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Recreational use of nitrous oxide

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Food grade N
2O charger (bottom right), cracker (top right) and balloon
3 liter can of recreational nitrous oxide to fill up balloons.

Nitrous oxide (street name nangs, hippy crack, whippets, whippits or cannies) is a gas which can induce euphoria, hallucinogenic states and relaxation when inhaled.[1] Nitrous oxide is a neurotoxin and excessive use can cause long-term neurological and physical damage.[2][3]

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 a moderately popular recreational drug in some countries.[4]

Increasing recreational use has become a public health concern internationally due to the potential for long-term neurological damage following excessive use.[1][2] Recreational users are often unaware of the risks associated with excessive use.[5] Possession of nitrous oxide is legal in many countries, although some have criminalised supplying it for recreational purposes.

Effects

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Nitrous oxide is used recreationally, as inhalation can induce euphoria, relaxation and a hallucinogenic state.[1] Long-term or habitual use can lead to severe neurological damage.[3]

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.[6]

It is not known if nitrous oxide causes drug dependency but its use can be habit-forming.[1] 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.[3] Symptoms are similar to B12 deficiency: anemia due to reduced hemopoiesis, neuropathy, tinnitus, and numbness in extremities. As such, a two week course of vitamin B12 injection (not oral supplementation) is recommended as a first-line treatment, combined with abstinence;[3] oral supplementation may be phased-in later.[7] Pregnant women should not use nitrous oxide recreationally, because chronic use is also teratogenic and foetotoxic.[medical citation needed]

Inhaling industrial-grade nitrous oxide is also 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; 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.[8]

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In 2022, a Portland, Oregon, couple became temporarily unable to walk due to spinal nerve damage caused by the recreational use of nitrous oxide, and still had difficulties walking a year later.[9]

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From 1993 to 2016, only 30 death certificates in England and Wales mentioned nitrous oxide. Of those, 6 were in the 17-year period from 1993 through 2009, and 24 were in the 7-year period from 2010 through 2016. [10]

In 2018, an Ohio University freshman died of asphyxiation as a result of nitrous oxide ingestion from whipped-cream chargers, allegedly as part of a hazing ritual.[11]

In 2020, a fifteen-year-old Irish boy died after ingesting nitrous oxide,[12] leading to Ireland's Health Service Executive classing it as a dangerous drug.[13]

Culture and society

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Discovery and early use

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Aquatint depiction of a laughing gas party in the 19th century

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".[14] 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".[15] Poet Samuel Taylor Coleridge described the effect as "like returning from a walk in the snow into a warm room".[14]

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.[16]

1840 illustration of a man inhaling nitrous oxide, and another experiencing its effects

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,[17][18] and by other legal or illegal sources.

20th century

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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.[17][18]

It was not uncommon [in the interviews] to hear from individuals who had been to parties where a professional (doctor, nurse, scientist, inhalation therapist, researcher) had provided nitrous oxide. There also were those who work in restaurants who used the N
2O stored in tanks for the preparation of whip cream. Reports were received from people who used the gas contained in aerosol cans both of food and non-food products. At a recent rock festival, nitrous oxide was widely sold for 25 cents a balloon. Contact was made with a "mystical-religious" group that used the gas to accelerate arriving at their transcendental-meditative state of choice. Although a few, more sophisticated users employed nitrous oxide-oxygen mixes with elaborate equipment, most users used balloons or plastic bags. They either held a breath of N
2O or rebreathed the gas. There were no adverse effects reported in the more than one hundred individuals surveyed.[18]

21st century

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Discarded whipped cream chargers in a London car park, 2017

As of 2019, the gas enjoys moderate popularity in some countries as a recreational drug. Nitrous oxide has the street names hippy crack and whippets (or whippits).[1] In Australia and New Zealand, nitrous oxide bulbs are known as nangs, possibly derived from the sound distortion perceived by consumers.[19][20]

In the Southeast Asia, the trend of using funky balls, which involves inhaling nitrous oxide from balloons, has become increasingly popular in certain social circles and among young adults. This trend is commonly seen at parties, music festivals, and in nightlife scenes.

In Thailand, the use of laughing gas balloons containing N2O gas first emerged around 2013, starting with low-priced offerings along Bangkok's Khao San Road. [21] These balloons soon became available in bars and nightclubs, spreading throughout Thailand and into other Southeast Asian countries. It is expected that this trend will also gain traction in Laos, especially with the influx of Thai tourists.

