AKA: Laughing Gas, Whippets, Balloons, NOS, “
hippy crack” (readers of right wing tabloids), N20
Form and Products: Nitrous Oxide is a non-flammable gas. It has a several legitimate uses including:
Medical Grade: used in medicine as an anaesthetic;
Food Grade: used as a propellant for example in whipped cream dispensers;
Automotive grade: used to increase engine power output (and may also contain sulphur dioxide)
Due to packaging and routes of use Nitrous Oxide may be confused with
other gases in cylinders including CO2 cylinders and cartridges used in
soda makers and tyre refills or helium, which is also discharged in to
balloons. (Helium isn’t generally inhaled in to lungs – just held in
the mouth and so isn’t being used as an intoxicant.)
Medical Cylinders are sometimes stolen from ambulances or hospitals. A
key risk of such cylinders is that they contain a large volume of gas
and may end up being connected to a face-mask. Such use, without
adequate access to oxygen can result in hypoxia and fatalities
Automotive cylinders are the least “clean” form of nitrous oxide. The
added sulphur dioxide in the cylinder is to deter inhalation and can
cause respiratory irritation.
Food grade and recreational products:
Early on, the easiest way to access Nitrous Oxide was in foodstuffs
that contained it such as whipped cream. The amount of gas was very low
and so this was a low risk route.
As gas use increased, the main product switched to small steel
“whippets” or gas chargers. These tended to be 8g cannisters and were
intended to be used with a dispenser. In recreational use a balloon is
placed over the nozzle and gas discharged into it for use or sale. One
whippet would easily fill three balloons. In the mid 2000s in North
East London the going rate was 3 balloons for £5 in the summer parks.
The other way to discharge balloons was using a “cracker.”
Usually a small metal cylinder, the whippet was placed inside, and a
balloon placed over the end. The closing of the cracker would depress
the valve. However the increased risk of these was they allowed people
to discharge gas straight in to the mouth.
Example costs: 480 chargers (8g/charger) £140
cost per gramme: 3p
enough for 1400 balloons @ £2/balloon = £2500+
Websites shifted to selling larger cylinders. Easigas and Fastgas
cylinders containing 580g-640g became more widespread and instead of
empty whippets littering the streets it was whole cannisters.
Weight-wise large cylinders are more weight efficient than smaller
chargers and so cost less to ship.
They were typically supplied with a plastic discharge piece over which
a balloon should be placed. However again they increased the risk of
gas being sprayed straight in to the throat and also of very heavy use
in binges.
Finally, super-size cylinders appeared on the market including flavoured and branded products.
Trends:
Use of Nitrous Oxide has been poorly monitored in the UK; the Crime
Survey of England and Wales primarily looks at Controlled Drugs. It
included Nitrous Oxide from April 2012, dropped it in April 2013 and
2014 and picked it up again in 2016.
The data recorded that in 2016-17 9% of 16-24 year olds reported use in
the last year. (This was AFTER the PSA had come in to force.) The
figure stayed level for the next three years suggesting that the PSA
had little impact on use. It then dropped to 4.2% in the year April
2022/March 2023. This was independent of any legal changes, not
associated with any significant awareness-raising campaign and so it is
not clear what this drop could be attributed to. It may have been
linked to growing awareness online of the neural damage associated with
heavy use.
Amongst 11-15 year olds there is some difference in levels of use
amongst girls and boys with reported use ever amongst girls higher in
2016 and 2017. In 2021 levels of use drop in both drop but the reported
use amongst girls finishes lower than amongst boys.
|
2016
|
2018
|
2021
|
boys
|
5.5
|
5.6
|
3.2
|
girls
|
6.5
|
5.9
|
2.8
|
Appearance: Gas; most easily identified through discarded cylinders and balloons
Cost:
This will depend on volume purchased and if it’s being bought from
someone selling balloons on the street or someone purchasing directly
from a wholesaler. It generally works out at 4p/g and will be cheaper
bought direct. So a 2kg cylinder can be bought for £80 – 4p/g. 24 8g
chargers are around £8 – 192g for £8.
Quality: Unknown; some of the mass produced imported cylinders claim to be food-grade but this is unknown.
Methods of Use: Inhalation.
Generally into a secondary vessel such as a balloon and less commonly
via a face mask. Inhalation directly from a cannister brings
significant risks.
Detection: Nitrous
Oxide is primarily excreted via exhalation and there are not detectable
metabolites that would allow for testing for example in urine.
Mechanism of Action: For a relatively simple molecule Nitrous Oxide has a complex mechanism of action which isn’t fully understood.
- nitrous oxide may be a chemical that we release naturally to inhibit neuronal processes;
- nitrous oxide may cause release of natural endorphins which act on
opioid receptors (i.e. have a weak opiate-like analgesic effect)
- nitrous oxide may act on benzo receptors (anti-anxiety effect)
- it may also inhibit Glutamate receptors blocking pain signals,
reducing muscle control and creating dissociation (ketamine-like
action).
