Increasing recreational nitrous oxide use: Should we worry? A narrative review.

BACKGROUND

Since 2000, the prevalence of recreational nitrous oxide (NO) use has increased in the Western world. Although NO is a relatively safe drug, the overall increase in the use of NO has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg NO tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of NO for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to NO-induced vitamin B deficiency. The increasing trend of recreational users with NO-induced neurological damage at emergency departments confirms the urgency of this development.

OBJECTIVE/METHODS: This narrative review describes recent trends in NO use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use.

RESULTS

Considering the rising trend in NO use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of NO, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive NO use.

CONCLUSION

It is concluded that the increase in excessive NO use is of serious concern.