| Nitrous Oxide: harm reduction advice |
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Drug Information - Nitrous Oxide/ Laughing Gas / N2O What is Nitrous oxide? Nitrous oxide, (N20) is a gas with pain-relieving properties. It has been used as a recreational drug for over 200 years; about as long as it has been used in medicine. Nitrous oxide mixed with oxygen is the ‘gas and air’ given to women in labour, and is used in dentistry to relieve pain and anxiety. It has become widely and easily available for recreational use because it can be legally sold for the purpose of making whipped cream quickly. Patterns of Use Since the ‘laughing gas parties’ held by the upper classes in the Georgian era, nitrous oxide is a drug most associated with occasional social use. It is popular at house parties and music festivals, where balloons filled with the gas may cost around £1.50. Whilst some people do take it alone (sometimes to enhance sexual pleasure), few make it a regular part of their lives. However, very occasionally, people become dependent and take it persistently. Appearance and effects Nitrous oxide itself is a colourless gas that is slightly sweet-smelling and tasting. Recreational users normally get it from whipped-cream chargers, sometimes called ‘whippits’, which are single-use, finger-length steel cartridges containing 8g of highly pressurised nitrous oxide. Whippits are usually discharged into a balloon with a kind of whipped cream dispenser or a smaller widget called a ‘cracker’. Nitrous oxide is also found in supermarket cans of whipped cream. Other sources include full sized gas cylinders, intended for medical or industrial use. When someone inhales nitrous oxide, the gas rapidly dissolves into the bloodstream, and hits the brain within seconds. Effects vary between people and are rarely quite the same twice, but a rush of dizziness and euphoria is normal, and people often burst out laughing. Sound is oddly distorted, voices and music often turning into a throbbing roar like a helicopter. Nitrous oxide is a ‘dissociative’ drug, so the user might feel like they are becoming apart from the situation they were in, or even their own body, and sounds and sights can seem to fade into the distance. Hallucinations are possible, from simple moving bright dots to complete detailed dreamscapes, although most users do not experience complex hallucinations. Coordination is affected and users may fall over if they are not sitting or lying down. The experience ends almost as swiftly as it began, with the peak lasting just seconds and the user back to normal within about 2 minutes. Sometimes, people take many ‘hits’ of nitrous oxide over a few hours. Aside from these mental effects, when inhaled recreationally in the usual (and safest) way, from a balloon, the gas in the lungs displaces air, temporarily preventing a normal amount of oxygen getting into the blood. This may cause the heart to beat faster, and limbs to feel tingly or heavy. Harms, and avoiding them Nitrous oxide use can cause harm and even death but most problems result from dangerous methods of use and not the drug itself. If the user is in good health, understands the risks, and avoids dangerous methods, nitrous oxide is one of the least risky drugs. It is very much less dangerous than other commonly used inhalants such as household solvents (e.g. butane and toluene). The foremost risk is of brain damage and death by asphyxiation. Secondly, addiction is a serious but very rare outcome of nitrous oxide use. These, and other lesser risks are described in detail below, with advice on how they can be avoided. The greatest risks from inhaling this drug come from using it in a way that causes uncontrolled and prolonged oxygen deprivation. Inhaling nitrous oxide in a dangerous way may not cause any warning symptoms until the user suffers sudden unconsciousness, then brain damage, followed by death within minutes. This risk requires some explanation. With knowledge, this risk can be easily avoided. If you hold your breath, your body is deprived of the oxygen it needs from the air. However, holding your breath is not very dangerous, because within seconds, the body’s automatic alarm system kicks in, making you feel uncomfortable, and before too long, it forces you to breathe. Surprisingly, this life-preserving system doesn’t work by directly monitoring falling oxygen levels, but instead detects the simultaneously rising levels of carbon dioxide which your body would normally breathe out. If you have your head in a bag of nitrous oxide, or even a bag of nitrous oxide mixed with air, you are still able to breathe out carbon dioxide freely, so your body is tricked into thinking that it is breathing normally. So you may feel no discomfort, and be enjoying the drug effects, right up to the moment when you black out. Unconscious with a bag over your head, it takes just a couple of minutes for brain cells to begin dying, and another couple of minutes before you are dead. Because the gas reduces anxiety and coordination even before causing unconsciousness, it may be impossible to escape from such a situation even if you realise your mistake. Several people have died in this exact way, and also from opening tanks of nitrous oxide in confined spaces such as cars, or strapping on medical gas masks attached to cylinders of pure N2O. It is vital to note that a person can suffocate like this even if they have access to some air; for example if they