Reasons for Use:
Amongst younger people key reasons for use are likely to be experimental/curiosity and then recreational use.
The short duration of effect, low risk, lack of indicators of use and,
until recently legality made Nitrous Oxide an appealing, lower risk
option than other drugs and less likely to be detected by parents or
teachers.
Amongst recreational users, a high level of social acceptability,
social aspects of use (sharing balloons), perceived low risk and ready
access made it a popular choice across a range of demographics
especially in party settings and unlicensed music events.
Nitrous use may have increased during Lockdown as it was a readily
available drug online meaning it could be ordered for delivery and
could be used alone.
Nitrous Oxide provides may provide a moderate level of euphoria,
reduction in anxiety, reduction in physical distress and a sense of
detachment so may have some appeal as an escapist drug.
Dose ranges:
The amount used can vary massively. Some people may use two or three
whippets in an hour and then stop. Heavy use could extend to several
large cylinders a day. reports of people using 240 8g chargers or 3 x
600g cylinders a day are not unheard of.
The larger cylinders make it much harder for people to keep track of
their use. At least with smaller, 8g whippets a person can see how many
they have used whereas with larger cylinders it’s hard to guess how
much has been used in a session other than cylinder being new or empty.
This increases risk of excessive dosing in a single session. Remember
that a large 600g cylinder is the same as 75 8g whippets.
Onset and Duration: The gas starts working seconds after inhalation and short-lasting effects lasting 5-10 minutes.
Effects: Giggles,
dizziness, loss of balance. Reduction in pain sensitivity. Falls. Mild
euphoria. Mild sense of detachment. Low levels of perceptual change.
Dependency:
Nitrous oxide is not considered to be significantly physically
addictive. However it is a rewarding chemical and may encourage people
to redose.
Use may be linked to anxiety and so these or other psycho-social factors may need to be addressed.
In animal studies, short-lived alcohol-like withdrawal symptoms have been observed after heavy dosing with nitrous oxide.
Fatalities
The
ONS reports that Nitrous oxide was the third most mentioned substance
on the death certificate after butane and propane, with 56 deaths
registered between 2001 and 2020, and 45 of those having been
registered since 2010.
Overdose: There is a risk of fatality usually caused by hypoxia.
This is less likely with low dose whippets. It is more likely where
large containers are used, if a mask is used or where a container is
left open.
Usually, with balloons, if someone had used enough to cause drowsiness,
they would drop the container or balloon, start to breath oxygen and
therefore come round.
This can’t happen with a mask in place. There have been fatalities
where a large container has been left open in a confined space (e.g. a
car) and as a result person continued to inhale gas. This is a greater
risk with larger cannisters being used with twist valves which don’t
close automatically.
Harm reduction: always twist shut the valve after each use; don’t use in confined spaces, don’t use a mask, leave window open.
Other risks:
Falls and Accidents: nitrous oxide can cause loss of balance and
coordination leading to falls. It is safer to use it when seated. Use
before or while driving or operating is dangerous and has been
implicated in fatal road accidents. Nitrous oxide is exhaled so in
confined spaces (such as cars) levels of gas can build up leading to
intoxicating – and possibly dangerous – concentrations.
Asphyxiation: as well as the
risks associated with excess inhalation (hypoxia) breathing problems
can also be caused by spraying gas directly down the throat. The
freezing gas can cause swelling of the windpipe or damage to lungs.
Harm Reduction: don’t spray gas straight from dispensers, cylinders or
crackers. Always use an intermediate device such as a balloon.
Freeze Burns: as gas cylinders
discharge they become very cold. This can cause damage to soft tissue
in contact with cylinders including hands or legs where cylinders are
held between legs.
Use gloves if holding a cylinder and discharging. Don’t allow cylinders to come in to contact with bare skin when discharging.
Vitamin B12 deficiency:
Use of nitrous oxide causes vitamin B12 deficiency. It converts the
active form of Vit B12 in to an inactive one, and this B12 deficiency
can lead to neural damage by reducing the availability of myelin which
forms the protective sheath of nerves. The damage is most common in
spinal tissue and can cause a range of issues, from numbness and
balance problems to paralysis which may be permanent.
Supplementing with B12 during use doesn’t appear effective as the
supplementary doses are rendered inactive by the Nitrous Oxide so to
manage these health issues, support to stop using Nitrous Oxide
combined with B12 supplements are essential.
Some research indicates that the neurotoxic effects of Nitrous Oxide
use are more significant amongst users of Asian heritage. It is not
clear if this apparent elevated risk relates to higher levels of use,
genetic differences or dietary differences.
Implications: when working with
gas users always screen for balance issues, shakes, increased dropping
things, limb weakness. When training other professionals, especially
doctors, remind them of the importance of asking about gas use when
working with young people with any possible neural issues such as
balance problems.
