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LAST UPDATE | 1 hr ago
RECREATIONAL USE OF nitrous oxide among young people was highlighted earlier this month as a growing concern, leading to serious and potentially permanent nerve damage.
Consultant neurologist at St James’s Hospital, Professor Colin Doherty said that the uncontrolled use of industrial-sized canisters poses significant health risks including nerve damage.
Professor Doherty explained how the gas interferes with vitamin B12 metabolism which is essential for healthy nerve function. He outlined how a new group of very young people is now presenting with spinal damage, often linked to recreational use at parties.
The warning comes amid evidence of rising use of nitrous oxide among teenagers and young adults. The latest Drug Treatment Report from the Health Research Board shows 54 people began treatment for problem use of nitrous oxide in 2024, more than half aged 17 or under. Twelve cases reported nitrous oxide as the main problem drug, with the majority reporting use alongside other substances.
Nitrous oxide has a number of industrial uses and can also be used medically. When mixed with air (50/50 gas and air), it is used as an anaesthetic gas for pain relief in dentistry and childbirth.
When inhaled, it causes a quick ‘rush’ with short-lasting effects. However, the HSE reports that when it is used in extra risky ways, in large doses or frequently over time, it can cause harm to health.
It can be found in different forms, such as in whipped cream chargers or ‘whippets’, which are small silver cartridges. It can also come as crackers with balloons attached or in large canisters that are used to fill balloons.
Nitrous oxide is often categorised as a ‘depressant’ or ‘dissociative’ drug. A depressant drug slows the body down. A dissociative drug has effects which cause a disconnect or detachment from yourself or your surroundings.
Many people know it as ‘Laughing Gas’, ‘Whippets’, ‘Chargers’, ‘N20’ or ‘Hippy Crack’. It can be confused with C02 that also comes in silver canisters used to inflate bike tyres. Because they are both gases used to fill balloons, nitrous oxide could also be confused with helium. The two gases are not related.
Nitrous oxide is inhaled from a balloon which has been filled with gas, sometimes referred to as ‘nagging’. Gas needs to be discharged from the canister into the balloon. To release the gas from ‘whippet’ canisters, they need to be fitted into a whipped cream canister or an object known as a ‘cracker.’
Large nitrous oxide containers are also used to release gas directly into a balloon. The objective is to attain the quick euphoric effects of the gas after inhalation.
The effects of inhalation can differ depending on: how much is taken (the dose is often unknown); personal factors such as the person’s mental health; if the person has consumed the drug before; and if other drugs, alcohol or prescription drugs are used at the same time.
The effects are almost immediate, within 10–30 seconds after use and are short-lived. These include a feeling of being detached from yourself and your surroundings (dissociation); euphoria and giddiness; relaxation and calm; time distortion; or visual patterning or hallucinations.
The HSE reports unwanted effects can include: headache, dizziness, blurred vision, unsteadiness, nausea, short-lived paranoia, blood pressure changes or sudden death due to a lack of oxygen. Further research is needed on short and long-term risks that are dependent on the method of use, how much is taken and how often it is used.
Taking nitrous oxide directly from the canister without a balloon can increase the risk of harm. Inhaling directly from a canister can cause frostbite to the mouth and nose, as well as potentially cause damage to the throat and lungs. Gas within the canister is extremely cold and needs to be warmed before inhaling.
People with high blood pressure, heart disease, or mental health conditions could be at greater risk. Nitrous oxide can cause a drop in oxygen levels that could increase heart rate. People risk falling or having accidents after use as balance is affected, increasing the risk of use near roadways or water.
Potential long term risks to health are increased by high volumes and frequency of use. This can lead to Vitamin B12 deficiency, causing nerve damage, pain or tingling in toes and fingers.
Damage may also involve nerves that are responsible for controlling muscles, leading to muscle weakness, loss of balance and difficulty walking. The damage may involve both the central and peripheral nervous system, especially the spinal cord. Some cases involve urinary incontinence, constipation and sexual dysfunction.
Damage may progress to an inability to walk. In rare cases, the damage is severe enough to cause paraplegia (paralysis of the lower body and legs). The European Monitoring Centre for Drugs and Drug Addiction report that many of the cases reported to poison centres from 2017 onwards involve neurotoxicity of varying severity.
Suffocation can happen when taking nitrous oxide. People risk being deprived of oxygen if too much nitrous oxide is inhaled or if a person uses it continuously without taking breaths.
The European Monitoring Centre for Drugs and Drug Addiction published a report in 2022 entitled Recreational Use of Nitrous Oxide — a Growing Concern for Europe. The report highlights the growing prevalence of recreational use in Europe since 2017, as both supply and use of the gas have increased.
It suggests that this is partly due to the recent availability of larger cylinders of the gas that deliberately target the recreational market, making nitrous oxide significantly cheaper and promoting broader, more regular and heavier use.
The report outlines that the key to the growing popularity has been the widespread availability of small, inexpensive cartridges of nitrous oxide used to make whipped cream. These are used to fill party balloons, from which the gas is then inhaled. It is relatively easy to buy cartridges from convenience stores, supermarkets and online suppliers.
Last June, The Journal Investigates found large canisters of nitrous oxide, or laughing gas, on online classified ad sites and even the Irish version of Amazon. During the investigation, the team could also buy it directly from brands that sell the gas online, revealing just how easy it is for anyone, including children, to obtain it.
Sinn Féin TD Mark Ward has actively called for changes to legislation as well as awareness campaigns to highlight the risks posed by nitrous oxide. He has spent 18 months developing legislation that would require distributors to hold a licence to sell it in Ireland, with sales limited to an approved set of purchasers, including medical or catering purposes.
There have also been calls for a sales ban on nitrous oxide to under-18s and increased powers for the gardaí to seize nitrous oxide.
Use of nitrous oxide gas is no laughing matter. Addressing the dangers of its use requires a multifaceted approach with improved monitoring, as well as targeted public health campaigns to increase awareness of both acute and chronic dangers of its use among young people.
Proposals to tackle misuse with legislation include ensuring that sellers must have a licence and that it can only be sold to a registered provider in selected industries, such as catering and medicine. This approach would focus on limiting the supply and providing powers of confiscation to the gardaí.
As the number of cases of young people with long term life-changing impacts from nitrous oxide use mount, public health awareness campaigns and legislation to restrict supply cannot come soon enough.
Dr Catherine Conlon is a public health doctor with the HSE.
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