Nitrous oxide (N2O), commonly referred to as laughing gas, along with various street names, is an inert gas which can induce euphoria, dissociation, hallucinogenic states of mind, and relaxation when inhaled. Nitrous oxide has no acute biochemical or cellular toxicity and is not metabolized in humans or other mammals. Rare deaths and injuries associated with use are due to asphyxia or accidents related to alcohol, or vitamin B12 deficiency. Excessive use can lead to long-term and significant neurological and haematological toxicity, such as subacute combined degeneration of spinal cord. First recorded in the 18th century at upper-class "laughing gas parties", the experience was largely limited to medical students until the late 20th century when laws limiting access to the gas were loosened to supply dentists and hospitals. By the 2010s, nitrous oxide had become more popular as a recreational drug in the Western world and other nations. Increasing recreational use has become a public health concern internationally due to the potential for long-term neurological damage caused by habitual use. Recreational users are often unaware of the risks. Owing to the chemical's numerous legitimate uses, the sale and possession of nitrous oxide is legal in many countries, although some have criminalised supplying it for recreational purposes.
Effects
When used recreationally, nitrous oxide can induce euphoria, relaxation and a hallucinogenic state. Long-term or habitual use can lead to severe neurological damage. Nitrous oxide is said to enhance the effects of psychedelics. Since nitrous oxide can cause dizziness, dissociation, and temporary loss of motor control, it is unsafe to inhale while standing up. Safer use can involve inhalation while seated to decrease risks of injury by falling. Inhalation directly from a tank poses serious health risks, as it can cause frostbite since the gas is very cold when released. For those reasons, most recreational users will discharge the gas into a balloon or whipped cream dispenser before inhaling.
Adverse effects Death can result if it is inhaled in such a way that not enough oxygen is breathed in. While the pure gas is not acutely toxic, it inactivates vitamin B12, with continued use causing neurological damage due to peripheral and central demyelination. Symptoms are similar to B12 deficiency: anemia due to reduced hemopoiesis, neuropathy, tinnitus, and numbness in extremities. Subacute combined degeneration of spinal cord can ensue. A two-week course of vitamin B12 injection (not oral supplementation) is recommended as a first-line treatment, combined with abstinence; oral supplementation may be phased-in later. Recovery is often protracted and incomplete. Inhaling industrial-grade nitrous oxide is dangerous, as it contains many impurities and is not intended for use on humans. "Food grade" nitrous oxide is also not meant to be inhaled, as the bulbs commonly have industrial lubricants from their manufacturing process on and in them. When the bulb is punctured, these solvents can aerosolize, introducing unknown particles into the gas. These lubricants commonly leave an oily residue on the bulb "cracker" or inside the whipped cream dispenser. It is not known if nitrous oxide causes drug dependency but its use can be habit-forming.
Disabilities In 2022, an addicted couple in Portland, Oregon became temporarily unable to walk due to spinal nerve damage due to vitamin B12 inactivation caused by chronic recreational use of nitrous oxide and still had difficulties walking a year later.
Nitrous-oxide-related deaths From 1993 to 2016, 30 death certificates in England and Wales mentioned nitrous oxide. Of those, 6 were in the 17 years from 1993 through 2009, and 24 were in the 7 years from 2010 through 2016. Furthermore, the Office for National Statistics reported 56 deaths from the substance within the same region between the years of 2001 and 2020. In 2018 an Ohio University freshman died of asphyxiation as a result of nitrous oxide inhalation from whipped-cream chargers, allegedly as part of a hazing ritual. In 2020 a fifteen-year-old Irish boy died after inhaling nitrous oxide, leading to Ireland's Health Service Executive classing it as a dangerous drug.
Society and culture
Discovery and early use
Inhalation of nitrous oxide for recreational use, with the purpose of causing euphoria or slight hallucinations, began as a phenomenon for the British upper class in 1799, known as "laughing gas parties". English chemist Humphry Davy offered the gas to party guests in a silken bag, and documented its effects in his 1800 book Researches, Chemical and Philosophical which investigated "nitrous oxide, or diphlogisticated nitrous air, and its respiration". Poet Samuel Taylor Coleridge described the effect as "like returning from a walk in the snow into a warm room". During the 19th century, William James and many contemporaries found that inhalation of nitrous oxide resulted in a powerful spiritual and mystical experience for the user. James claimed to experience the fusing of dichotomies into unity and a revelation of ultimate truth during the inhalation of nitrous oxide. The memory of this experience, however, quickly faded and any attempt to communicate was difficult at best. James described a man who, when under the influence of the gas, claimed to know the secret of the universe.
Until at least 1863, low availability of equipment to produce the gas, combined with low usage of the gas for medical purposes, meant it was a relatively rare phenomenon that mainly happened among students at medical universities. When equipment became more widely available for dentistry and hospitals, most countries also restricted the legal access to buy pure nitrous oxide gas cylinders to those sectors. Even so, its use in parties continued, with gas provided by medical professionals or restaurant workers.
20th century A report from Consumers Union report from 1972 (based upon reports of its use in Maryland 1971, Vancouver 1972, and a survey made by Edward J. Lynn of its non-medical use in Michigan 1970) found that use of the gas for recreational purposes was then prevalent in the US and Canada.
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