Over the last several years, the use of the recreational drug nitrous oxide – also known as ‘nos’, laughing gas, and balloons – has surged amongst younger people, with over half a million young people – almost 9% of 16-24-year-olds – reporting its use in the 2019/20 Crime Survey for England and Wales.

Academic Neurologist Dr Nikos Evangelou of the University of Nottingham described the situation as an epidemic, writing on Twitter: “On call for Nottingham Neurology and I realised there is an epidemic of nitric oxide-induced spinal cord and nerve damage. Terrifying to see paralysed young people from laughing gas canisters.”

His concerns are echoed by a neurologist at Sandwell and West Birmingham NHS Trust, Dr David Nicholl,  who said: “We’re seeing dozens of young people coming into hospital; some of them have life-changing neurological injuries” and by consultant neurologist Alastair Noyce, “We used to see people with tingling and numbness in their legs, difficulty walking. This year we’ve had several people who literally can’t walk at all when they come to the hospital.”

Medical usage of nitrous oxide gas

Used in medical settings for general anaesthesia, sedation, dental anaesthesia, and to treat severe pain, it is also used by women experiencing contractions during labour.

It can induce a mildly euphoric feeling, and recreational users report hallucinations, giggling, and a feeling of being light-headed and relaxed.

Long-term health risks

Between 2001 and 2020, ONS figures reveal 56 registered deaths involving nitrous oxide in England and Wales, with 45 of those having been registered since 2010.

The long-term risks of inhaling nitrous oxide can be life-changing, as it can cause severe neurological problems by inactivating Vitamin B12 in the body. Metabolisation of Vitamin B12 damages the protective layer of nerves, often those in the rear of the spine. This damage to the myelin sheath can cause demyelination, which means that nerve messages that pass along a damaged nerve become delayed or blocked, something often seen with MS patients.

Dr Trevor Pickersgill, a consultant neurologist at Cardiff and Vale University Health Board explains, “That causes spinal cord damage, which can be irreversible if untreated.” It can also cause memory loss, incontinence, numbness and spasms.

Kerry Donaldson, a 25-year-old former receptionist recently shared her story online. Suffering from a disc bulge in her lower back, and nerve damage which has left her unable to walk due to heavy use of the gas, she said,

“’I started using nitrous oxide roughly four to five years ago. I was doing it on-and-off, usually at the weekends. It was the social thing, everybody was doing it. I didn’t really understand the damage that it could cause. I just thought it was a bit of fun, I didn’t think it would harm me. I started losing feeling in my legs and hands. I went to the hospital and I was really honest to the doctors about using nitrous oxide. My B12 levels were low, so I was put on B12 injections.’

In addition to neurological damage, specialists have also reported another significant risk – burns. A burns matron from Chelsea and Westminster Hospital NHS Foundation Trust, Nicole Lee, explained via social media:  “Patients are coming into the service following inhalation of the gas. With these larger canisters they’re resting them between their legs, which is then leading to cold injuries being seen within the leg area.” These injuries have resulted in the need for skin grafts in some patients.

This risk is heightened due to the immediate effect of the gas, which, as it can alter people’s senses, means they don’t feel the cold and pain until the damage is done.

Nitrous oxide and the law

In 2021, the Home Secretary asked the independent Advisory Council on the Misuse of Drugs (ACMD) to review its harm.

Though it is illegal to sell nitrous oxide for its recreational use, it is not a crime to possess the drug. Sold in small silver canisters and inhaled using balloons, recently there has been a surge in super-sized canisters being made available for sale online. Currently, 100 small canisters can be purchased by over 18s for as little as £35 with no checks made.

Treatment and Guidelines

Alistair Noyce of Barts Health NHS Trust and colleagues have devised a treatment that involves direct muscular injections of B12 “as early as possible”. The specialists hope to work towards a standardised treatment with the Association of British Neurologists (ABN).

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