Nitrous oxide is readily available to those who want to use it recreationally for the high it provides. You can easily buy online with just a few clicks. However, despite its availability, the drug, commonly referred to as “whippet” (or “whippit”), “laughing gas,” or “hippie crack,” can cause permanent, complete, or partial paralysis. Serious consequences may occur.
The good news is that the damage can be reversed, but clinicians need to diagnose patients quickly and treat them appropriately, Yale experts say.
Serious neurological complications can be reversed if patients are treated early. Therefore, it is important to know about nitrite use and it is important to screen for nitrite use.
Dr. Tova Gardin
In 2020, nitrous oxide was the second most commonly used recreational drug among 16 to 24-year-olds in the UK, after cannabis, according to a UK government report. Its use is now rapidly increasing in the United States. A 2019 study by the U.S. Substance Abuse and Mental Health Services Administration found that approximately 13 million Americans ages 12 and older have misused nitrous oxide in their lifetime.Some experts fear the coronavirus pandemic has made the abuses even worse..
Recreational inhalation of nitrous oxide can impair the metabolism of vitamin B12 in the body. This is a dangerous effect because vitamin B12 is essential for maintaining the body’s myelin sheath, which insulates and protects the nerves in the brain and spinal cord. Long-term use of nitrous oxide can cause a variety of neurological and hematological symptoms. [related to blood]complications of mental illness such as neurological damage and psychosis.
Now, in a case study published in October 2023, BMJ case report, Yale University researchers emphasized the urgent need for clinicians to thoroughly evaluate patients suffering from symptoms of B12 metabolic disorders. With prompt action, even serious consequences can be successfully treated, they say.
“Recreational use of nitrous oxide is on the rise,” says Tova Gardin, MD, a neuroimmunologist and psychiatrist at Yale School of Medicine and lead author of the study. “Serious neurological complications can be reversed if patients are treated early. Therefore, it is important to know about nitrite use and it is important to screen for nitrite use.”
What is nitrous oxide? Since when has it been used recreationally?
Nitrous oxide is a colorless gas used as a sedative for various dental and medical procedures. It is also available for purchase and is intended to be used in a dispenser to give whipped cream the fluffy consistency of a commercial can. Inhaling nitrous oxide can cause short-term feelings of euphoria and relaxation. However, users may also experience headaches, dizziness, anxiety, and loss of consciousness.
The use of nitrous oxide stalks for recreational purposes dates back to the late 18th century.th It was invented by the British chemist Joseph Priestley in 1772, not long after this century. Another British chemist, Humphrey Davy, soon became known for hosting parties where surgeons and playwrights inhaled gas from green silk bags.
In fact, it was through these parties that Davey first became aware of the drug’s pain-relieving effects. By the mid-19th century, dentists and doctors began experimenting with the drug’s paralyzing effects on patients undergoing various procedures. Currently, it is the most frequently used anesthetic for partial sedation in dentistry. It is also often used in conjunction with other anesthetics during surgical procedures and childbirth.
Recreational use of nitrous oxide has skyrocketed in popularity, driven by the fact that it is legal and not difficult to obtain. It is especially common at underground raves and music festivals. And dangerously, its misuse is especially prevalent among adolescents and young adults.
Given the easy availability of nitrous oxide, few people who use this substance recreationally realize how seriously dangerous it can be.
“When I went to a popular retail website and typed in ‘nitrous oxide,’ the algorithm suggested I buy it with it, not for whipped cream, but for drug use. That was shocking,” Gardin said.
Treating the effects of nitrous oxide requires a thorough evaluation
In a case study, Gardin said her team’s recent work was inspired by a man in his 30s who developed numbness, weakness, and difficulty walking after chronically using nitrous oxide. Reporting. He has never had any problems with mobility. After taking his thorough medical history, clinicians learned that he had been using nitrous oxide daily for 4 to 5 months.
The team’s first step in trying to understand what was going on was to order a magnetic resonance imaging (MRI) scan, which revealed an abnormality in the man’s dorsal column. The dorsal columns are central nervous system pathways related to sensory functions. They diagnosed him with subacute combined spinal degeneration, which was causing his symptoms.
Next, the research team looked for co-occurring causes of vitamin B12 deficiency. Blood tests revealed that the patient’s vitamin B12 levels were within normal limits. However, further testing revealed elevated levels of methylmalonic acid and homocysteine, two metabolites of vitamin B12. “This gave us a clue that the patient was having some difficulty metabolizing vitamin B12,” Gardin said.
From there, the clinician ran tests looking for antibodies to intrinsic factor and gastric parietal cells. This can signal pernicious anemia, a rare autoimmune disease that can impair vitamin B12 absorption. They found this to be the case for their patients.
Effects of nitrous oxide Recovery with vitamin B12 supplementation
To treat the vitamin B12 metabolic disorder, it was first necessary to completely stop using nitrous oxide. The clinician then began the vitamin B12 supplementation process and treated the patient with intramuscular injections of vitamin B12 over a 7-day period. After that, you will receive weekly injections for one month and will need to receive vitamin B12 supplements every month for the rest of your life. Physical therapy and occupational therapy are also required. Importantly, mental health care services were also recommended to assist with his drug use.
After treatment, the patient regained sensation and the ability to walk. “Our patient wanted to share his story to let others know that neurological function can be restored with early intervention,” Gardin says. “It would have been easy for us to blame his problems on nitrous oxide use and call it a day. But we did additional screening to look for issues with vitamin B12 metabolism and vitamin B12 deficiency. It is important that these patients receive the neurological and psychiatric care they need.”
What clinicians need to know about using nitrous oxide
Dr. Gardin says nitrous oxide use is increasingly common and more widespread than many people realize, and that patients who present with neurological or psychiatric symptoms associated with nitrous oxide use are He emphasized the need for immediate screening for other vitamin B12 metabolism problems. Additionally, treatment of complications from chronic nitrous oxide use requires a multidisciplinary approach that addresses all underlying neurological and psychiatric causes. “Chronic use of nitrous oxide may be part of a fortification cycle, in which its use causes disturbances in the metabolism of vitamin B12, leading to neurological and psychiatric symptoms, which are linked to the use of nitrous oxide. Ensuring comprehensive neurological and psychiatric care is the best way to treat and prevent relapse for people who use nitrites chronically.
