In recent years, nitrous oxide – commonly known as “nos” – has become an extremely popular recreational drug. It has reportedly been widely used at festivals this summer. In the 2019-20 Crime Survey for England and Wales, almost 9% of 16 to 24-year-olds said they had taken nitrous oxide in the last year, up from 6.1% in 2012-13. Experts say that as use of the drug has increased, so have cases of spinal cord and nerve damage, including paralysis. “There is no doubt that we have seen an increase in cases, as this was almost unheard of last year and now [we] see cases weekly,” said Dr Nikos Evangelou, an academic neurologist at the University of Nottingham. Writing on Twitter, Evangelou described the situation as an epidemic, adding: “Horrifying to see young people paralyzed by laughing gas.” Dr David Nicholl, a neurologist at Sandwell and West Birmingham NHS Trust, also called the problem an epidemic in a recent TikTok video. “We see dozens of young people entering the hospital because they don’t have their legs. Some of them have life-changing neurological injuries,” he said. Discovered by chemist Joseph Priestley in 1772 – and subsequently the subject of myriad experiments and cartoons – nitrous oxide became a useful tool in medical settings to treat severe pain. While it can cause laughter and hallucinations, it can also cause neurological problems by inactivating vitamin B12. “B12 is vital for the production of myelin, which is the fatty sheath around your body’s nerves,” said Dr Trevor Pickersgill, consultant neurologist at Cardiff and Vale University Health Board. When B12 is inactivated by nitrous oxide, myelin is no longer maintained in good condition. “This causes damage to the spinal cord, which can be irreversible if left untreated,” Pickersgill said. Dr Mark Ellul, a specialist secretary in neurology based in Liverpool, said cases of nerve damage from the use of nitrous oxide were common. “I would say as a unit we probably see a case every few weeks,” he said. “Most are young and many did not previously know that the substance could be harmful. In some cases the effects can be quite severe and long-lasting.” A study conducted by researchers in Strasbourg reported that five patients were admitted to a tertiary care center between April 2020 and February 2021 with rapidly evolving neurological symptoms after using nitrous oxide. Archie Bland and Nimo Omer take you to the top stories and what they mean, free every weekday morning Privacy Notice: Newsletters may contain information about charities, online advertising and content sponsored by external parties. For more information, see our Privacy Policy. We use Google reCaptcha to protect our website and Google’s Privacy Policy and Terms of Service apply. “When I did a retrospective analysis of all patients admitted 10 years before April 2020, not a single patient was diagnosed with neurological complications due to nitrous oxide abuse in our hospital,” said lead author Maximilian Einsiedler. Although it is illegal in the UK to provide nitrous oxide for human consumption or sell it to children, it is not illegal to possess the drug. Users often buy small silver gas canisters – known as whippits because of their original purpose as whipped cream chargers – and inhale them from a balloon. However, there are concerns that large gas canisters are becoming more common, with giant canisters 80 times the size of whips found on London streets after Notting Hill Carnival this weekend. Harry Sumnall, professor of substance use at Liverpool John Moores University, said there was no hard data on the prevalence of serious problems arising from nitrous oxide use in the UK. While Sumnall said even a relatively small increase in cases from the low reference levels worried neurologists, he said the people most at risk of major complications were those exposed to high amounts of the gas. “Just to put it in perspective, [there are] over 600,000 users in the UK and most people, if they use it, will use it a few times a year, at really low risk levels,” he said.
