Nitrous oxide has returned to our headlines – last month two possession with intent to supply Crown Court cases collapsed and this week the 2016 mortality figures were released. The cases were brought forward under the Psychoactive Substances Act 2016 (PSA) and fell apart when both judges ruled that nitrous oxide was in fact exempt from the legislation. Resisting the urge to write another commentary criticising the PSA, I should prefer to use these collapsed cases and statistics as a reason to reflect on the harms of nitrous oxide and its associated legal status.
Discovered by Joseph Priestley in 1772, it was, alongside ether, one of the earliest anesthetics – still used widely today in dentistry and hospital medicine. Its euphoric effects (hence ‘laughing gas’) lended itself to becoming a favourite party drug of the Georgian and Victorian chattering classes. Consequently, unlike the truly novel substances, we have centuries of evidence pertaining to the risks associated with its medical and recreational use – these are few indeed.
Despite being neither new, particularly harmful, and possibly not even psychoactive, nitrous oxide was caught up in the new psychoactive substance (NPS) legislation. Just as mephedrone was subject to a baseless tabloid campaign, resulting in its banning in 2010, so too with nitrous oxide. Nicknamed and demonised as ‘hippy crack’ by red-top media, simultaneously invoking classism of the 1960s and racism of the 1980s, it was vital that the UK ban nitrous oxide to prevent users [our innocent children] from becoming the immoral dregs of society, or worse, dead. The oft-heard cry from The Simpsons’ Helen Lovejoy, “won’t somebody please think of the children” is a tried-and-tested logical fallacy, driving us towards irrational, unsubstantiated policy. The Government caved in and nitrous oxide was banned.
Clearly nitrous oxide pales in comparison to crack cocaine, but how harmful is it? When discussing drug-related harm to young people in a recreational setting, alcohol provides the most natural comparison. The Office of National Statistics reports that between 1993-2016, 30 drug-related deaths mention nitrous oxide on the death certificate – lightning strikes killed around 40 in the same period. The figures for 2016 are not yet available, but in 2015 alone, 8758 people died from alcohol, an annual death rate that has remained roughly constant for the last 15 years. Accordingly, expressed in terms of deaths per year, alcohol is some 7000 times more deadly than nitrous oxide.
Death is, of course, not the only drug-related burden that society shoulders. What of criminal justice costs? I cannot source figures for the costs of policing nitrous oxide itself, but Crown Court cases, like those last month at Taunton and Southwark Courts, incur daily costs between £5000-8000. Alcohol-related costs are, unsurprisingly, far higher with estimates readily running into the billions. And what of medical costs? Though the NHS does not fully disaggregate its annual Hospital Episode Statistics, there exists a primary diagnosis of “poisoning by anaesthetics and therapeutic gases” under which nitrous oxide falls. In 2015-16, 371 patients presented with such a poisoning, of whom 302 were admitted, between them occupying 309 ‘bed days’. By contrast, over 107,000 patients presented with alcohol-specific diagnoses. Note that this includes only mental & behavioural disorders, liver disease, and toxicity, and excludes, for example, trauma from an alcohol-induced fight. Between them they occupied some 400,000 ‘bed days’, contributing in no small part to the annual cost of alcohol to the NHS (c. £3.5bn) indeed or to society (between £21-52bn). The NHS estimates that there were 1.1m admissions related to alcohol consumption in England alone, some 7% of all admissions.
I have been as biased against nitrous oxide as possible in interpreting these statistics, likely by an order of magnitude or so – many of the 30 deaths where nitrous oxide is mentioned will have been caused by something else and many of the 371 patients in 2015-16 will have been poisoned by something else, not to mention the omitted swathes of alcohol-related illness. However you lean on the numbers, the fact remains that alcohol is thousands of times more damaging to society. Public health and criminal justice policies, particularly in this era of austerity, are irrevocably tied up with economics – infinite wants coupled with finite resources. Yet we insist on following a policy where vast sums of money are funneled into unnecessary court and policing costs, not to mentioned the lives ruined by convictions and prison sentences.
According to the recently-released 2016 figures, there were 8 nitrous oxide-related deaths last year. I hear no clamouring for the mandatory construction of lightning conductors on the 14th hole, nor for the extermination of every fox, ferret and fawn (there were 9 non-rat, non-dog mammal-related deaths in 2010…). No matter how tragic or emotive a death, expenditure in already-stretched systems is not justified if the incidence of harm is suitably low.
Despite campaigners heralding the collapsed court cases as the end of the PSA, no such U-turn will be seen. The UK is championing itself as the international leader in new psychoactive substance control at the Commission for Narcotic Drugs, the United Nations body responsible for international drug control. To turn back now would be impossible. Instead the Government will stick to its rhetoric, with the Home Office claiming last month after the court cases: “These dangerous drugs have already cost far too many lives and the Psychoactive Substances Act is sending out a clear message – this government will take whatever action is necessary to keep our families and communities safe.” In preparations for the PSA, the Home Office continually pushed the idea that ‘legal high’ was a misleading term that implied a level of safety which many NPS did not meet. This much I agree with. In associating nitrous oxide with other former ‘legal highs’ under the PSA, however, the Government has created the same harm equivalence and shot itself in the foot. Police forces titling their anti-NPS campaigns Operation Nitrox only further reinforce this false equivalence.
If the Government’s intention was really to keep young people safe, there would be an immediate and dramatic increase in alcohol duty – wine and spirit duty in real terms has fallen by 30% and 50% respectively since the late 1970s. Britain’s most harmful drug is cheaper and more readily available than ever – ‘Big Alcohol’ is winning.
A closing note: it is, perhaps, of interest that Crispin Blunt MP gave an impassioned defence of alkyl nitrates (poppers) in the House of Commons when the PSA was under debate. He argued, as a gay man and a responsible user, that as poppers form a vital part of gay culture and sexuality it would be madness to ban them. They remain legal. I mean Crispin Blunt no ill will, and I am very glad that he stood up, not only for himself, but for the wider gay community. It does seem a shame, however, that low-risk enjoyment for young people appears not to feature on any MP’s agenda – nitrous oxide went undefended.
Oli Stevens – DrugScience Research Officer
 Since 2008, any drug detected at death is required to be recorded on the death certificate not just those suspected to be causative. Of the 30 deaths between 1993-2016 which mention nitrous oxide, 26 occurred after 2008.