Recreational Nitrous Oxide Abuse: Prevalence, Neurotoxicity, and Treatment

Gao

2022

Toxics

Today, the concomitant abuse of nitrous oxide (N2O) and illicit drugs is evident and problematic. However, there are few reports regarding the clinical manifestations of N2O users when they present to the emergency department (ED). The purpose of this study was to describe the clinical presentations, the associated illicit substances used in combination, and the outcomes in N2O users visiting the ED. This was a retrospective observational cohort study. All N2O adult users admitted to the ED at Linkou Chang Gung Memorial Hospital between 2012 and 2020 were included. Demographic variables, clinical symptoms, and examination results were collected from medical records. Univariate comparisons were conducted between pure N2O users and combined illicit drug users. A total of 40 patients were included, 24 of which were pure N2O users. Limb weakness and numbness accounted for the majority of chief complaints. Neurologic symptoms were the most common clinical manifestations (90%). A more severe ED triage level, faster heart rate, greater agitation, and cardiovascular symptoms were significantly noted in combined illicit drug users. In ED, limb numbness/weakness should arouse physicians’ awareness of patients using N2O. Combined use of N2O and illicit drugs can cause great harm to health.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Clinical Presentations of Nitrous Oxide Users in an Emergency Department

Gao

2022

Toxics

Internal Medicine Journal

“…[9][10][11][12] The Ecstasy and Related Drug Markets Survey 2019 found within their sample (n = 797 self-reporting when interviewed) that use of N 2 O in the past 6 months had increased from 26% in 2003 to 53% in 2019. 10 With the perceived benefits of low cost, legal status and easy accessibility, N 2 O abuse has become a common problem in diverse parts of the world, 7 including the UK, 2,13 Saudi Arabia, 14 China [15][16][17] and Australia. [9][10][11][12] Despite its widespread abuse, the risks associated with N 2 O exposure are not sufficiently recognised by either consumers or healthcare providers.…”

Section: Introductionmentioning

confidence: 99%

Nitrous oxide‐induced neurological disorders: an increasing public health concern

Redmond

Cruse

Kiers

2022

Background Neurological presentations resulting from nitrous oxide (N2O) abuse are increasing in Australia and worldwide. Despite known neuropsychiatric sequelae, N2O canisters remain readily available and its use unregulated. Aims To examine the demographics, clinical and electrophysiological findings of patients presenting with neurological complications of N2O abuse, and thus inform clinicians and public health decision‐makers of the significant public health concerns of this increasing practice. Methods Consecutive patients presenting to a tertiary referral metropolitan hospital were included in this series. Patients were identified by a search of discharge summaries of patients admitted with acute or subacute neuropathy or myelopathy and a history of N2O abuse, and from the electrophysiology database. Results Thirteen patients were identified, most presenting with subacute paraesthesia, sensory ataxia and lower limb weakness. Eleven had low serum vitamin B12. Spinal magnetic resonance imaging was consistent with subacute combined degeneration in eight. Nerve conduction studies revealed a motor or sensorimotor axonal neuropathy (three with motor predominance). There was a bimodal demographic distribution consisting of socially isolated, international university students and local residents with a history of mental illness and polydrug abuse. Conclusions Recreational N2O use is an emerging health problem in Australia. International university students and patients with pre‐existing mental illness or polydrug use appear to be at increased risk. A severe motor neuropathy may emerge following vitamin B12 replacement. Public health measures are required to limit the availability of N2O and to educate adolescents and young adults about the potential for significant harm.

“…Although general prevalence data are lacking for most countries and N 2 O use is usually not included in general population surveys, there are some indications that problematic N 2 O use is on the rise [1,2,9]. In the United States, the number of N 2 O related cases reported to the Food and Drug Administration (FDA) (FDA Adverse Event Reporting [FAERS] data) increased from 25 in 2012 to 2015 to 99 in 2016 to 2019 [10], which referred in 70% of cases to subjects age 13 to 29 years.…”

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confidence: 99%

“…The typical recreational N 2 O user takes ≤5 hits (whippets) in a single session [8] and is unaware of its side-effects [17]. Although incidental N 2 O use is indeed associated with little or no harm, prolonged use of high doses may lead to neurological damage [8], including generalized demyelinating polyneuropathy, resulting in paraesthesia, unsteady gait, weakness and even paralysis because of spinal cord injury [1,2,8,11]. In almost all clinical cases, N 2 O-related neurological symptoms were accompanied by vitamin B 12 (cyanocobalamin) deficiency [1,8,9,18].…”

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confidence: 99%

Recreational N₂O use: just laughing or really bad news?

et al. 2021

There is evidence of a global increase in N 2 O use among young people, along with a low level of awareness about the risks of prolonged/heavy use and late presentation to treatment after experiencing side effects. We advocate a combined effort of legislation and better education about side effects to limit problems associated with excessive N 2 O use.Nitrous oxide (N 2 O; laughing gas) has been inhaled by hundreds of millions of patients in medical settings for acute pain control mainly in surgery and dentistry since 1844. N 2 O also has a long history of recreational use, but recently, there has been an increase in recreational N 2 O use in many countries, including Australia, United Kingdom, United States, the Netherlands, and China [1-3]. The highest rate of last year N 2 O use was found in the United Kingdom in 2019/2020 with 8.7% of youngsters age 16 to 24 years [4] using N 2 O in the past year, although it has stabilized over the past few years. In the United Kingdom, N 2 O use is the second most popular drug among 16-to 24-year-olds, following cannabis [5]. In Australia, an increase of 8% in 2003 to 67% in 2020 was reported among recreational drug users in New South Wales [6]. The apparent upsurge of N 2 O use and the related public nuisance (empty balloons, canisters and bulbs) have led to an increased coverage in the media demanding legislative measures aiming to take N 2 O out of legal circulation in some countries [7], although some experts are warning that criminal drug runners will then control the market and young minors will be exposed to a myriad of more harmful controlled drugs. They propose instead that youngsters should be approached with credible information to limit their use, raise awareness of early symptoms (persistent numbness and tingling in feet, mouth, tongue and fingers) and seek help [8].Although general prevalence data are lacking for most countries and N 2 O use is usually not included in general population surveys, there are some indications that problematic N 2 O use is on the rise [1,2,9]. In the United States, the number of N 2 O related cases reported to the Food and Drug Administration (FDA) (FDA Adverse Event Reporting [FAERS] data) increased from 25 in 2012 to 2015 to 99 in 2016 to 2019 [10], which referred in 70% of cases to subjects age 13 to 29 years. The FAERS cases (n = 128) comprised hospitalization (34%), disabling events (7%), life threatening events (7%) and fatalities (25%). Improved registration of the N 2 O-related events (e.g. coding) may partly explain the increasing trends in N 2 O related adverse events, but several studies from other countries have shown a similar gradual increase in clinical cases [2,9,11,12].