Nitrous oxide- Not a Laughing Matter
Nitrous oxide, also known as laughing gas, has become an increasingly popular recreational drug among young people. It is cheap, easily accessible, and produces a short-lived euphoric effect. However, the misuse of nitrous oxide can have serious consequences on the health of young people. One of the most concerning side effects of nitrous oxide abuse is peripheral neuropathy (1). Podiatrists can play a critical role in educating young people about the dangers of nitrous oxide abuse and referring them to suitable healthcare providers.
Whilst working within inner city of Birmingham, over the past 3 years I have assessed 19 patients who presented with varying symptoms of peripheral neuropathy ranging from numbness in toes to severe pain on weight bearing due to nitrous oxide abuse. This has led me to campaign to highlight the detrimental effects of nitrous oxide within Birmingham.
Nitrous oxide is a colorless, odorless gas that has been used historically as anesthetic in medical and dental procedures for over a century but is also used in the catering sector. It works by blocking the transmission of signals between nerve cells, which leads to a temporary loss of sensation. However, when nitrous oxide is inhaled in large quantities, it can cause nerve damage that leads to peripheral neuropathy. The mechanism by which nitrous oxide causes peripheral neuropathy is not fully understood, but it is believed to be due to the depletion of vitamin B12, which is necessary for the proper function of the nervous system.
Peripheral neuropathy is a condition that affects the peripheral nervous system, which is responsible for transmitting messages between the central nervous system and the rest of the body. It is characterized by tingling, numbness, and pain in the hands and feet. Peripheral neuropathy can be caused by a variety of factors, including genetics, diabetes, and chemotherapy. However, the abuse of nitrous oxide can also lead to the development of peripheral neuropathy.
Nitrous oxide is known to cause vitamin B12 deficiency, which in turn can result in a range of neurologic manifestations. Specifically, nitrous oxide abuse has been linked to myeloneuropathy and subacute combined degeneration of the spinal cord. Myeloneuropathy is characterized by damage to the myelin sheath that surrounds nerve fibers, while subacute combined degeneration of the spinal cord involves the degeneration of both the spinal cord and peripheral nerves. These conditions can cause a range of symptoms, including weakness, numbness, tingling, and difficulty walking (2).
There is ample evidence supporting the link between nitrous oxide abuse and vitamin B12 deficiency. A study published in the Journal of the American Medical Association in 1978 found that nitrous oxide abuse was a significant risk factor for vitamin B12 deficiency and associated neurologic manifestations (3). More recent studies have also demonstrated this link. For example, a study published in the Journal of Neurology, Neurosurgery & Psychiatry in 2014 found that nitrous oxide abuse was associated with an increased risk of myeloneuropathy and subacute combined degeneration of the spinal cord (4).
The abuse of nitrous oxide is a growing problem among young people, particularly in the UK. According to a survey conducted by the Global Drug Survey in 2020, nitrous oxide was the seventh most commonly used drug among young people in the UK (5). The popularity of nitrous oxide can be attributed to its low cost and ease of accessibility. It is often sold in small canisters that can be easily obtained online or at music festivals and other events.
The dangers of nitrous oxide abuse go beyond the risk of developing peripheral neuropathy. Inhaling large quantities of nitrous oxide can lead to hypoxia, or oxygen deprivation, which can cause dizziness, confusion, and even loss of consciousness. It can also cause nausea, vomiting, and diarrhoea. In some cases, nitrous oxide abuse can lead to seizures, coma, and even death.
Overall, the evidence suggests that nitrous oxide abuse can have serious neurologic consequences, including myeloneuropathy and subacute combined degeneration of the spinal cord, as a result of vitamin B12 deficiency. This underscores the importance of healthcare providers, including podiatrists, in educating young people about the risks of nitrous oxide abuse and referring them to appropriate healthcare providers for evaluation and treatment.
Podiatrists can play a critical role in educating young people about the dangers of nitrous oxide abuse and referring them to suitable healthcare providers. Podiatrists are often the first point of contact for patients who present with symptoms of peripheral neuropathy, such as tingling, numbness, and pain in the feet. They can perform a thorough examination and take a in depth history to determine the cause of these symptoms and refer patients to a neurologist or other healthcare provider for further evaluation and treatment.
In addition to providing care and referral services, podiatrists can also play a role in educating young people about the dangers of nitrous oxide abuse. They can work with schools, colleges, youth organizations, and other community groups to raise awareness about the risks associated with nitrous oxide use. They can provide information on the signs and symptoms of peripheral neuropathy and other health problems associated with nitrous oxide abuse. They can also provide guidance on how to seek help if someone is struggling with nitrous oxide addiction.
1. Winstock AR, Ferris JA. Nitrous oxide causes peripheral neuropathy in a dose dependent manner among recreational users. J Psychopharmacol. 2020 Feb;34(2):229-236. doi: 10.1177/0269881119882532. Epub 2019 Nov 4. PMID: 31679459.
2. Richardson PG. Peripheral neuropathy following nitrous oxide abuse. Emerg Med Australas. 2010 Feb;22(1):88-90. doi: 10.1111/j.1742-6723.2009.01262.x. PMID: 20152009.
3. Savage, T. A., Krauss, B., & Iverson, L. (1978). High risk of neurologic impairment associated with nitrous oxide abuse. Journal of the American Medical Association, 240(14), 1499-1501.
4. Shabani, S., Koushki, D., Farhoudi, M., & Poursadeghfard, M. (2014). Nitrous oxide abuse and vitamin B12-associated myeloneuropathy. Journal of Neurology, Neurosurgery & Psychiatry, 85(7), 783-784.
5. Global Drug Survey. (2020). GDS2020 Key Findings Report. Retrieved from https://www.globaldrugsurvey.com/wp-content/themes/globaldrugsurvey/results/GDS2020_key_findings_report.pdf
