The recreational use of nitrous oxide has become a serious enough problem in Canada that the Canadian Medical Association Journal has published a detailed report on what physicians should be aware of and the toxic effects and long term damage to patients.
The report was written by Dr. Cyrille De Halleux and Dr. David N. Juurlink, researchers associated with the Department of Medicine at the University of Toronto and the Ontario Poison Centre at the Sunnybrook Research Institute in Toronto. Their report was peer reviewed.
According to their report, nitrous oxide (N2O) has become a popular but dangerous recreational drug. Colloquially referred to as “laughing gas,” it was first used therapeutically in 1844 for patients undergoing dental surgery.
In a controlled setting such as a dental office, the gas is mixed with oxygen and administered in controlled doses and is monitored by health professionals, said the report.
The problem, said the report, is when people inhale the raw gas for a quick buzz. Often this is done using tiny cartridges of compressed N2O that are used for whipped cream devices. These cartridges are easily available in many food and restaurant supply stores.
"Upon inhalation, users experience euphoria, analgesia and dis-inhibition. The effects last only a few minutes, and repeated use is common when sustained effects are desired," said the report.
It was also stated that regular daily use can occur when users try to get a sustained high and this carries the risk of alveolar hypoxia, a condition that induces lung inflammation.
"Although isolated, short-term use rarely leads to serious complications, chronic use can cause neurotoxicity that is often not fully reversible; cervical myelopathy, peripheral neuropathy and encephalopathy have been described," said the report.
The authors also wrote that the true prevalence of recreational nitrous oxide use in Canada is unknown. An international survey carried out in 2021 revealed that 15 per cent of Canadian respondents reported having used nitrous oxide in the preceding year. This was compared to a usage survey showing an average level of 10 per cent for all respondents of other countries.
The authors also wrote that acute, heavy use of nitrous oxide can occasionally cause death by asphyxiation, isolated, short-term use rarely leads to serious complications.
Regular inhalation, however, can have serious and even devastating neurologic consequences. We discuss recreational nitrous oxide use and its toxicity, including methods and patterns of use, pathophysiology, clinical presentation, diagnosis and management. We draw on evidence from case reports, case series, surveys and mechanistic studies related to nitrous oxide use and its complications, said the report.
In conclusion, the report stated:
"The low cost of and ease of access to nitrous oxide make it a popular recreational drug, especially among younger people. It can cause functional vitamin B12 deficiency and is an easily overlooked cause of neurologic abnormalities, typically myelopathy, peripheral neuropathy or encephalopathy, sometimes accompanied by hematologic abnormalities. Clinicians should enquire about nitrous oxide use in patients with unexplained findings suggestive of vitamin B12 deficiency or other compatible neurologic symptoms."
The report recommended further research into the issue.
A full text copy of the nitrous oxide report can be found online here.
