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Why nitrous oxide is nothing to laugh about

This fast-acting anaesthetic gas enjoys a reputation of being harmless, but could be lethal

Also known as ‘hippy crack’, this fast-acting anaesthetic gas enjoys the reputation of being harmless, but could be lethal


Nitrous oxide, or laughing gas, inhaled recreationally through balloons
poses a significant risk to young people. Picture: iStock

At this year’s RCN congress later this month, the college’s mental health forum will introduce a matter for discussion relating to the increasing use of the anaesthetic gas, nitrous oxide, to gain a ‘high’.

The forum is primarily concerned with eliciting conversation among nurses about the prevalence of the use of the gas and the complications it can cause. The forum is also interested in how we, as a profession, can inform the public while offering care and treatment for those who may choose to use it.

Many of us will be aware as nurses that nitrous oxide, commonly known as laughing gas, has been used in dentistry and surgery as an anaesthetic and analgesic since its introduction in 1844.

Recreational use

In modern times, however, there has been increasing use of the gas recreationally in the UK, particularly by younger people. It makes users euphoric though the effects pass quickly. 

Often referred to as ‘hippy crack’, nitrous oxide enjoys a social acceptability as being almost harmless; the truth however could not be further from reality.

A freedom of information request made to the Office for National Statistics in 2017 revealed that, between 2007 and 2015, 19 deaths were attributed to nitrous oxide, with figures for 2016 yet to be published.

‘Little is known about the addictive nature of nitrous oxide, but it is accepted that a psychological dependency can occur for frequent users’

Research by Seddon and Noble (2015) revealed that nitrous oxide is becoming increasingly popular with young people, with 7.6% of 16-24 year olds using it, compared with 4.2% who take cocaine and 3.9% who take ecstasy.

Many young people choose to mix it with other drugs especially alcohol, potentially leading to further pulmonary complications and a higher risk of injury or incident.

Brain damage due to hypoxia

The gravest scenario when using nitrous oxide can be brain damage due to hypoxia. This is because those using the gas universally inhale it without supplemental oxygen as would be the case if given clinically. The result is that each nitrous oxide inhalation can trigger a hypoxic response.

Nitrous oxide is fast acting and its effects last a short time, but it is recognised as producing cumulative results, so that the greater amount used the more pronounced the effects are. What this means for the person inhaling nitrous oxide is that repeated use or use for long periods during a single session often lead to marked oxygen deprivation. It is this deprivation that can, and sadly has, lead to loss of life by starving individual brain cells of their oxygen and killing them.

Little is known about the addictive nature of nitrous oxide, but it is accepted that a psychological dependency can occur for frequent users. At RCN congress, the mental health forum wishes to generate discussion about what the signs and symptoms of such dependency might be. These include airway and respiratory problems, oesophageal and facial burns from the coldness of the compressed gas.

‘As nurses, we need to be equipped to support individuals who choose to use nitrous oxide, like any other substance that is misused or abused’

Understanding why someone may choose to use nitrous oxide to detract from other psychological or physical health ailments or problems also deserves consideration.

Better informed

The forum also would like to encourage people to be better informed about the prevalence of nitrous oxide use to ensure greater research and availability of assistance for people living with dependency on nitrous oxide or even those thinking of using it.

Bringing the matter out into conversation will help to challenge the misguided view that nitrous oxide is harmless. On the contrary, it can be lethal. And it is easily purchased despite legislation to control its sale.

As nurses, we need to be equipped to support individuals who choose to use nitrous oxide, like any other substance that is misused or abused.


Further information


About the author

Stuart McKenzie is a clinical nurse manager, forensic, intensive psychiatric care and rehabilitation services at Ailsa Hospital and Woodland View Hospital, NHS Ayrshire and Arran, and a member of the RCN mental health forum. Follow him on Twitter @stueymckenzie

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