Nitrous oxide, also known as NOS, is a colourless gas.
Since the mid-19th century, it’s been used by physicians and dentists in relation to sedation and pain reduction. Modern society also uses it as a food additive for whipped cream.
“In England and Wales, nitrous oxide was the third most used drug in 2018, 2019 and 2020 after cannabis and cocaine.”(1)
People also refer to it as “laughing gas”, “balloons”, “whippets”, and “hippie crack”.
It’s widely used at free parties and music festivals, though with its rise in popularity and due to it being easy to get hold of (i.e. through buying whipping cream equipment), it’s seen more often at house parties, and in other social settings where people want to get high.
Nitrous oxide was discovered by Joseph Priestley in 1772. Later, in 1844, dentist Horace Wells, discovered its anaesthetic properties. Pain management and reduction in the medical field are obviously invaluable, especially where surgery is required.
As with any drug, nitrous oxide is used by all sorts of people from all walks of life. While people of all ages experiment, NOS use is especially prevalent amongst people in their early 20s.
Children as young as thirteen are known to have tried it.
People from various ethnic backgrounds are known to use it, and it’s been popular at illegal raves, nightclubs, and music festivals.
Interestingly, due to cultural guidance banning the use alcohol and drugs, “there are anecdotal reports that nitrous oxide use is increasing within some Muslim communities”.(1)
In general, there was some reduction in use after the pandemic.
People don’t always view NOS the same way they do other drugs.
This is likely due to it being used in the medical field and because for a long time, the long-term effects of its use weren’t well-known.
In fact, building awareness still needs a lot of effort because of how severe some of the effects can be. More on this down the page.
NOS is a psychoactive drug, meaning it alters the functioning of the brain. It inhibits some brain receptors, causing an analgesic effect (meaning it stops pain signals, hence it is given to women in labour).
It also stimulates the release of naturally occurring opioid painkillers in the brain, as well as dopamine (causing feelings of pleasure), which are what lead to its euphoric effects.
Finally, nitrous oxide also inhibits the brainstem’s respiratory centre and this increases CO2 blood levels leading to the experience of a ‘high’.
The sought-after side effects are short-lived, usually lasting for 5 to 10 minutes. They include the following:
Other effects that can happen immediately are negative and include:
As with any psychoactive substance, there are risks because they impact body functioning. Nitrous oxide is especially risky for people with pre-existing health conditions such as heart disease and epilepsy, respiratory conditions and psychosis.
While seizures, heart attack, and death can occur, there are long-term effects that might evolve for some people, and these, at worst, are devastating.
Due to its psychoactive effects, NOS use can lead to addiction. People come to rely on nitrous oxide to function “normally” after a period of time of repeated use. This takes treatment to overcome.
Repeated use, and in some rare cases, immediately, myeloneuropathy can develop. This causes permanent nerve damage and disability. There are cases of users left wheelchair-bound due to NOS use.
The main dangers associated with nitrous oxide abuse are because of how it interferes with the body’s use of an essential vitamin. Nitrous oxide “can impair the body’s metabolism of vitamin B12”.(2)
Many people go through life without worrying too much about vitamins and minerals, not spending to much time considering the idea of certain ones being “essential”.
In a world where we are bombarded with information, knowledge on vitamins and minerals doesn’t particularly stick out.
As well as a well-balanced nutritional diet being invaluable in getting those vitamins into our body, there are also behaviours that stop us taking in vitamins and minerals, or absorbing them in instances where they’re already in the body.
Inhaling nitrous oxide prevents the body from metabolising B12. Similarly, alcohol stops the body absorbing vitamin B12. In rehab centres, users of both substances require high-dose B12 injections.
Vitamin B12 deficiency causes neurological, musculoskeletal, neuropsychiatric, psychiatric, cognitive, mobility, vascular, and sensory damage. It really is an essential vitamin that impacts almost all systems of the body.
To understand how this is experienced, take a look at the symptoms below that people can end up with due to deficiency.
Long-term, left untreated, vitamin B12 deficiency can lead to seizures, stroke, heart attack, dementia, and long-term disability. In one case study, a person became reliant on a walking stick, while another had to use a wheelchair. (3)
The effects of nitrous oxide abuse can be reversed if it’s caught early enough and the person stops using it. A combination of vitamin supplements (i.e. vitamin B12 and folic acid) and lifestyle changes (stopping use) can very quickly turn things around.
For some people, if the B12 deficiency has existed for a long time, it can take longer to recover and a more in-depth health plan from professionals.
Like any addiction, that to nitrous oxide isn’t easy to just stop for many reasons. Repeated substance abuse causes severe changes in the brain.
Addiction alters impulse control so willpower lessens and new neural pathways are created reinforcing unhealthy behaviours that become too easy to repeat.
An addiction of this severity requires treatment. This goes without pointing out that a high level amount of people who suffer with addiction often also have experienced some level of trauma, which also needs support to process and manage.
There are different types of addiction treatment. All have their benefits and being individuals, each person finds what works for them, though a combination-approach is what improves the likelihood of a positive outcome.
Treatments for addiction include:
It’s absolutely essential that a person stops using NOS if they want to heal. Vitamin B12 can only be restored if the body is given the conditions to be able to absorb it.
Where severe deficiency has occurred, a person will require vitamin B12 loading doses. Usually, this is six injections across two weeks, though some people require injections every other day until neurological symptoms start to reduce.
After this, regular monthly, two or three monthly injections for the rest of a person’s life is the common way forward.
Your aftercare programme beyond a stay at rehab will include regular B12 injections as well as some therapeutic input to keep you focused. Some people go on to become peer mentors to help others on their road to sobriety.
Spreading awareness of the effects and long-term damage of nitrous oxide abuse is important. It’s often seen as a drug that doesn’t cause any serious harm. This simply isn’t true.
Where people have pre-existing heath conditions or use NOS regularly, a vitamin B12 deficiency can develop and this leads to incredibly dangerous health risks.
Caught early enough and with the right treatment, the damage can be reversible. It’s essential people speak with a doctor and get the required treatment.
Loading up with vitamin B12 via a doctor is critical where severe deficiency has occurred.
Nitrous oxide is inhaled. Where people use it recreationally, they dispense the gas from whipping cream canisters, or from illegally gained hospital canisters, and fill balloons with the gas.
They then inhale and exhale the gas, in and out from the balloon into their lungs, causing a loss of oxygen and increase in CO2 in the lungs.
When people inhale NOS, it affects the neurons in the brain causing an increase in dopamine which leads to feelings of euphoria. It’s important to note, however, that nitrous oxide inhalation doesn’t always make a person laugh.
This drug also leads to hallucinations and loss of consciousness.
The long-term effects of inhaling nitrous oxide include addiction and those linked to vitamin B12 deficiency such as nerve damage, brain damage, loss of mobility, stroke, dementia, and heart problems.
NOS use can lead to seizures due to hypoxia. This is due to a lack of oxygen in the brain during NOS inhalation.
In worst cases, this can be fatal. The brain needs oxygen to live.
When a person uses nitrous oxide and it causes vitamin B12 deficiency, it starts to destroy the myelin sheath around the nerves. This leads to peripheral and central nervous system demyelination.(4)
In the body, it would feel like a tingling and numbness in the hands and feet. There are many other symptoms, too, which is why contacting a doctor for treatment is vital.
[2] https://medicine.yale.edu/news-article/nitrous-oxide-effects-are-reversible-with-early-treatment/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC4453489/
Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
