Recreational Use of Nitrous Oxide – a Growing Concern in Europe

Nitrous oxide, commonly known as laughing gas, is used medically as an analgesic and anaesthetic. It has been used recreationally for its brief euphoric effects for over 200 years, however, in the last decade, there has been a large increase in its recreational use and, more recently, an increase in reported serious health and social harms in some countries. The situation in seven European countries has been analyzed, including epidemiology, health and social harms, policy responses, and lessons learned. This can be used to inform relevant stakeholders on how to respond to nitrous. Case studies on the situation with nitrous oxide in Denmark, France, Ireland, Lithuania, the Netherlands, and Portugal were developed based on the information collected by the national Early Warning Systems within their networks and literature. For the case study of the United Kingdom, open-source data were used. In addition, relevant information was retrieved from PubMed and Web of Science. Easy availability, low price, short-lived effects, and perception as a safe and socially acceptable drug might explain growing popularity of nitrous oxide. The market has expanded in recent years with a range of specialised internet shops, partly offering it under the disguise of ‘party accessories’, but also openly when the legal situation permits. Social media is also used to promote and sell it. In some cases, the supply has moved from shops to social media following measures to restrict its supply. Of special concern is that most use of nitrous is by young people, including teenagers inexperienced with drug use. The current situation has led to an increase in frequent and heavy use and an increase in poisonings reported to poison centres. According to the French Addictovigilance networ, the number of notifications linked to nitrous increased from 10 in 2018 to 358 in 2021. Harms include frostbites, barotrauma, serious neurological toxicity (such as myeloneuropathy), cardiovascular consequences (such as thrombo-embolic events), psychiatric disorders, and driving under the influence. More recently, harms are fuelled by a switch from small canisters to large cylinders. Poison centres and the French Addictovigilance system played a key role in detecting, monitoring, and responding to the issue of nitrous oxide. Its growing recreational use is a public health concern requiring an integrated multi-sectoral approach to reduce demand, availability, and risks. The responses might include prevention, monitoring, treatment, and legislative actions. Data sharing at EU level to monitor this issue is needed.