Nitrous oxide abuse has been identified as a potential new drug epidemic around the world. Long used as an effective anaesthetic and pain reliever, nitrous oxide is being misused increasingly for recreational purposes.

For many, the fleeting high of inhaling nitrous oxide, or laughing gas, encourages recurrent use—especially because the effects last only a minute or two. However, frequent use can lead to addiction and long-term health issues, including neurological conditions and traumatic injuries.

“It is what some would call habit-forming or addictive. It does produce a euphoria,” Ethan Bryson, MD, an anesthesiologist at the Icahn School of Medicine at Mount Sinai in New York City and co-author of a review on the consequences of nitrous oxide abuse, tells MDLinx.

Garakani A, Jaffe RJ, Savla D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature. Am J Addict. 2016;25(5):358–369.

“Because it’s a very short-acting experience, people will then continue to use it while they have it available, sort of chasing that euphoria, trying to make the experience last longer—which is what is primarily responsible for the chronic neurological signs that we’re seeing.”

Here's what to look for in your patients

When patients who have been misusing nitrous oxide come to the hospital, the types of injuries they have may be the first clue they’ve been inhaling the gas. These commonly include head injuries, bone fractures, and other physical traumas.

He clarifies that, during medical and dental procedures, nitrous oxide is administered with oxygen to prevent hypoxia.

Neurological deficits can crop up with more chronic use, tied to the inactivation of vitamin B12.

Evans EBN, Evans MRB. Nangs, balloons and crackers: Recreational nitrous oxide neurotoxicity. Aust J Gen Pract. 2021;50(11):834–838.

This disrupts the pathway involved in the creation of myelin, which coats the nerves in the spinal cord and throughout the body.

What doctors can do

Physicians have an important role to play in addressing the growing problem of nitrous oxide abuse, according to Dr. Bryson. The first step is simply considering that certain patients may be misusing the gas, and asking about this, regardless of their age.

“If somebody comes into your emergency room with physical signs that would suggest a vitamin B12 deficiency, that’s got to be on the list of potential causes, especially in someone with a history of substance use disorder or who admits to recreational substance use,” Dr. Bryson says.

Raising awareness about the dangers of nitrous oxide misuse is important, too, he indicated, because people “who may think that this is a safe and relatively innocuous thing to do might think twice about getting themselves into a situation where they find they’re inhaling a lot of this gas over a period of time.”