Increasing recreational nitrous oxide use: Should we worry?

<p>Background: Since 2000, the prevalence of recreational nitrous oxide (N ₂O) use has increased in the Western world. Although N ₂O is a relatively safe drug, the overall increase in the use of N ₂O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N ₂O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N ₂O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N ₂O-induced vitamin B ₁₂ deficiency. The increasing trend of recreational users with N ₂O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N ₂O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N ₂O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N ₂O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N ₂O use. Conclusion: It is concluded that the increase in excessive N ₂O use is of serious concern.</p>