in Australia who at some time have used nitrous, so quite a large number," he says.

There were 20 deaths involving nitrous oxide between 2000 and 2021, according to a recent National Drug and Alcohol Research Centre study.

Data on admissions to hospital emergency departments is inconsistent, because often people will present with the inability to walk, numbness or tingling in their hands or feet, or psychosis.

It is often not recorded as being caused by nitrous oxide abuse and can be coded as "poisoning by inhaled anaesthetics", which could involve other substances.

But those on the frontline, including Dr Hayllar, are increasingly seeing the health impacts firsthand. 

In one case, he treated a patient in their early 20s who now requires a permanent catheter after abusing nitrous oxide heavily for months.

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"They had an Indwelling urinary catheter, and they also lost feeling in their legs, so they were very unsteady on their feet," he says.

"Unfortunately, even though they had managed to stop using the nitrous oxide, they didn't get full recovery of those problems."

Patients spending up to $750 a day on nitrous oxide

At the peak of Molly's use, she used most of her salary to fund her habit. When that wasn't enough, she turned to buy-now pay-later apps.

"You can go into a smoke shop or a convenience shop and use Afterpay, so I racked up a couple grand of debt actually by using them," she says.  

Dr Hayllar refers to a case in medical literature of a young student in Sydney who was spending up to $750 a day on nitrous oxide products.

After just one week, she became psychotic and struggled to walk.

"She had no connection with reality, she was hearing voices and very confused, so she went to hospital because those effects had come on so quickly."

As nitrous oxide use increases in frequency, "you need to use bigger quantities to get that same effect", Dr Isoardi adds.

"It can prove quite costly, we've had patients who resort to pretty much anything, and sell pretty much anything that they can, to afford the habit," he says.

For Dr Isoardi, it's not the substance abuse that surprises her, but the availability.

"I can understand that people turn to substances to address things in their lives," she says.

"What I can't understand is how it's so readily available and so easy to obtain, and that there is no higher regulation to try to stop someone at three in the morning ordering 1,000 canisters.

"I think it's pretty clear that these aren't being used for food purposes, despite what the websites suggest."

Larger canisters "certainly present a huge risk for for people," Dr Hayllar adds.

'It's honestly just not worth it'

After national concerns about recreational use of nitrous oxide, the gas was listed as a Schedule 6 poison — meaning that since 2022, the product's packaging must include labels identifying it as a poison and warn that it could cause nerve damage if inhaled. 

In response to increased misuse by young people, Western Australia recently introduced new laws to crackdown on nitrous oxide abuse, including limiting the purchase to registered food and beverage businesses and restricting the size of canisters.

Dr Isoardi believes other states should follow suit, pointing to mounting concerns over the increasing availability of larger canisters, which increase the risk of nitrous use exponentially.

"I think that because it's legal people think that it's safe, but it's not at all safe, certainly not in large quantities and over long periods of time," she says.

For Molly, it took almost three months of rehabilitation before she could walk again.

One year on, she still hasn't completely regained feeling in her legs.

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"I'm hoping that all the other states follow behind [WA] eventually because it does need to be done," she says.

"You've got to look at me, look at my story, it's just not worth it.

"It can happen to anyone, and it could only be that one nang that possibly kills you and puts you in the position I was in."