Sarah* had no idea what they were when she found what looked like silver bullets in her 17-year-old’s pockets. “It’s just laughing gas to have fun at parties,” James* told her. “Everyone’s doing it.” She was relieved that he wasn’t doing anything stronger. It didn’t occur to her that a substance most teenagers (and many of their parents) consider relatively harmless could do him serious damage.
David Nicholl, a consultant neurologist at Queen Elizabeth Hospital in Birmingham, who has taken to TikTok (@drdavidnicholl) to raise awareness of the risks of nitrous oxide, says otherwise. The popularity of “nos” soared during lockdown — it is now the second most commonly used drug after cannabis among 16 to 24-year-olds, according to the Crime Survey for England & Wales — and Nicholl says misuse of the substance is the most common cause for emergency admissions to his ward.
Typically they see one or two young patients a week — mostly male, and presenting with tingling or numbness in their limbs, feelings of panic and difficulty walking because of vitamin B12 deficiency, which can cause permanent nerve damage to the spinal cord. Nicholl hates the term laughing gas. “It trivialises the issue,” he says. “We should think of nitrous oxide as more dangerous than cocaine, in so much as I haven’t seen one patient present with a problem related to cocaine in two years. I’ve had two referrals with neurological problems linked to nitrous oxide this morning.” The government may not have gone that far, but it will become a class C drug on November 8, meaning that possession will become illegal, with those who repeatedly misuse the drug facing up to two years in prison.
Discovered in 1772 by the English chemist Joseph Priestley, nitrous oxide became popular as a dental anaesthetic and a fashionable high at Georgian parties before becoming a fixture of the labour ward. Commercially it is sold in metal cartridges, ostensibly for use in whipped cream dispensers. In reality “whippets” are easily bought for a few pounds from websites that sell in bulk and offer fruit flavours, “discreet” packaging and next-day delivery.
Discharged into balloons, they are inhaled for a short high, which tends to lead to frequent redosing. “How many whippets is too many in one session?” asked one user in a recent post on the online forum Reddit. “Most I’ve done back-to-back is about 15, with a two-minute break in between.”
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In medical settings nitrous oxide is mixed with 50 per cent oxygen, but recreationally users have “no idea” of the dosage, Nicholl says. “We had a patient a couple of months ago with hundreds of cylinders in the back of the car. It was mind-blowing.”
Discarded canisters are a frequent sighting at music festivals and many street corners. After this year’s Notting Hill carnival Kensington and Chelsea council said it collected five skips’ worth from its streets.
● Laughing gas to be banned from next month
● Teenagers suffering nerve damage from laughing gas
As James’s usage increased, Sarah noticed that his behaviour became increasingly erratic; he complained of numbness in his hands and feet, along with a constant sore throat and mouth ulcers. She persuaded him to see their GP, who referred him to a neurologist, who explained that nitrous oxide had deprived his body of oxygen, which leads to the loss of vitamin B12, essential in the production of myelin, the fatty sheath that protects nerves. Poorly functioning myelin can lead to irreversible spinal cord damage, paralysis and other neurological problems. Sarah was horrified to read news stories of twentysomethings whose balloon binges had left them in wheelchairs.
Other symptoms include bladder and bowel disturbance, erectile dysfunction, blood clots and thrombosis — “nitrous oxide makes your blood more sticky”, Nicholl explains — frostbite and cold burns if users inhale the gas directly from the canister, and raised intracranial pressure, which can lead to “a risk of going blind”.
Odourless and colourless, the gas leaves little “evidential trace” other than the canisters, says Dan Gibbons from the solvent abuse charity Re-Solv (re-solv.org). He advises parents to be alert to their teenagers’ behavioural changes. “Maybe they’re starting to disengage, they’re not enjoying hobbies they used to.”
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Nicholl believes increased use is being driven by poor mental health, compounded by social media advertising of large cylinders easily bought online that (unlike almost everything else) have halved in price in 18 months. Although he would welcome a crackdown on unscrupulous sellers, he is worried that plans to criminalise the gas won’t deter teenagers unaware of the health risks.
Many of the patients he treats are already too embarrassed to tell their friends they have been hospitalised after taking it, he says. “There’s a real sense of shame.”
*Names have been changed