deliberately left the bag loose around their neck, or left their car window slightly open. Getting some oxygen, but not enough, will have the same fatal effect, although perhaps more gradually. Pressurised gas from whippits and gas cylinders takes up much more space than might be expected when it is released; pushing air out of gaps where the user might have thought it would come in. These risks of death or brain damage by asphyxiation are very easy to avoid. What the potentially fatal methods have in common is that if the user passes out, they will continue to inhale the gas or a low-oxygen gas and air mixture instead of pure air, leading eventually to death. With the common balloon method, (condoms are usable too) oxygen levels in the body still drop, but if the user gets too close to passing out, they will be unable to hold the balloon to their lips, and will automatically breathe air again. With this method, delivery of the gas is not automatic and continual so asphyxiation is virtually impossible. Even with this method, users often get a headache, which may be from not taking enough breaths of air, or from not leaving several minutes between balloons for recovery of oxygen levels, as well as from the effects of the gas on blood vessels in the head. Gas at pressure is dangerous, so care must be taken when filling balloons. Faulty dispensers (especially cheap ‘crackers’), or incorrect use, could cause explosions. When gas is released from pressurised containers, the gas and the metal of the container briefly becomes intensely cold (-40°C). People have given themselves frostbite of the lips, mouth and even vocal chords through inhaling laughing gas directly from the whippit ‘cracker’, or the nozzle of gas cylinders, and further serious damage could be done to the lungs if the gas came out at high pressure. Dispensing several whippits consecutively with one cracker can cause cold burns to hands. There is a risk of falling when taking nitrous oxide whilst standing or dancing. It is safest to get comfortable on a sofa or bed. It is possible that some mental health problems might be worsened, or relapses triggered, by the trippy effects of nitrous oxide, although there is no specific evidence of this. People with heart conditions or abnormal blood pressure may be at higher risk as the drop in oxygen levels caused by inhaling nitrous oxide raises the heart rate and can cause arrhythmias (skipped beats), which are usually not problematic, but could cause heart attacks and similar emergencies in susceptible people. For similar reasons, it would be inadvisable to mix laughing gas with other drugs, especially stimulants, as effects on blood pressure and heart rate could be unpredictable. There is a risk of contamination of the gas with harmful substances. Tanks of nitrous oxide intended for use in cars are usually contaminated with sulphur dioxide and other toxins. It has been noticed that some brands of whipped-cream chargers leave an oily residue inside the dispenser, suggesting that they contain some impurities. No specific evidence of harm from this exists, and many people have used the chargers with no health problems, but there can be no guarantees of safety when using this product in a way not intended by the manufacturers. Addiction and harms from long-term use Because the effects of nitrous oxide are pleasurable but short-lasting, people are often tempted to take it repeatedly over a short space of time. Very occasionally people become psychologically addicted to nitrous oxide and find it difficult to resist taking it every day. People with mental health issues may be at additional risk of addictive behaviours. Nitrous oxide is not particularly addictive compared to other drugs, and addictions usually require a combination of a psychological vulnerability, (such as low moods or worries that the drug briefly relieves), and easy access to the gas. Stressed dentists and anaesthetists who work with the substance always at hand have become addicted. Although addiction is unlikely, if it occurs it can be very harmful. Aside from the disruption that maintaining a drug addiction causes to lives, it has been found that nitrous oxide can be physically and mentally damaging when taken many times each day for long periods as it gradually inactivates the vitamin B12 reserves in the body. Individuals who inhaled large amounts of nitrous oxide daily for long periods have suffered nerve and brain damage because vitamin B12 is essential for the maintenance of a healthy nervous system. The symptoms of such damage vary, and have included severe weakness of the arms and legs in some, and in a handful of cases, episodes of mental illness. Treatment with high doses of B12 is effective, but some damage can be irreversible. It is likely that less severe vitamin B12 deficiencies caused by nitrous oxide overuse go undiagnosed, but cause milder symptoms, such as depression, forgetfulness and tiredness. If you are struggling to control your use of any substance you should see your doctor. Law It is illegal to sell nitrous oxide to under-18s, and selling it to anyone you suspect may use it for the purposes of inhalation is illegal under the Medicines Act. However, it is widely and legally sold as a means to whip cream. Possession of whippits is legal, but if the police found you with large amounts of whippits without a cream-preparation-based explanation, you could be charged with intending to supply it for inhalation. |