Recreational nitrous oxide misuse is resulting in serious neurological impairment and persistent disability among users

Mosalski, Simon; Tanner, Anne; Shiner, Christine T

doi:10.5694/mja2.51201

Topics

Rehabilitation

Health occupations

Poisoning

Environment and public health

Substance-related disorders

To the Editor: Published evidence recognises that the recreational misuse of nitrous oxide (N₂O) can be associated with vitamin B₁₂ deficiency and subacute combined degeneration of the spinal cord.1 Misuse of N₂O is increasing,2 with canisters (known as “nangs” or “whippits”) readily available for legal purchase in convenience stores and online ostensibly for the purpose of whipping cream.

1 St Vincent’s Hospital Sydney, Sydney, NSW
2 University of New South Wales, Sydney, NSW

Correspondence: simon.mosalski@svha.org.au

Competing interests:

No relevant disclosures.

1. Garakani A, Jaffe RJ, Savla D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature. Am J Addict 2016; 25: 358–369.
2. Winstock AR, Timmerman C, Davies E, et al. Global Drug Survey 2020 psychedelics key findings report. GDS, 2021, https://www.globaldrugsurvey.com/wp‐content/uploads/2021/03/GDS2020‐Psychedelics‐report.pdf (viewed March 2021).
3. Bethmont A, Harper CE, Chan BS, et al. Increasing illicit use of nitrous oxide in presentations to NSW emergency departments. Med J Aust 2019; 211: 429. https://www.mja.com.au/journal/2019/211/9/increasing‐illicit‐use‐nitrous‐oxide‐presentations‐nsw‐emergency‐departments
4. Blair C, Tremonti C, Edwards L, et al. Vitamin B12 supplementation futile for preventing demyelination in ongoing nitrous oxide misuse. Med J Aust 2019; 211: 428. https://www.mja.com.au/journal/2019/211/9/vitamin‐b12‐supplementation‐futile‐preventing‐demyelination‐ongoing‐nitrous
5. NSW Health. Nitrous oxide: the facts [fact sheet]. Sydney: NSW Health. https://yourroom.health.nsw.gov.au/resources/publications/Pages/nitrous‐oxide‐drug‐facts‐english.aspx (viewed March 2021).

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