Laughing gas appears initially to be a fairly harmless drug. It doesn’t have a giveaway smell or any obvious adverse side effects – and it’s cheap. Post-pandemic there has been a huge rise in the number of teenagers and young adults taking it: today there are more than 600,000 regular users in the UK. After the Notting Hill Carnival, there were more than 3.5 tonnes of canisters left behind. Which is why, yesterday, Rishi Sunak has pledged to make laughing gas a class C drug by the end of the year in a move to ban the substance. The Prime Minister has come under some immediate criticism for choosing to focus efforts on a drug assumed to be benign, but the nitrous oxide’s debilitating long-term consequences have received much less attention.
Inhaling the substance gives users a fleeting high, its effects lasting only seconds. Then it’s straight back to normality. It’s popular because it’s such a quick hit. However, prolonged use can have devastating consequences, causing nerve damage, paralysis, and, in extreme (and rare) cases, death.
‘Because the drug affects the spinal cord, it’s not just walking that’s affected. I’ve seen many people who are incontinent, and people who have erectile dysfunction.’
‘One of my patients came to hospital paralysed. He is now beginning to walk, but he can’t run,’ Nikos Evangelou, a consultant neurologist based in Nottingham, tells me. ‘The last couple of guys I saw were also paralysed when they presented to hospital. People are slow to present because they think the tingling and numbness is the “normal action” of the drug.’
Laughing gas induced nerve damage is, in fact, fast becoming an epidemic. In a recent TikTok video, Consultant neurologist David Nicholl said he’d seen a significant uptick in cases presenting in hospital post-pandemic. ‘In the last 20 years,’ he said, ‘a consultant would maybe see one or two cases, but then it started picking up in the pandemic, so during lockdowns we would maybe see a case every couple of months or so but now we see one every week. I would describe it as an epidemic, and that’s not just me saying that: colleagues would too.’
The gas, referred to as ‘NOS’, ‘balloons’ and, in certain newspapers, ‘hippy crack’, is formally known as nitrous oxide. Joseph Priestley discovered it in 1772. Today it’s used as a dental anaesthetic and in cooking for making whipped cream. (Internet data will, no doubt, be able to show there’s a raft of teenagers very into dessert toppings.)
Once it came in small silver canisters called ‘whippets’. Now, the canisters on the streets are much larger – and more dangerous as a result. They cost as little as £30 and can be bought legally online; there are even QR codes on some canisters that give users a discount for their next purchase. Whereas ‘whippets’ gave a single hit, users today no longer know how much they are taking and are therefore much more likely to inhale greater amounts of the drug. ‘People are getting much higher doses than what they’re used to,’ one doctor says. ‘For that reason, we’re seeing many more people coming in with complications.’
How does the drug work? Nitrous oxide causes changes in the body when it’s inhaled. The process – ‘oxidation’ – inactivates vitamin B12, which is an important substance necessary for the formation of brain and nerve cells. In its inactive form, B12 cannot produce important parts of nerve cells, called myelin, or help to produce DNA. When neurons ‘demyelinate’, they cannot transmit nerve signals effectively. This manifests as spinal cord lesions and neuropathies, causing serious neurological disease.
At first, B12 deficiency may seem harmless: users’ hands and feet might tingle. But, as it progresses, it gets far more serious. The initial ‘buzzing’ sensation in the user’s feet evolves to become a loss of sensation in their limbs, causing difficulty walking. Dr Stephen Keddie, a senior neurology doctor working in East London, describes how bad it can get: ‘We’ve had people come in with complete loss of sensation in the lower limbs, with difficulty walking because they’ve got no idea where their limbs are in space – we call that proprioceptive loss – and that can make them walk with a very broad-based gait.’
And it’s not just lower limbs that are impacted: patients find the tingling and numbness can occur in their hands, causing a loss in their manual dexterity. As a result, people have reported difficulties putting on makeup, playing computer games, typing or using a computer mouse, and even writing.
The brain is affected too: patients’ cognitive processes slow down. Some can’t talk properly; others suffer memory problems. ‘Because the drug affects the spinal cord, it’s not just walking that’s affected. I’ve seen many people who are incontinent, and people who have erectile dysfunction,’ Dr Keddie says. ‘These are all things that are underreported.’ Worst of all? Nerve damage caused by B12 deficiency is not fully reversible.
