Doctors have sounded the alarm over the increase in cases of nerve damage related to the use of nitrous oxide.
In recent years, nitrous oxide, commonly known as “nos”, has become a very popular recreational drug. It has reportedly been used extensively at festivals this summer.
In the 2019-20 Crime Survey for England and Wales, almost 9% of 16-24-year-olds said they had taken nitrous oxide in the past year, compared with 6.1% from 2012-13.
Experts say that as use of the drug has increased, so have cases of spinal cord and nerve damage, including paralysis.
“There is no doubt that we have seen an increase in cases, as this was almost unknown last year and now [we] see cases weekly,” said Dr Nikos Evangelou, an academic neurologist at the University of Nottingham.
Writing on Twitter, Evangelou described the situation as an epidemic, adding: “It’s terrifying to see young people paralyzed with gas canisters laughing.”
Dr David Nicholl, a neurologist at Sandwell and West Birmingham NHS Trust, also called the problem an epidemic in a recent TikTok video.
“We are seeing dozens of young people entering the hospital because they don’t have legs; some of them have life-changing neurological injuries,” he said.
Discovered by chemist Joseph Priestley in 1772, and subsequently the subject of countless experiments and cartoons, nitrous oxide became a useful tool in medical settings to treat severe pain.
While it can cause laughter and hallucinations, it can also cause neurological problems by inactivating vitamin B12.
“B12 is crucial in the production of myelin, which is the fatty sheath that surrounds the body’s nerves,” said Dr Trevor Pickersgill, consultant neurologist at Cardiff and Vale University Health Board. When B12 is inactivated by nitrous oxide, myelin is no longer maintained in good condition. “This causes damage to the spinal cord, which can be irreversible if left untreated,” Pickersgill said.
Dr Mark Ellul, a specialist neurology registrar based in Liverpool, said cases of nerve damage from the use of nitrous oxide were common. “I would say as a unit we probably see a case every few weeks,” he said. “Most are young, and many previously did not know the substance could be harmful. In some cases, the effects can be quite severe and long-lasting.”
A study by researchers in Strasbourg reported that five patients were admitted to a tertiary care center between April 2020 and February 2021 with rapidly progressing neurological symptoms after using nitrous oxide.
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“When I did a retrospective analysis of all patients admitted for 10 years before April 2020, no patient had been diagnosed with neurological complications due to nitrous oxide abuse in our hospital,” said the lead author, Maximilian Einsiedler.
Although it is illegal in the UK to supply nitrous oxide for human consumption or to sell it to children, it is not illegal to possess the drug. Users often purchase small silver cans of gas, known as whippits for their original purpose as cream chargers, and inhale them from a balloon.
However, there are concerns that large gas canisters are becoming more common, with giant canisters 80 times bigger than whippits found on the streets of London after Notting Hill Carnival this weekend.
Harry Sumnall, professor of substance use at Liverpool John Moores University, said there was a lack of data on the prevalence of serious problems arising from the use of nitrous oxide in the UK.
While Sumnall said even a relatively small increase in cases from a low baseline worried neurologists, he said the people most at risk of major complications were those exposed to large amounts of the gas.
“Just to put it into perspective, [there are] over 600,000 users in the UK, and most people, if they’re using it, will use it a few times a year, with very low levels of risk,” he said.