Nitrous oxide has been gaining popularity as a party drug around the world for some time now, including in Germany. The narcotic is supposedly low-risk, but excessive recreational use can cause severe and sometimes permanent nerve damage. Such secondary diseases have become more and more common since 2020, as a study from the greater Paris area has now shown. Young and socially disadvantaged people in particular are increasingly consuming high and therefore harmful amounts of nitrous oxide. This makes nitrous oxide abuse a public health problem.
Nitrous oxide (N2O, nitrous oxide) has been used as an anesthetic in anesthesia for over 200 years to put patients under anesthesia for a short time. Only small, harmless amounts of the gas are used under medical supervision. In recent years, however, nitrous oxide has also become a popular recreational and party drug around the world. Balloons are filled with nitrous oxide and the gas is then inhaled. Although the intoxicating effect wears off after a few minutes, it can have significant subsequent damage. This is becoming an increasing health problem, not least because some young people regularly inhale large amounts of the gas.
If used improperly, nitrous oxide can damage the nervous system because it causes a functional deficiency of vitamin B12 in the body. This vitamin is necessary for the function of the so-called myelin sheaths – the sheathing structures that protect the nerve cells in the body and spinal cord. Without sufficient vitamin B12 available, this protective layer is destroyed and nerve damage occurs. Those affected then have problems walking and numb feet and hands. In severe cases, permanent paralysis can also occur. The symptoms can be partially reversed by taking vitamin B12, but not always completely.
In individual overdoses of the drug, blood formation as well as the heart and lungs are also affected, so that acute cardiac arrhythmias, strokes and breathing problems, even suffocation, can sometimes occur.
How many nitrous oxide users end up in hospital?
A team led by Yachar Dawudi from the hospital center in Saint-Denis has now investigated how often serious damage occurs as a result of nitrous oxide consumption in the greater Paris area. To do this, the doctors recorded all people over the age of 18 in 78 hospital departments for neurology and internal medicine who presented with severe nitrous oxide poisoning between 2018 and 2021. They also compared the frequency of this with the frequency of comparable neurological diseases based on the health insurance data of 91,000 hospital patients.
The result: Of the 181 patients recorded in hospitals, 25 percent had damage to the spinal cord, 37 percent had damage to peripheral nerves, and 38 percent had a combination of both. The patients were primarily young adults with poor socioeconomic conditions: most (60 percent) were between 20 and 25 years old and lived in urban, socially disadvantaged areas; 37 percent were unemployed, according to the team. On average, those affected consumed 1200 grams of nitrous oxide daily. Their symptoms appeared between two and twelve months after consuming nitrous oxide. In some cases, inhaling nitrous oxide from four balloons after just seven weeks led to severe nerve damage. The threshold for the risk of developing serious health problems from nitrous oxide is therefore significantly lower than the consumption of many young people, as the neurologists report.
The study also traces the course of the trend: Until the end of 2019, no such cases were observed in the greater Paris area. From 2020 onwards, nitrous oxide poisoning became more and more common. The recorded nitrous oxide damage reached a peak in mid-2021. For both types of recorded nerve damage, the incidence in the corresponding age group was higher than for comparable disorders that were not caused by nitrous oxide, as the team reports. Statistically speaking, 6.15 and 7.48 out of 100,000 people suffered severe nerve damage as a result of nitrous oxide consumption. Spinal cord inflammation or Guillain-Barré syndrome, on the other hand, only occurred in 0.35 and 2.47 out of 100,000 people, respectively.
Legal rules required
The neurologists conclude from the data that young people are increasingly consuming very high and therefore harmful amounts of laughing gas. They are therefore calling for politicians to take information campaigns and other measures to counteract this trend. In Germany, too, the party drug laughing gas is a well-known and currently controversial problem, even if figures on the amount consumed and patients with long-term consequences are not (yet) available. The German Society of Neurology is currently conducting a survey to determine the extent of the problem. The society is already calling for laws to regulate and restrict the sale of laughing gas to private individuals. The sale and consumption of laughing gas are not yet prohibited in Germany.
Source: Yachar Dawudi (Centre Hospitalier de Saint-Denis) et al., Journal of Neurology, doi: 10.1007/s00415-024-12264-w