Nitrous Oxide Abuse – Laughing Gas Is No Joke, Nurses Say

Laughing gas, “hippy crack”, noz, balloons, chargers – nitrous oxide goes by many names, but how well do recreational drug users and healthcare professionals understand the risks? According to the Royal College of Nursing (RCN), there’s a lack of understanding about nitrous oxide abuse and its health consequences – both amongst users and nurses in frontline services.

At the RCN Congress 2019, mental health educator, Becky Hoskins, said: “Often referred to as “hippy crack”, nitrous oxide appears to enjoy social acceptability as being almost harmless, [popularised by movie franchises such as Fast and Furious and video games such as Need for Speed]. The truth, however, could not be further from this view.”

In this blog, we’ll look at who is using nitrous oxide and why. What are the main concerns from nurses about nitrous oxide abuse? And what healthcare solutions can make the most difference?

If you want to stop using nitrous oxide, please speak to UKAT. We’ll assess your situation, including your full history of addiction and the wider picture of your health, so we can recommend the most effective treatment for you.

Who is Using Nitrous Oxide (Hippy Crack)?

In 2017-18, 750,000 people used nitrous oxide in England and Wales – 2.3% of 16 to 59-year-olds. 69% of all “hippy crack” users were aged 16 to 24 (521,000 people).

The numbers using nitrous oxide today, as well as the bias towards younger users, are similar to Home Office findings in 2016-17 and 2013-14. This suggests that the Psychoactive Substances Act (2016), which prohibits the supply of laughing gas for psychoactive use, has not decreased nitrous oxide use.

A 2016 study found that the UK had the highest nitrous oxide use amongst six nations surveyed. They identified the primary sources of purchase (internet), routes of administration (by mouth via balloon), and location of use (at house parties).

Laughing gas is primarily used in social contexts. A 2018 Kingston University study amongst students found that 97% prefer taking the drug with friends.

Why Do People Use Nitrous Oxide?

There’s low awareness of the risks of nitrous oxide abuse

In the Kingston University study, 92% were unaware of the harmful side effects of using laughing gas. Researchers concluded that young adults in England had a lack of concern with side effects, coupled with a willingness to use nitrous oxide.

People first try ‘hippy crack’ out of curiosity

First-time nitrous oxide users often try it for the experience. Some say they feel peer pressure to join in with friends. The desired effects include euphoria or relaxation.

Nitrous oxide is easy to purchase

Most users report that “hippy crack” is easy to get hold of (57%).

What are Nurses’ Concerns about Nitrous Oxide Abuse?

The RCN’s Mental Health Lead, Catherine Gamble, said: ‘[Nitrous oxide] might give a short-term high, but the long-term damage is no laughing matter. Along with the physical effects on the body, which themselves can be very serious, there are the psychological impacts associated with the abuse of any substance which can lead to addiction.”

Risks of nitrous oxide abuse include:

Nitrous oxide and hypoxia (lack of oxygen)

RCN member, Becky Hoskins, said: “The gravest of scenarios when using this gas can be brain damage as a result of hypoxia. This is because those using the gas recreationally inhale it without supplementary oxygen, as would be the case if given clinically. […] Repeated use of the gas, or use for extended periods during a single session, often leads to marked oxygen deprivation.”

Vitamin B12 deficiency

Speaking at the 2019 Congress, Royal College of Nursing member Claire Picton, said: “Nitrous oxide can cause problems for people by affecting the absorption of Vitamin B12. Vitamin B12 deficiency can occur or be made worse, so it can cause long-term chronic problems.”

Health problems associated with Vitamin B12 deficiency include mental confusion, brain fog, peripheral neuropathy (nerve damage in hands, feet or arms), spinal degeneration and high levels of homocysteine in the blood (which increases the risk of cardiovascular disease and dementia).

Brain development in young adults

Also connected to Vitamin B12 deficiency are risks to the still-developing brain amongst young people. “Brain development from age 18 to 25 years specifically involves the rewiring-process within the prefrontal cortex. […] Vitamin B12 deficiency – a result of repeated nitrous oxide intake – will likely impair these processes.”

Nitrous oxide addiction risk

RCN member, Becky Hoskins, said: “Little is known about the addictive nature of nitrous oxide, but it is accepted that a psychological dependency can occur for frequent users.”

Many young people also mix “hippy crack” with alcohol and other drugs, which can lead to further complications, including a higher risk of addiction.

Oesophageal or facial burns

It’s particularly dangerous to inhale nitrous oxide direct from a canister because the gas is under very high pressure. Doing so can cause burns to the face, mouth, throat or oesophagus.

Risk of death from nitrous oxide

When compared to alcohol and drugs like cocaine or heroin, the risk of death from nitrous oxide use is low. However, the drug has been linked to 17 deaths in the last 3 years.

Healthcare Solutions for Nitrous Oxide Abuse

Nitrous oxide education

The RCN Mental Health Lead, Catherine Gamble, said: “Better public information, especially aimed at festival-goers and young people, about the risks, would help people stay safe and reduce the burden on nursing professionals.”

Research studies also point to the lack of awareness of the effects and risks of nitrous oxide abuse. There’s a particular need for education around the dangers that come with increased doses in a single session, as well as chronic use of “hippy crack”.

Specialist addiction treatment for nitrous oxide abuse

Although emergency care is vital for addressing nitrous oxide abuse, there are limitations and pressures within Accident & Emergency settings. Nurses and doctors may not have a full picture of the drugs a patient has been using. They also may not be fully aware of the signs of nitrous oxide abuse, as identified at the RCN Congress 2019.

If you’re addicted to nitrous oxide, residential rehab or outpatient drug counselling are the best solutions. Specialist clinicians and/or addictions therapists will support you to stop using nitrous oxide and other substances safely. You will also develop addiction recovery strategies, to understand why you use nitrous oxide and prevent relapse.

Please call or message UKAT today for confidential and fast access to addiction treatment.