In Vietnam, the use of laughing gas as a recreational substance began in the 2000s due to its affordability. Now, funky balls are popular among younger people and are seen as trendy. They are widely available in bars, pubs, and even online for home delivery. This trend is most noticeable in urban areas and social gatherings frequented by young adults.

In China, recreational nitrous oxide use is on the rise and has become a social issue.[22][23]

In the United Kingdom, as of 2014, nitrous oxide is estimated to be used by almost half a million young people at nightspots, festivals and parties. Officials in Norfolk, Hertfordshire and Thames Valley had reported increasing numbers of discarded whipped-cream chargers being found.[24]

Recreational users generally use 8 gram (¼ oz) containers of nitrous oxide "whippets", which they use to fill balloons or whipped cream dispensers. The gas is then inhaled from the balloon or dispenser.[25] This is necessary because nitrous oxide is very cold when it undergoes adiabatic decompression on exit from a canister; inhalation directly from a tank is dangerous and can cause frostbite of the larynx and bronchi.[26]

Legality

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Australia

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Supply of nitrous oxide for recreational purposes is illegal; however, it is permissible to supply it for cooking and baking purposes. As a deleterious substance, the supply of the substance for the purposes of inhalation can result in a two-year period of imprisonment.[27]

The canisters are commonly referred to in Australia as nangs.[28]

Netherlands

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Sign stating "forbidden to use nitrous oxide" in the Poelestraat in Groningen which is also known as the main nightlife area with bars, pubs, and clubs. Since 1 January 2021 the use of nitrous oxide in the area has been prohibited.

Since 1 January 2023, the possession, importing, and sale of nitrous oxide is banned in the Netherlands, with exceptions for medical use, and the food industry.[29] It is illegal under the Opium Act.[30]

Sweden

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Using nitrous oxide for recreational use is called "boffning" as slang. It is not illegal, and whipped cream chargers with nitrous oxide can be purchased as kitchen supply.[31][32] Most retailers have a voluntary age restriction of 18 years for purchase. At festivals or bigger events, sales have been stopped, referring to "environmental hazardous chemical handling".[33]

United Kingdom

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Supply of nitrous oxide for recreational purposes is illegal under the Psychoactive Substances Act 2016. This means anyone found to be selling or giving away nitrous oxide for illicit purposes could face up to 7 years in prison and/or an unlimited fine.[34] On 3 March 2023, it was announced that nitrous oxide will be prohibited under the Misuse of Drugs Act 1971.[35]

On 5 September 2023, it was announced by the British government that nitrous oxide will be categorised as a class C drug by the end of 2023, in an effort to crack down on anti-social behaviour.[36]

Slang terms used for the canisters in the United Kingdom include balloons, nos, whippits, laughing gas, hippie crack, chargers and noz.[37]

United States

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Under United States federal law, possession of nitrous oxide is legal and is not subject to DEA purview. It is, however, regulated by the Food and Drug Administration under the Food Drug and Cosmetics Act. Prosecution is possible under its "misbranding" clauses, prohibiting the sale or distribution of nitrous oxide for the purpose of human consumption (the recreational drug use market). Given the necessity of proving the intent of either buyer or seller in this case, though, such prosecutions are rare.

Many states have laws regulating the possession, sale, and distribution of nitrous oxide; but these are normally limited to either banning distribution to minors, or to setting an upper limit for the amount of nitrous oxide that may be sold without a special license, rather than banning possession or distribution completely. In most jurisdictions, like at the federal level, sale or distribution for the purpose of human consumption is illegal. In California, for instance, inhalation of nitrous oxide "for the purpose of causing euphoria, or for the purpose of changing in any manner one’s mental processes," is a criminal offense under its criminal code (Cal. Pen. Code, Sec. 381b). In most jurisdictions, small N2O cartridges, used to make whipped cream, can be legally purchased by anyone. In some jurisdictions, sales of canned whipped cream using nitrous oxide are limited to adults.[38]

In all US jurisdictions, however, distribution, possession, and inhalation are legal when done under the supervision and direction of licensed medical professional such as a physician or dentist.

Thailand

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In 2021, Thailand banned funky balls after discovering they could deprive users of oxygen, posing serious health risks. The Thai Food and Drug Administration warned against their use and distribution, with penalties for violators. Despite the ban, there have been reports of funky balls resurfacing in areas like Khao San Road in 2024, catering especially to foreign visitors.

