Nitrous oxide - Overview

Nitrous oxide, more commonly known as “laughing gas”, is a gas used in medicine for its anaesthetic and analgesic properties.

Grand format
protoxyde azote

Introduction/Background

Nitrous oxide, more commonly known as “laughing gas”, is a colourless gas used in medicine for its anaesthetic and analgesic properties. It is also used as a pressurising gas in aerosol food sprays, such as in canisters for whipped cream or dry air fresheners.

Since the 2000s, the OFDT’s monitoring scheme for Emerging Trends and New Drugs (TREND) has highlighted the recreational uses of this substance which provokes euphoric effects that last several minutes. The contents of the canister is emptied into a balloon, then inhaled by the user.

Production/supply

Due to its industrial use, nitrous oxide is not listed as a narcotic substance. In most cases, the small gas canisters for manufacturing whipped cream are used to fill party balloons, from which the gas is inhaled. The canisters are purchased from physical shops (supermarkets) and online.

Since 2017, points of sale have been multiplying: local shops, groceries, bars, and nightclubs have started to sell the canisters, initially in Hauts-de-France, then throughout the entire metropolitan territory. In 2019, websites specialising in the sale of nitrous oxide started offering new containers which are rapidly replacing “canisters”: larger canisters (the largest weighing over 600 grams, and enabling more than 80 balloons to be prepared for a cost ranging between 25 and 30 € per unit), and bottles (referred to as “cylinders” by on-line retailers, and “tanks” by users, which weigh up to 15 kg for an estimated capacity of between 1 000 and 2 000 balloons at a price exceeding 200 €). Domiciled abroad (mainly in Belgium and the Netherlands), these companies ensure the delivery of the gas to the buyer’s home within a matter of days. They offer bulk purchasing, leading to economies of scale. Palettes of several hundreds of large canisters can also be delivered following the establishment of a personalised quote.

Since 2020, structured networks (some already involved in selling narcotics) have been importing significant quantities of nitrous oxide into the metropolitan territory via websites. They ensure its storage and retail sale (a quantity of seven tonnes of nitrous oxide with a market value of 2.7 million euros was thus seized by law enforcement in December 2021, in Seine-et-Marne). When the supply of nitrous oxide is part of organised narcotic trafficking networks, its terms of sale and promotion are the same as those of other substances: shops, “drives”, and purchases through dedicated social media accounts (Snapchat), potential deliveries, promotion, and marketing of the substance, notably via flyers.

Use in the adolescent population

Like poppers, nitrous oxide is used by high school and university students, partly for the same reasons: ease of access to the substance (legal status), effects appreciated for their speed of onset (sudden euphoria) and their transience (several minutes).

A dedicated section of the National Adolescent Health and Substance Use Survey in Middle and High Schools (EnCLASS) shows that, in 2021, the use in adolescence did not seem marginal given that 5.5% of ninth grade students said they had already used nitrous oxide, boys twice as often as girls (7.3% vs. 3.7%).

Through the Survey on Health and Drug Use on National Defence and Citizenship Day (ESCAPAD), it was observed that, in 2022, 2.3% of 17-year-olds used nitrous oxide, and 1.2% had used it in the last 12 months.

The geographical breakdown of these users is highly atypical: they are significantly more numerous in proportion in Île-de-France and Provence-Alpes-Côte d’Azur both in terms of lifetime use (3.2% and 3.5% respectively) and use in the last year (1.6% and 2.2% respectively). Moreover, the levels of use of nitrous oxide vary up to threefold between rural areas and large cities (1.1% in rural communities, 3.1% for urban units with at least 200 000 inhabitants).

Use in the adult population

The measurement of nitrous oxide usage among the adult general population is still in its early stages.

Nevertheless, the TREND scheme observed the contexts of use in the adult population in 2022. Although originally limited to the alternative party scene, the use of nitrous oxide is currently observed in various contexts (free parties, warehouses, but also non-specialist festivals, parties...) associated with cannabis and alcohol.

Impacts

The mechanism of action of nitrous oxide is still not completely clear. The most notable acute psychological effects are reduced pain, euphoria, reduced anxiety, delusions, and changes in consciousness. The psychological effects fade after several minutes.

The physical effects are insignificant, unless there is a lack of oxygen from inhaling too high a concentration of laughing gas, or for too long. The typical acute complications are nausea, loss of balance, and headaches. Another danger of inhaling nitrous oxide is cold burns (frostbite) to the nails, throat, and tongue, if it is inhaled directly from the canister. The most serious complication is a sudden loss of consciousness (or “ball-holes” as per user vocabulary) which may result in respiratory arrest. Dissociative effects have also been described.

In cases of chronic use, an addiction may occur. However, no signs of withdrawal have been described up to now. In cases of persistent use over time, there may be partly irreversible long-term after-effects: damage to the spinal cord, vitamin B12 deficiency, anaemia, mental illnesses, and neurological disorders. A serious long-term undesirable effect is brain nerve cell damage linked to a repeated lack of oxygen (deterioration of cognitive functions, such as concentration and the ability to memorise).

In line with the increase in uses, the TREND sites describe a resurgence of cases showing severe damage linked to the use of nitrous oxide, listed by Regional Abuse and Dependence Monitoring Centres. By way of example, the Monitoring Centre of Lille lists:

  • In 2019: 17 serious cases, 6 involving women
  • In 2020: 25 serious cases, 2 involving women
  • In 2021: 45 serious cases, 12 involving women
  • In 2022: 81 serious cases (requiring hospitalisation or presenting a serious, significant, or concerning clinical conditions).

Phénomènes émergents liés aux drogues. Tendances récentes sur les usages de drogues à Lille et dans les Hauts-de-France en 2021 [in French]

Perceptions/opinions

The characteristics of nitrous oxide (ease of access, belief in its legal status, transient effects) contribute to shaping a positive image of the gas among young people - users or not - to the extent that its use is not or little perceived as potentially dangerous for health.

According to users surveyed for one of our publications on the psychoactive uses of nitrous oxide in 2022, this substance is catching up with poppers, which share these characteristics. Laughing gas differs from other substances, notably alcohol and cannabis, the use of which is more difficult to control, both in the short term (emerging powerful, long-lasting effects which are difficult to control, and often undesirable like the “hangover” for alcohol) and the long term (risk of addiction). In the same sense, the mode of use, via inhalation, is seen as less risky, as if it is relatively harmless to your health, in comparison with the modes of use associated with other substances, notably smoking. All respondents were aware of the most common undesirable effects and health risks involved in use, and the ways to protect themselves.

Harm reduction concern the dangers immediately associated with use (loss of consciousness, burns, etc.). In other terms, in representations, the dangerous nature of nitrous oxide is seen as short-term and linked to the situation of use, which needs to be made safe. On the other hand, the health impacts linked to a frequent and extensive use of the substance are much less often recognised. When this is the case, the respondents show little worry and concern for these risks, which they associate with problematic use (like using alone, outside of party events, daily, or several times a week), far removed from their moderate and controlled use.

Legal framework and recent public guidelines

Law no. 2021-695 dated 1 June 2021 “aimed at preventing the dangerous uses of nitrous oxide” bans selling to minors (art. L. 3611-2 of the Public Health Code) and stipulates a penalty fine of 15 000 € for “causing a minor to abuse a consumer product to obtain psychoactive effects from it” (art. L. 3611-1). Selling to adults is also banned in bars, discos, temporary drinking establishments (fairs, public celebrations...) and in tobacconists. The law stipulates the possibility to limit the maximum amount able to be sold to private individuals and also bans the sale and distribution of accessories enabling use, such as “crackers” or balloons intended for this purpose.