Warning: This Popular Recreational Activity Can Cause Serious and Permanent Neurological Defects

Not a laughing matter

By CANADIAN MEDICAL ASSOCIATION JOURNAL  

Nitrous oxide, often referred to as “laughing gas”, is a widely recognized recreational drug, especially among young individuals. Its popularity is driven by its affordability and easy online access. 

However, chronic use can lead to serious neurological issues stemming from a functional vitamin B12 deficiency. Key symptoms include damage to the spinal cord, nerve damage, and behavioral abnormalities. Medical professionals are advised to question patients about nitrous oxide use if they present symptoms suggestive of vitamin B12 deficiency.

Nitrous oxide, commonly known as “laughing gas,” is not just a popular recreational drug, particularly among the youth, but also an anesthetic frequently utilized in pediatric and dental procedures. 

Due to its affordability and easy online accessibility, many are resorting to its use for a quick high. In the 2021 Global Drug Survey, 10% of all respondents, and 15% of Canadian respondents, indicated having used the drug in the previous year.

Growing Concerns Among Professionals

“The low cost of and ease of access to nitrous oxide make it a popular recreational drug, especially among younger people,” writes Dr. Cyrille De Halleux, a specialist in internal medicine, critical care, and resident at The Hospital for Sick Children (SickKids) and chief fellow in the Division of Clinical Pharmacology and Toxicology at the University of Toronto, Toronto, Ontario.

Health Implications of Nitrous Oxide

Chronic use of nitrous oxide can cause functional vitamin B₁₂ deficiency, which can result in long-term health effects, especially neurological consequences. The three most common presentations of toxicity are damage to the spinal cord (myelopathy), nerve damage affecting strength and sensation (neuropathy), and behavioral abnormalities (encephalopathy). Treatment includes stopping the use of the substance, vitamin B₁₂ supplementation, and methionine.

“Clinicians should enquire about nitrous oxide use in patients with unexplained findings suggestive of vitamin B₁₂ deficiency or other compatible neurologic symptoms,” the authors conclude.

Reference: “Diagnosis and management of toxicity associated with the recreational use of nitrous oxide” by Cyrille De Halleux and David N. Juurlink, 21 August 2023, Canadian Medical Association Journal.
DOI: 10.1503/cmaj.230196