What are the effects of recreational nitrous oxide use?

Dear Hippi crack and Balloon-head,

Nitrous oxide has a long medical history as a mild anesthetic, commonly used today for sedation and pain relief during minor medical procedures. It's casually known by many names, including laughing gas, whippets (when the gas is inhaled from a whipped cream dispenser), nitro, buzz bombs, hippy crack, and more. Nitrous oxide is a colorless, slightly sweet-smelling gas that may cause giddiness, a dreamy or floating sensation, and a pain-free state. Legally, it’s most commonly used during minor oral surgery and dental work, but it’s also become a popular recreational drug — the seventh most popular in the world, to be exact. Most recreational users of nitrous oxide choose to use the drug in social settings, and unlike many other illicit drugs, the effects are short-lived, typically lasting between two and five minutes per use. Despite being available in the United States for purchase, recreational use is illegal due to the potential health risks associated with improper use, which may result in brain damage, suffocation, and even death. Despite the nickname, nitrous oxide is no laughing matter!

When a health care provider uses nitrous oxide to manage a patient’s pain during a medical procedure, the gas is carefully administered to ensure the correct ratio of nitrous oxide to oxygen in order to decrease pain without impacting breathing. Outside of a medical setting, people using nitrous oxide recreationally aren't able to control the amount of nitrous oxide as precisely, potentially leading a person to starve themselves of oxygen accidentally. This lack of oxygen may in turn cause the user to pass out or even die. Additionally, nitrous oxide is an anesthetic, which impairs the body’s coordination and awareness even when oxygen flow is maintained to the brain, leading to increased risk of falling. In fact, many injuries and deaths from inhaling nitrous oxide are due to injuries sustained by falling or passing out.

Other than the risk of falling or passing out, what’s all this business about “killing brain cells?” Well, it depends. As mentioned previously, attempting to breathe large amounts of nitrous oxide may result in oxygen starvation and suffocation; if oxygen access isn’t restored, that suffocation may lead to brain damage and death within minutes. Use of nitrous oxide is more likely to result in suffocation if it’s used in a way that prevents easy and rapid access to oxygen, such as filling a car, room, or bag over the head with nitrous oxide. Additionally, long-term use of nitrous oxide affects the body’s ability to use the vitamin B12, which is an essential vitamin for maintaining brain health and functioning. Over time, vitamin B12 deficiency may result in damage to the material covering the neurons in the brain (called myelin), negatively affecting brain function.

While oxygen starvation and injuries from falls are the most acute risks associated with nitrous oxide use, they’re not the only ones. Inhaling large quantities of nitrous oxide may result in loss of blood pressure, heart attacks, or other adverse cardiac events, and this is more likely to affect people with underlying heart conditions. Using any inhalant from a pressurized canister also poses the risk of damaging the throat, vocal cords, and lungs, since the released gas is both highly pressurized and intensely cold (up to negative 40 degrees Celsius!). Inhaling nitrous oxide directly from the dispenser or nozzle of the canister may even result in frostbite. And, while nitrous oxide is less addictive than many other recreational drugs, it's still possible to become psychologically addicted to the pleasurable effects of taking nitrous oxide.

Beyond recreation, nitrous oxide is used in a variety of ways, including some that may surprise you! Its most common use is to numb and sedate patients for minor medical procedures. It's also found in whipped cream canisters as a food additive and in car engines to enhance their performance. Nitrous oxide is also increasingly being used to treat patients who are experiencing alcohol withdrawal, and there is preliminary research suggesting it may be beneficial in treating depression (though much more research into this topic is needed before drawing any firm conclusions).

Despite the health risks, many people still use nitrous oxide recreationally. While there is no “safe” level of drug use, nitrous oxide is one of the least risky recreational drugs out there, when used by people in good health who take some safety precautions to reduce the risk of life-threatening effects. If you choose to use the drug, you may decide to take the following steps to reduce your risk:

• Sit or lay down: Nitrous oxide both impairs your coordination and increases the risks of fainting, so find a spot to sit or lay down where you aren’t at risk of hitting your head or otherwise injuring yourself if you lose coordination or consciousness.
• Use the balloon method: This method involves releasing the gas from the pressurized canister into a balloon, then holding the balloon to the mouth and breathing in the gas from there. This method achieves a few things. First, it regulates the pressure and temperature of the gas, reducing the risk of frostbite and damage to the mouth and lungs. Second, it’s considered the least risky method of inhalation because if oxygen levels in your body drop too much, you won't have the muscle control to continue holding the balloon to your lips, resulting in you dropping the balloon and breathing in oxygen from the surrounding air.
• Avoid filling a space with nitrous oxide: This includes a room, car, bag over the head, gas mask, or other enclosed space. Doing so greatly increases the risk of oxygen starvation and death, since you might be unable to escape the situation and regain oxygen access if you lose coordination or consciousness.
• Use in social settings around other people: In case you do injure yourself or lose consciousness, the other people around you will be able to seek medical assistance on your behalf.
• Avoid combining with other drugs or alcohol: While there’s limited evidence that mixing nitrous oxide with other drugs increases the physical risks, using other drugs simultaneously may further impair your coordination or decision-making, potentially leading you to take fewer safety precautions than you otherwise would.

Nitrous oxide has a host of legitimate uses, but it’s not without its health risks if used improperly. But whether you choose to use or abstain, acquisition of knowledge never hurts! For more information about nitrous oxide and other inhalants, check out the National Institute on Drug Abuse (NIDA) website.