Background: Since 2000, the prevalence of recreational nitrous oxide (N 2O) use has increased in the Western world. Although N 2O is a relatively safe drug, the overall increase in the use of N 2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N 2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N 2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N 2O-induced vitamin B 12 deficiency. The increasing trend of recreational users with N 2O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N 2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N 2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N 2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N 2O use. Conclusion: It is concluded that the increase in excessive N 2O use is of serious concern.