Nitrous oxide: a unique official French addictovigilance national survey

Abstract

IntroductionNitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide.Materials and methodsWe analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported.ResultsA total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported.DiscussionThe combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider “nitrous oxide” in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out.

Marked increase in severe neurological disorders after nitrous oxide abuse: a retrospective study in the Greater Paris area

“…While this study was restricted to the Greater Paris area, which comprises 20% of the French population (12.4 million inhabitants), N 2 O consumption has become a worldwide practice [ 6 – 8 , 20 ]. In France, both COVID-19 and lockdown may have contributed to the increased consumption [ 8 , 21 ], but there was already a global trend of increased use before the pandemic in other countries [ 22 , 23 ].…”

“…While this study was restricted to the Greater Paris area, which comprises 20% of the French population (12.4 million inhabitants), N 2 O consumption has become a worldwide practice [ 6 – 8 , 20 ]. In France, both COVID-19 and lockdown may have contributed to the increased consumption [ 8 , 21 ], but there was already a global trend of increased use before the pandemic in other countries [ 22 , 23 ]. Globally, the escalation in N 2 O consumption, as well as the reported increase in complications, dates back to around 2018, coinciding with the introduction of N 2 O carboys on the market 23 , 24 .…”

“…Furthermore, as the incidence of severe N 2 O-induced (NI) neurological disorders (NI-NDs) increases, so does the risk of confusing NI-NDs with its differential diagnoses, potentially leading to therapeutic errors. Although several small series are available, the incidence of NI-NDs has only been captured indirectly through spontaneous drug safety notifications [ 8 ]. We investigated the incidence and characteristics of severe NI-NDs among adults in the Greater Paris area.…”

Yes, nitrous oxide addiction undeniably exists!

“…All substances that act upon the opioid or GABA system are known to have an addictive potential. Thirdly, there is the evolution of N2O consumption: since 2018, consumption has surged, far surpassing the balloons and 'five shots' mentioned by Back et al, reaching levels equivalent to several hundred cartridges daily [5]. N2O has become a public health problem in many countries during the last few years [6].…”

“…The Addictovigilance network relies upon medical notifications of SUD, a regulatory obligation for health professionals. A total of 525 cases of N20 use were published [5], with an exponential increase between 2019 and 2021. Changes in notification characteristics were observed, including increased quantities consumed (use of cylinders), a negative evolution of usage contexts with a search for self-therapeutic effects.…”