Alarming increase in poisonings from recreational nitrous oxide use after a change in EU-legislation, inquiries to the Dutch Poisons Information Center

Riel, Antoinette van; Hunault, Claudine C.; Hengel-Koot, I.S. van den; Lonkhuyzen, Johanna J. Nugteren–van; Lange, Dylan W. de; Hondebrink, Laura

doi:10.1016/j.drugpo.2021.103519

Cited by 19 publications

(44 citation statements)

References 8 publications

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“…In the Netherlands, the incidence rate of N 2 O poisonings reported to the Netherlands Poison Information Centre (NVIC) steeply increased from around 6 per year between 2010 and 2015 to 144 N 2 O reported poisonings in 2020. Only 15% of the N 2 O cases had concomitantly used other drugs and the median age of patients was 22 years (NVIC, 2020; van Riel et al, 2021). In 2019 and 2020, 79% of the N 2 O inquiries at the NVIC indicated heavy and/or frequent N 2 O use, 42% of them had used 2 kg tanks (9% in 2018; 31% in 2019; and 51% in 2020) and 38% reported signs of peripheral neuropathy (van Riel et al, 2021).…”

Section: Reported N2o-related Incidentsmentioning

confidence: 99%

“…Only 15% of the N 2 O cases had concomitantly used other drugs and the median age of patients was 22 years (NVIC, 2020; van Riel et al, 2021). In 2019 and 2020, 79% of the N 2 O inquiries at the NVIC indicated heavy and/or frequent N 2 O use, 42% of them had used 2 kg tanks (9% in 2018; 31% in 2019; and 51% in 2020) and 38% reported signs of peripheral neuropathy (van Riel et al, 2021). Since their introduction, large 2 kg tanks or even 10 kg tanks are used, instead of the standard cartridges of 8 g, to fill the balloons.…”

Section: Reported N2o-related Incidentsmentioning

confidence: 99%

“…Furthermore, N 2 O canisters/whippets are readily available to purchase in night and kitchen shops, on the Internet or via street dealers. With respect to the overall safety of N 2 O use, the emerging use of larger tanks or ‘smart whip’ cylinders, containing 0.6–10 kg of N 2 O, is of concern, because they efficiently allow a much higher exposure of individual users to N 2 O (higher dose, longer continuous duration) compared to whippets, which has meanwhile led to increased reports of peripheral neuropathy (van Riel et al, 2021). In the ethnic minority group of young Dutch Muslim migrants, marginalization, boredom, unemployment, deteriorated social interactions, social isolation and macho behaviour were important drivers of excessive N 2 O use (Nabben et al, 2021).…”

Section: Risk Factors Of Excessive N2o Usementioning

confidence: 99%

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Increasing recreational nitrous oxide use: Should we worry? A narrative review

2022

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Background: Since 2000, the prevalence of recreational nitrous oxide (N2O) use has increased in the Western world. Although N2O is a relatively safe drug, the overall increase in the use of N2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N2O-induced vitamin B12 deficiency. The increasing trend of recreational users with N2O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N2O use. Conclusion: It is concluded that the increase in excessive N2O use is of serious concern.

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Section: Reported N2o-related Incidentsmentioning

confidence: 99%

Section: Reported N2o-related Incidentsmentioning

confidence: 99%

Section: Risk Factors Of Excessive N2o Usementioning

confidence: 99%

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Increasing recreational nitrous oxide use: Should we worry? A narrative review

2022

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“…Increased availability of larger volumes of N 2 O might underlie clinicians’ concerns. The Dutch Poisons Information Center reported an annual average of six poisonings between 2010 and 2015, which rose to 144 in 2020 10. The increase was associated with a shift from heavy and frequent use of 8 g cartridges to large canisters (up to 1 kg) and cylinders (2-10 kg).…”

Section: Clinical Presentationsmentioning

confidence: 99%

Recreational use of nitrous oxide

Sumnall

2022

BMJ

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“…For instance, the majority (77%) of N 2 O users in the Netherlands was unaware of the drug’s harmful effects (Kaar et al, 2016). The use of hundreds of bulbs daily for prolonged periods of time and continuous filling and inhaling N 2 O balloons using large 2 kg N 2 O-tanks is emerging (van Riel et al, 2022), though fortunately, this is still an exceptional practice among recreational N 2 O users. These new practices are of concern, because repeated exposure to high doses of N 2 O for a prolonged time is known to induce vitamin B 12 deficiency and related neurological damage, such as (irreversible) neuropathy and paralysis (for references, see van Amsterdam et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Nitrous oxide–induced reproductive risks: Should recreational nitrous oxide users worry?

Amsterdam

Brink

2022

J Psychopharmacol

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Background: Nitrous oxide (N2O) is a frequently used anaesthetic. Since the year 2000, recreational use of N2O, also known as ‘laughing gas’, became popular as a recreational drug due to its mild psychedelic effect. In the 1980s, several reports warned against N2O-induced reproductive risks among healthcare personnel, questioning the occupational safety of N2O in health care. Methods: Data about the reproductive risks of N2O were collected from literature. Results: Particularly in the past, professionals working in dental and midwifery practices, operating theatres and ambulance transport were exposed to high levels of N2O. Adverse reproduction effects included congenital anomalies, spontaneous abortion and reduced fertility rates in females. Following occupational measures, like maximal exposure limits for ambient N2O, this occupational risk was considerably reduced. Recreational users of N2O, however, voluntarily and repeatedly expose themselves to (very) high doses of N2O. As such, they exceed the health exposure limits some hundred times, but they are fully unaware of the related reproductive risks. Conclusion: We advocate to increase the awareness in recreational N2O-users about its potential reproductive risks, especially in heavy users, pregnant users or those who intend to become pregnant.

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Alarming increase in poisonings from recreational nitrous oxide use after a change in EU-legislation, inquiries to the Dutch Poisons Information Center

Cited by 19 publications

References 8 publications

Increasing recreational nitrous oxide use: Should we worry? A narrative review

Increasing recreational nitrous oxide use: Should we worry? A narrative review

Recreational use of nitrous oxide

Nitrous oxide–induced reproductive risks: Should recreational nitrous oxide users worry?

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