So could youngsters, once perfectly healthy, permanently lose their ability to walk or run as a result of abusing nitrous oxide? ‘It’s conceivable if you have severe enough damage in your spinal cord’, a neurologist tells me, ‘that you could remain wheelchair-bound for life.’
‘It’s devastating,’ another neurologist says as he recalls the patients that he’s seen. ‘These are young people who have their whole lives ahead of them, unable to walk or go to the toilet by themselves as a result of using NOS.’
Patients who are treated in hospital receive intravenous vitamin B12 injections until they can at least walk with the aid of a stick. Once discharged, they will continue on oral B12 medication at home. While some see an improvement in symptoms, a full recovery isn’t thought possible; many remain disabled in some way. One 25-year-old from London said that her laughing gas use has caused damage to her back, and now, her dad is her full-time carer. ‘I know there’s no way of reversing the damage I’ve done, and I feel like my life’s over – and I’m only 25,’ she told the Sun.
Laughing gas is not thought to be physiologically addictive, like heroin. Yet several doctors I spoke to said that they saw their patients continue to take it even after suffering serious mobility and nerve damage. One user, Billie Dee, said that coming off laughing gas was harder than coming off other substances. ‘Having been addicted to MDMA and cocaine,’ she said. ‘I can honestly say nitrous oxide for me was far more addictive than any other class A drug.’
It has reportedly become the preferred drug of choice in many Asian communities. Dr Keddie says that many of those presenting in his East London clinic are from Asian backgrounds. ‘You do tend to see quite a lot of people who are Muslim.’ Youngsters from these backgrounds who can’t drink are likely using laughing gas because it is hard to spot. While cannabis has a characteristic smell, and often causes its users’ eyes to go red, laughing gas is not at all conspicuous. It’s a convenient high: short-lived and lacking in side effects, initially anyway.
The sad reality is that we are stabbing in the dark when it comes to dealing with laughing gas; long-term data has not been collected, and many studies are only just beginning now.
The sad reality is that we are stabbing in the dark when it comes to dealing with laughing gas; long-term data has not been collected, and many studies are only just beginning now. ‘The spectrum of disease is so varied,’ Dr Keddie says, ‘and we don’t know what the risk factors are. Using evidence from friends as a reason why you think you’re going to be okay is absolutely not evidence-based whatsoever.’
A number of doctors told me that their patients often didn’t turn up for their follow-up appointments either, meaning that they don’t see how they’re doing several months on and cannot fully predict how long-lasting or severe the impacts of the drug are. Even Prince Harry has admitted to taking ‘slow, penetrating hits’ of nitrous oxide — while his son was being born, despite it usually being the person actually giving birth requiring light anaesthetic — though this revelation has been brushed aside as the media focuses on his admission to using stronger substances.
It was made illegal to buy laughing gas for recreational use seven years ago. But walk down almost any street on a Saturday morning and you’ll see canisters littering the roads. During Notting Hill carnival, teenagers strolled through west London inhaling the stuff with impunity. Have the police turned a blind eye to what is, in fact, a highly dangerous substance? Even in Holland, where cannabis is legal, the sale of laughing gas is tightly regulated.
The British Compressed Gases Association (BCGA) has been campaigning heavily for the government to ban its retail sale. Indeed, recent data from the Crime Survey for England and Wales shows that around 230,000 adults between the age of 16 and 24 said they had taken the substance in the last year. Some UK doctors have been working with the Advisory Council on the Misuse of Drugs (ACMD) to better inform the government of the harms caused by laughing gas and to push the argument for the reconsideration of its the legal status, though they advised last month that ‘no single recommendation on its own is likely to be sufficient to successfully reduce the harms associated with nitrous oxide use’.
There had been murmurings under the previous home secretary Priti Patel of steps to be taken to stop young people coming to harm from nitrous oxide. Now though, it is at long last that Rishi Sunak’s government has announced plans for a ban that looks to prevent not only the littering of canisters across our streets — but the horrifically debilitating effects of the drug.
Comments