The recreational use of nitrous oxide, commonly known as whippets, laughing gas, or hippie crack, has become increasingly popular among young adults. However, the consequences of using this readily accessible drug can be severe, including permanent paralysis. Fortunately, a recent case study conducted by Yale researchers has shown that early diagnosis and treatment can reverse the damage caused by nitrous oxide.
According to a British government report, nitrous oxide was the second most frequently used recreational drug among 16- to 24-year-olds in the UK in 2020, with cannabis being the only drug used more frequently. In the United States, its use is also on the rise, with a survey conducted by the Substance Abuse and Mental Health Services Administration revealing that nearly 13 million Americans aged 12 and older had misused nitrous oxide in their lifetime. Experts believe that the COVID-19 pandemic may have contributed to the increase in nitrous oxide abuse.
When nitrous oxide is inhaled recreationally, it impairs the body’s ability to metabolize vitamin B12. This is dangerous because vitamin B12 is crucial for maintaining the myelin sheath, which protects the nerves in the brain and spinal cord. Prolonged use of nitrous oxide can lead to various complications, including neurological, hematological, and psychiatric issues such as nerve damage and psychosis.
The case study, published in BMJ Case Reports, emphasizes the importance of healthcare professionals promptly evaluating patients who show symptoms of impaired vitamin B12 metabolism. The researchers stress that with timely intervention, even severe consequences can be treated successfully.
Dr. Tova Gardin, a neuroimmunologist and psychiatrist at Yale School of Medicine and the lead author of the study, highlights the increasing prevalence of recreational nitrous oxide use and the need to screen for it. By treating patients early, serious neurological complications can be reversed. Nitrous oxide, a colorless gas commonly used as a sedative in medical and dental procedures, can produce feelings of euphoria or relaxation when inhaled. However, users may also experience headaches, dizziness, anxiety, or loss of consciousness.
Recreational use of nitrous oxide dates back to the late 18th century, shortly after its invention by English chemist Joseph Priestly. English chemist Humphry Davy first discovered its analgesic effects during parties where guests would inhale the gas. Since then, it has been widely used as an anesthetic in dentistry and surgery.
Due to its legal status and easy accessibility, recreational nitrous oxide use has become increasingly popular, particularly at underground raves and music festivals. Alarmingly, adolescents and young adults are frequently misusing this substance without fully understanding its potential dangers.
Dr. Gardin’s case study was inspired by a man in his 30s who experienced numbness, weakness, and difficulty walking after long-term nitrous oxide use. Despite having no prior mobility issues, a thorough clinical history revealed that he had been using nitrous oxide daily for several months.
An MRI scan revealed abnormalities in the man’s dorsal column, a pathway associated with sensory function in the central nervous system. He was diagnosed with subacute combined degeneration of the spinal cord, the cause of his symptoms.
To determine the underlying cause of vitamin B12 deficiency, the researchers performed blood tests. They found that the patient’s B12 levels were within the normal range but discovered elevated levels of two metabolites of vitamin B12—methylmalonic acid and homocysteine. This indicated an issue with B12 metabolism.
Further testing revealed that the patient had pernicious anemia, an autoimmune disorder that impairs vitamin B12 absorption. The treatment plan consisted of discontinuing nitrous oxide use completely and providing the patient with intramuscular vitamin B12 injections for seven days. Subsequently, he received weekly injections for one month and will require lifelong monthly vitamin B12 repletion. Physical and occupational therapy were also necessary, along with mental health care services for substance use.
After undergoing treatment, the patient regained sensation and the ability to walk. Dr. Gardin stresses the importance of sharing this case to highlight the fact that early intervention allows individuals to recover neurological function.
It is crucial for healthcare professionals to be aware of the increasing prevalence of nitrous oxide use and promptly screen patients presenting with neurologic or psychiatric symptoms related to its use for other vitamin B12 metabolism issues. Taking a multi-disciplinary approach that addresses all underlying neurologic and psychiatric causes is essential for treating the complications associated with chronic nitrous oxide use.
Chronic use of nitrous oxide can lead to a cycle of dependence, where the drug causes impaired B12 metabolism, resulting in neurological and psychiatric symptoms that can further reinforce its use. Dr. Gardin emphasizes the importance of comprehensive neurologic and psychiatric care to treat and prevent relapse in individuals who chronically use nitrous oxide.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it