In Thailand, funky balls are not considered illegal drugs but are used legally for anesthesia. However, people need permission from health authorities to use or sell them, ensuring they are used safely and legally.[39]

Vietnam

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Vietnam has not officially banned the use of N2O gas, but the government is considering stricter measures to control its recreational use.[40]

See also

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References

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  1. ^ a b c d e Xiang Y, Li L, Ma X, Li S, Xue Y, Yan P, Chen M, Wu J (June 2021). "Recreational Nitrous Oxide Abuse: Prevalence, Neurotoxicity, and Treatment". Neurotox Res (Review). 39 (3): 975–985. doi:10.1007/s12640-021-00352-y. PMID 33770366. S2CID 232376295.
  2. ^ a b van Amsterdam JG, Nabben T, van den Brink W (2022). "Increasing recreational nitrous oxide use: Should we worry? A narrative review". J Psychopharmacol. 36 (8): 943–950. doi:10.1177/02698811221082442. PMID 35678512.
  3. ^ a b c d Evans EB, Evans MR (November 2021). "Nangs, balloons and crackers: Recreational nitrous oxide neurotoxicity". Aust J Gen Pract (Review). 50 (11): 834–838. doi:10.31128/AJGP-10-20-5668. PMID 34713284. S2CID 240153502.
  4. ^ Quax, Marcel L. J.; Van Der Steenhoven, Timothy J.; Bronkhorst, Martinus W. G. A.; Emmink, Benjamin L. (July 2020). "Frostbite injury: An unknown risk when using nitrous oxide as a party drug". Acta Chirurgica Belgica. 120 (1–4). Taylor & Francis on behalf of the Royal Belgian Society for Surgery: 140–143. doi:10.1080/00015458.2020.1782160. ISSN 0001-5458. PMID 32543291. S2CID 219702849.
  5. ^ Allan J, Cameron J, Bruno J (2022). "A systematic review of recreational nitrous oxide use: implications for policy, service delivery and individuals". Int J Environ Res Public Health. 19 (18): 11567. doi:10.3390/ijerph191811567. PMC 9517250. PMID 36141850.
  6. ^ van Amsterdam, Jan; Nabben, Ton; van den Brink, Wim (2015-10-22). "Recreational nitrous oxide use: Prevalence and risks". Regulatory Toxicology and Pharmacology. 73 (3): 790–796. doi:10.1016/j.yrtph.2015.10.017. ISSN 1096-0295. PMID 26496821.
  7. ^ Noh, Thomas; Osman, Gamaleldin; Chedid, Mokbel; Hefzy, Hebah (July 2020). "Nitrous oxide-induced demyelination: Clinical presentation, diagnosis and treatment recommendations". Journal of the Neurological Sciences. 414: 116817. doi:10.1016/j.jns.2020.116817. ISSN 0022-510X. PMID 32302804. S2CID 214779625.
  8. ^ Erowid F, Erowid E. "N2Oily: Nitrous Oxide Chargers—Residue and Usage Surveys." Erowid Extracts. Nov 2009;17:12–14.
  9. ^ Schuster-Bruce, Catherine (18 March 2023). "A man woke up unable to walk. It turned out vitamin B12 was inactivated in his body after he took laughing gas". Insider. Retrieved 18 March 2023.
  10. ^ "Drug-related deaths involving nitrous oxide, 1993 to 2016". Office for National Statistics. 28 September 2017. Retrieved 14 February 2019.
  11. ^ Dakin Andone and Carma Hassan. "Family files lawsuit in death of fraternity pledge at Ohio University". CNN. Retrieved 10 November 2019.
  12. ^ "'Just say no' - heartbroken father whose son died from laughing gas warns others to stay away from 'lethal' drug". independent. Retrieved 10 July 2020.
  13. ^ Gleeson, Colin (8 July 2020). "Minister seeks report on use of laughing gas following death of a teenager". The Irish Times. Retrieved 10 July 2020.
  14. ^ a b Kelsey-Sugg, Anna (19 February 2019). "When people partied with nitrous oxide, it sparked a medical breakthrough". www.abc.net.au. Retrieved 6 July 2020.
  15. ^ Davy, Humphry (1800). Researches, chemical and philosophical : chiefly concerning nitrous oxide, or diphlogisticated nitrous air, and its respiration. London : printed for J. Johnson, St. Paul's Church-Yard, by Biggs and Cottle, Bristol.
