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

Abstract

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.

Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users

“…However, the evidence base is limited, and large‐scale research is necessary to corroborate and extend on our findings. As high‐risk N 2 O use is on the rise [6, 26, 77], it remains crucial to extend our knowledge to better inform treatment, encourage public health campaigns and provide arguments for the debates regarding N 2 O legislation. This narrative review provides a starting point for future research, showing that N 2 O could well be addictive and should be treated as a potentially addictive substance while we build on the existing evidence.…”

Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review

“…When detecting early signs of N 2 O toxicity (such as paraesthesia and numbness), this calls for systematic screening for those biomarkers when considering N 2 O-related toxicity or abuse/dependence, perhaps in conjuncture with a spinal cord MRI. Besides neurotoxicity, other N 2 O-related toxicity has also been documented, such as adverse reproduction effects in females after N 2 O exposure [ 92 ]. For N 2 O-related neurotoxicity, most symptoms can be reversed by vitamin B12 suppletion.…”

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

“…Irritability, psychotic symptoms, self-harm or violent behaviours following N 2 O use have occasionally been reported (Chien et al, 2020; Fidalgo et al, 2019). The association between occupational exposure of dental assistants and midwives to N 2 O (Rowland et al, 1992, 1995) may imply a reproductive risk, particularly for heavy recreational female users of N 2 O (van Amsterdam and van den Brink, 2022). A specific harm, observed in the Netherlands, was the growing number of N 2 O-related traffic accidents.…”