Laughing gas: How dangerous is the party drug?

I was 17 years old the first (and only) time I used laughing gas — nitrous oxide — for fun. I was with some friends who showed me. It was sold at the grocery store.

As an anxious teenager, I was wary, but the fact it was available for legal purchase at the supermarket helped assuage my concerns. If it was really that harmful, I thought, surely it wouldn't be available for anyone to buy.

Health experts say this is a common introduction to the party drug. Kids are told, often by peers, that laughing gas won't harm them. They may believe it because there are no warnings plastered across whipped cream canisters in stores. You don't have to find a dealer, or even be 21, to get hold of the substance.

Many teenagers don't realize laughing gas is dangerous 

In 2018, a report published in the journal Frontiers in Psychiatry reported that 92% of teenagers in the UK who had heard of laughing gas "were not aware of any side effects" associated with its use.

Now, governments are moving to regulate the substance. The UK passed a law in 2023 banning nitrous oxide. It is classified as a drug in the Netherlands. And as recently as May 2024, Louisiana became the first US state to sign a law prohibiting laughing gas from being sold in retail stores. German regulators are also considering a ban.

But why? What makes nitrous oxide dangerous? Here's what you should know about laughing gas and how it can affect your health.

What is laughing gas and why is it widely available?

Laughing gas is the colloquial term for nitrous oxide, a clear gas.

It is used in medicine to relax patients when they are having wisdom teeth removed, for instance, or during childbirth.

Nitrous oxide can cause a euphoric feeling that users describe as a "head rush." You may feel light-headed, dizzy or disoriented.

When used recreationally, the effect of the gas is short-lived, lasting 30 seconds to a minute. Users may inhale it multiple times in a single session.

Along with its use in medical settings, nitrous oxide is used to make whipped cream, hence its availability at your local grocery store.

The canisters are reportedly also sold at kiosks and corner shops across Europe and in vape shops in the US.

Health experts say they have seen a boom in the number of vendors selling nitrous oxide since 2017. That's according to Devan Mair of a student campaign at Queen Mary University of London called N2O: Know the Risks. 

N₂O is the chemical formula for nitrous oxide — a compound of two nitrogen atoms and one oxygen atom. 

Can nitrous oxide be addictive?

Although health experts have said most laughing gas users take the substance infrequently, some research has indicated a subset of individuals who appear to get hooked. But the evidence is thin.

Researchers set out to determine whether nitrous oxide could be addictive in an evaluation of the evidence, a so-called meta study published in the journal Addiction in October 2023.

They found that, although the research is sparse, what has been published indicates "consistent evidence for the presence of at least four substance abuse disorder criteria in heavy N2O [nitrous oxide] users."

The authors concluded that nitrous oxide "could well be addictive." They advised that it should be handled as a "potentially addictive substance" until more assessments are conducted.

How common is laughing gas usage?

Recreational use of nitrous oxide varies from country to country.

The UK, for example, has reported some of the highest levels of its illicit use. A British government report in 2020 warned that nitrous oxide was second on the list of the most commonly used recreational drugs among people aged 16 to 24.

In other European countries and in the US, people also use the substance to get high, with numbers of these users reportedly growing.

A 2018 study of nitrous oxide use in China indicated that teens picked up the habit from peers who studied abroad. Nitrous oxide is banned for recreational sale in Australia and Japan.

Research on the drug's ubiquity in places like India, the Middle East and sub-Saharan Africa is largely non-existent.

What are the negative side effects of laughing gas?

Apart from the initial short-term effects described above, regular use of laughing gas has been associated with neurological complications. 

In heavy users, nitrous oxide can inactivate vitamin B12, which aids in the formulation of myelin, Mair told DW.

Myelin, or the myelin sheath, is a protective layer on nerves — including those in the brain and spinal cord. When myelin fails to form, a person's nerves can become damaged, resulting in numbness, the feeling of pins and needles in the hands and feet, loss of balance and general weakness. 

Mair said such cases were common in the UK. "At the Royal London Hospital in East London, in Feb 2023, there was a case of nitrous oxide-related nerve damage every nine days," he said.

Experts say if a heavy recreational user of nitrous oxide starts to notice serious symptoms of a B12 deficiency, they should seek emergency care immediately.

According to a 2023 report on nitrous oxide published by the British government, these warning symptoms include: tingling and numbness in the hands or feet, skin crawling, and later, "staggering uncoordinated walk, lower limb weakness, muscles stiffening or tightening, overactive or overresponsive bodily reflexes such as twitching, bladder/bowel complaints of incontinence or retention and sexual dysfunction."

The adverse effects of nitrous oxide can be reversed, but only if they are addressed quickly. Seek medical advice if you feel unsure and require more information.

Edited by: Zulfikar Abbany

Sources:

Up: The rise of nitrous oxide abuse. An international survey of contemporary nitrous oxide use. Journal: Journal of Psychopharmacology. https://pubmed.ncbi.nlm.nih.gov/26912510/

Laughing gas inhalation in Chinese youth: a public health issue. Journal: The Lancet. https://www.thelancet.com/journals/lanpub/article/PIIS2468-26671830134-8/fulltext

No Laughing Matter: Presence, consumption trends, drug awareness, and perceptions of "Hippy Crack" (Nitrous Oxide) among young adults in England. Journal: Frontiers in Psychiatry https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786547/

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. Journal: Addiction Opinion and Debate https://onlinelibrary.wiley.com/doi/10.1111/add.16380

Nitrous oxide: updated harms assessment, UK government report, 2023 https://www.gov.uk/government/publications/nitrous-oxide-updated-harms-assessment/nitrous-oxide-updated-harms-assessment-accessible#uk-prevalence-and-patterns-of-use