  16. ^ James, William (1882), The Subjective Effects of Nitrous Oxide, retrieved 27 November 2015
  17. ^ a b Brecher EM (1972). "Consumers Union Report on Licit and Illicit Drugs, Part VI – Inhalants and Solvents and Glue-Sniffing". Consumer Reports Magazine. Retrieved 18 December 2013.
  18. ^ a b c Lynn, Edward J.; Walter, Richard G.; Harris, Lance A.; Dendy, Robert; James, Mary (1972). "Nitrous Oxide: It's a Gas" (PDF). Journal of Psychoactive Drugs. 5. Journal of Psychedelic Drugs: 1–7. doi:10.1080/02791072.1972.10471462. Archived from the original (PDF) on 2019-07-25. Retrieved 2017-02-15.
  19. ^ Emory, Sami (1 March 2017). "Will Nangs Kill You?". Vice.
  20. ^ "'Nanging' out: the rise of nitrous oxide as a Sydney party drug". The Sydney Morning Herald. 22 August 2015.
  21. ^ Gunasagaran, Suhasini (2 February 2021). "Happy Balloons Become Popular Recreational Drug in Laos". Aseanapol. Retrieved 2024-04-04.
  22. ^ "In Depth: China Needs to Get Serious About the Growing Abuse of Laughing Gas, Experts Say". Caixin Global. 2020-12-21.
  23. ^ "年轻人滥用笑气该怎么管？". Xinhua. 2023-04-13.
  24. ^ "Warning over laughing gas misuse". The Guardian. 9 August 2014.
  25. ^ Garland EL, Howard MO, Perron BE (December 2009). "Nitrous oxide inhalation among adolescents: prevalence, correlates, and co-occurrence with volatile solvent inhalation". J Psychoactive Drugs. 41 (4): 337–47. doi:10.1080/02791072.2009.10399771. PMC 2921531. PMID 20235440.
  26. ^ van Amsterdam, Jan; Nabben, Ton; van den Brink, Wim (December 2015). "Recreational nitrous oxide use: Prevalence and risks". Regulatory Toxicology and Pharmacology. 73 (3): 790–796. doi:10.1016/j.yrtph.2015.10.017. ISSN 1096-0295. PMID 26496821.
  27. ^ "Are nangs actually legal?". Leave Law to Criminals. 16 February 2019. Archived from the original on 17 February 2019. Retrieved 16 February 2019.
  28. ^ "'It's flat-out stupid': Warnings on the dangerous rise in use of 'nangs'". www.abc.net.au. October 16, 2017.
  29. ^ Rankin, Jennifer (2022-11-15). "Dutch to ban laughing gas over fears for health and road safety". The Guardian. ISSN 0261-3077. Retrieved 2023-10-20.
  30. ^ "Opium act (drugs)". www.belastingdienst.nl. Retrieved 2023-10-20.
  31. ^ "Är lustgas farligt?". Ungdomsmottagningarnas öppna webb (in Swedish). RFSU and "Ungdomsmottagningarna". Retrieved 2023-04-22.
  32. ^ Walldán, Camilla (2021-11-02). "Polisen varnar ungdomar att andas in farlig lustgas". Kungälvs-Posten (in Swedish). Retrieved 2023-04-22.
  33. ^ Eliasson, Jessica (29 December 2022). "Här kommer lustgasbilen med leverans". Uppsala Nys Ridning (in Swedish). Retrieved 2023-04-22.
  34. ^ "The Law: Psychoactive Substances". Talk to Frank. 14 February 2019. Retrieved 14 February 2019.
  35. ^ "Nitrous oxide to be banned under plans to clamp down on anti-social behaviour". Sky News. Retrieved 2023-03-26.
  36. ^ "Nitrous oxide to be categorised as class C drug". Sky News. Retrieved 2023-09-05.
  37. ^ "Nitrous Oxide – A colourless gas that people inhale, usually via a balloon". Talk to Frank. Retrieved 14 February 2019.
  38. ^ "Want to buy canned whipped cream in New York state? Don't forget your ID". NBC News. 29 August 2022.
  39. ^ "อย. เตือนสูดดมลูกโป่งก๊าซหัวเราะ อันตรายถึงเสียชีวิต ผู้ขายมีความผิด" [FDA warns that inhaling laughing gas balloons can be deadly.]. Food and Drug Administration (in Thai). 15 December 2023. Retrieved 2024-04-04.
  40. ^ "Are funky balls banned in Vietnam? Is it illegal and sanctioned to use funky balls in Vietnam? How will illegal production of funky balls supplied to the market be sanctioned in Vietnam?". LawNet. 7 October 2022. Retrieved 2024-04-04.
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