In education stressing that gas-related damage can occur with
relatively low levels of use and documented cases have occurred where
people have been using 20 whippets a day over a number of weeks. The
risks clearly rise with very heavy gas use so people using large
cylinders may be especially at risk.
Legal Status:
Nitrous Oxide became a Class C drug in November 2023. In theory this
means a maximum of two years for possession and 14 years for supply.
Prior to 2016 Nitrous Oxide would have been regulated by the Medicines
Act and Food Standards regulations. So supply for the purpose of
inhalation would have fallen under these medicines regulations in the
same way applies to Nitrites.
Nitrous Oxide then fell under the Psychoactive Substances Act 2016
making it an offence to supply it where it was known it would be used
for the purpose of intoxication or where the supplier was reckless that
it could be thus used.
Websites supplying could reduce exposure to this legislation by asking
the purpose of use. While the PSA made it easier to prosecute people
supplying gas with balloons outside a party, it was not effective in
regulation the supply of large cylinders under the claim it was for the
catering industry. The PSA didn’t make personal possession an offence,
but did create a power to confiscate.
In lieu of other enforcement powers some local authorities used Public
Space Protection Order powers (PSPO) to regulate possession or supply
of Nitrous Oxide
Although the Advisory Council on the Misuse of Drugs recommended
against making Nitrous Oxide a Controlled Drugs the Home Office
proceeded to do so.
The Home Office made changes to the Misuse of Drugs Regulations as follows:
Possession: “any person may possess nitrous oxide except where the person—
(a)intends to wrongfully inhale it; or
(b)intends to supply it to another person for its wrongful inhalation by any person.
In guidance to accompany the legislative changes “If in possession of
nitrous oxide, it will be for individuals to demonstrate that they
possess the drug for legitimate purposes.”
This is an unusual legal construction as the guidance suggests a
reverse burden of proof. If a case goes to court it is up to the
Prosecution to establish beyond reasonable doubt that the person
intended to inhale the gas, not for the defendant to demonstrate that
the possession was legitimate.
Supply: any person may—
(a)supply, including by way of administration, nitrous oxide, except
where the person knows, or is reckless as to whether, it is likely to
be wrongfully inhaled by a person; or
(b)offer to supply nitrous oxide, except where the person knows, or is
reckless as to whether, if the substance were supplied in accordance
with the offer, it would be likely to be wrongfully inhaled by any
person.
This is unusual as generally with Controlled Drugs there is an absolute
binary “you are allowed to supply this” or “you are prohibited from
supplying this.” And the Government’s approach – eliding the “reckless”
aspects of the PSA with the Class C status of the MoDA creates a new
legal grey area.
Such an approach is not easy to enforce and introduces a confusing
evidentiary burden as it is hard to prove, for example that an online
retailer is being “reckless.”
Back-story and Sources:
Nitrous Oxide was identified and recorded by Joseph Priestly in 1772
and use for psychotropic effect documented by Humphry Davy in 1800.
From the late 1700s onwards Nitrous Oxide was used for recreational
purposes. In 1844 it’s use as an anaesthetic was recognised by a
dentist, Horace Wells.
Apocryphally this feature of Nitrous Oxide was inspired by seeing
people using it at parties and falling but not experiencing pain.
Since then Nitrous Oxide has continued to be used in medicine,
was explored for use in psychiatric settings, and has been used
recreationally.
In the 1980s and 1990s while something of a feature of the US drug
scene Nitrous didn’t really feature significantly in the UK. Aside from
people who had ready access to it in medical settings, use wasn’t
widespread.
The use of Nitrous Oxide to “top up” on other recreational drugs such
as MDMA was being noted in the media in the early 90s in the US
and
Nitrous use slowly increased in the early 2000s. Nitrous Oxide started
to become a feature in a lot of bars in the Mediterranean where
balloons of nitrous would be given away with shots or sold in bars and
clubs.
In the mid 2000s the upsurge of Novel Psychoactives, sometimes referred
to as “legal highs” drove an expansion of high street “head shops” and
online retailers selling unregulated drugs and this helped drive an
increase in Nitrous Availability and use.
While many novel psychoactives were brought under the Misuse of Drugs
Act the rest were more loosely regulated under the Psychoactive
Substances Act 2016. The looser regulation that this afforded meant
that possession of Nitrous Oxide was not illegal and supply was only an
offence if it was known (or the retailer was reckless) that the product
would be used for intoxication.
So while other emergent drugs vanished from the scene, sales and use of
Nitrous Oxide expanded massively with a significant number of online
retailers selling it directly or via platforms such as e-bay or Amazon.
Direct sales also continued to take place “under the counter” from
shops and onward distribution from people buying large cylinders and
then selling balloons on to end users in street, club and party
settings.
The impact of the move from the Psychoactive Substance Act to the
Misuse of Drugs Act has yet to be fully measured. Online retailers
appear to still be trading, using the argument that it remains
legitimate to supply for authorised uses.
It seems likely however that overall availability and use will decline
as personal possession becomes a criminal offence and supply is reduced.