What is Nitrous Oxide (Noz) Abuse?
The drug nitrous oxide goes by several nicknames, including laughing gas, nozz, whippets, nangs, or Nos. It is a colorless gas with a somewhat sweet flavor and odor.
This substance is predominantly used in dental practices in the United States, although it is gaining popularity as a potential nonaddictive, rapid-acting emergency room painkiller. It is also used in several commercial and industrial products to maximize oxygenation or fuel potency; for example, nitrous oxide cannisters are used in commercial kitchens to produce whipped cream.
With medical supervision, this long-used anesthetic and analgesic gas is safe. It can effectively relieve pain as well as anxiety related to medical or dental procedures. However, because of its sedative effects, it has also long been a substance of abuse.
Nitrous Oxide: Medical Applications vs. Addiction
It is currently believed that nitrous oxide works on some of the same neurotransmitter receptors in the brain as alcohol and benzodiazepines, giving it a relaxing, painkilling, and anxiety-reducing effect. The drug binds to receptors associated with gamma-aminobutyric acid (GABA), one of the most important neurotransmitters in the brain.
GABA manages communication between neurons. When there is not enough GABA, neurons fire rapidly, which can lead to several conditions, ranging from an anxiety disorder to epilepsy. When a drug like nitrous oxide binds to these receptors instead, GABA remains active in the brain for longer, reducing anxiety and the risk of a seizure.
Drugs that bind to these receptors induce a sense of calmness, relaxation, and sleepiness. Unlike alcohol or benzodiazepines, however, nitrous oxide metabolizes rapidly out of the body, as it has a half-life of just five minutes. When it is used as anesthesia, administration is either continuously managed at very low doses and monitored by a medical professional, or other substances are added to anesthesia.
Because nitrous oxide interacts with the GABA receptors for a few minutes, it creates a rapid and enticing high for people who struggle with drug abuse or addiction. Young people who purchase numerous whipped cream cannisters may be abusing Noz, while adults in specific medical professions are at an increased risk for abusing nitrous oxide alongside other drugs.
Recreational Nitrous Abuse
There is no level of nitrous oxide abuse that is safe. While medical professionals can administer this gas to many different people, taking it without specific medical cause is inherently dangerous. It can lead to sudden death, addiction, and long-term damage to major organ systems. Typical side effects associated with recreational abuse of Noz include:
- Euphoria, or feeling high
- Numbness in the extremities or throughout the body
- Uncontrolled laughter or giddiness
- Losing control of one’s movements
- Blurry vision
- Lightheadedness or dizziness
- Physical weakness
- Sudden death
People who are at risk for abusing nitrous oxide include adolescents, young adults, and professionals with access to the drug, such as nurses, emergency responders, and dentists.
Although purchases of nitrous oxide are regulated by states, it is not illegal to possess the drug. Some food products, like whipped cream cannisters, may have a small amount of nitrous oxide. It is possible for adolescents to acquire this dangerous chemical without adult knowledge and without breaking laws. However, even in places with specific requirements for nitrous oxide purchases, “nozz parties” are becoming popular among adolescents and young adults.
One report suggests that about 0.5% of adolescents struggle with inhalant abuse of any kind, including nitrous oxide. However, another survey reported that as many as 29.4% of US respondents to the 2014 Global Drug Survey (GDS) reported abusing Noz at any point in their lives, even once.
Nitrous oxide is associated, especially in the US, United Kingdom, and Australia, with raves, clubs, and parties. People are more likely to do whippets (abusing nitrous shots from whipped cream cartridges) or inhale the drug from bags or balloons. People who abuse nitrous oxide in these situations may also abuse other substances, including alcohol, tobacco, marijuana, or cocaine. Combining drugs is extremely dangerous and increases the risk of overdose.
Abusing Medical Nitrous Oxide
Signs of Addiction to Noz
It is extremely rare for nitrous oxide to be prescribed as a treatment. Anesthesiologists working in surgery departments and dentists’ offices are the most likely to use nitrous oxide in a medical capacity; however, the gas is increasingly being used to dull pain, especially among women giving birth, and in ambulances and emergency rooms.
These situations help doctors avoid prescribing large doses of narcotics to control pain in these settings, putting their patient at risk for opioid addiction or dependence. A variant of nitrous oxide, called nitric oxide, is used to widen blood vessels in the lungs of babies born prematurely.
People who are most likely to abuse nitrous oxide around medical preparations are those who work with the gas on a regular basis. For example, dentists are at a greater risk for abusing nitrous oxide compared to the general population; however, dentists also statistically struggle with drug and alcohol abuse more than the general population.
Between 10% and 12% of the entire population struggles with substance abuse and addiction at some point in their lives; in comparison, between 12% and 19% of dentists develop an addiction. The most abused drugs among dentists include alcohol (37%); prescription medications, including opioids and benzodiazepines (31%); and nitrous oxide (5%).
Treatment to Overcome Noz Abuse
Chronic health issues due to Noz abuse include peripheral neuropathy (loss of sensation in the limbs), brain damage, and lung damage. While there are no specific medication-assisted therapies (MATs) to manage withdrawal symptoms associated with detoxing from Noz, working with a physician or addiction specialist to safely overcome physical dependence on this drug is the first step in recovery. Professionals can help individuals through the withdrawal process, offering medical care as well as psychological support.
The National Institute on Drug Abuse (NIDA) recommends following detox with at least 90 days of treatment in a rehabilitation program. These programs provide therapy to change behaviors associated with addiction, manage cravings, and help the person develop coping mechanisms to avoid relapse in the future. Adding mutual support groups, ongoing therapy for any co-occurring mental health conditions, family therapy, and complementary medicine to long-term recovery increases a person’s chances of remaining sober and healthy.
How Does Breathing Nitrous Oxide Affect Your Long-Term Health?
Nitrous oxide is a colorless gas that has a sweetish odor and flavor. When the substance is inhaled, it produces analgesia, or insensitivity to pain, just after an experience of mild hysteria, typically displayed through laughter. The mild excited euphoria before painlessness and relaxation led to nitrous oxide receiving the nickname laughing gas.
Nitrous oxide is often used to reduce anxiety and pain in surgery, especially dental procedures. It is also used in several commercial applications, especially to compress substances like whipped cream in canisters; when these whipped cream cartridges (used to charge shipped cream canisters) are abused, they are referred to as whippets.
Because nitrous oxide is legal to possess in the United States and other countries, and reasonably easy to purchase, the gas has become a substance of abuse among adolescents and young adults. Many states have laws regarding distribution, but like with other inhalants, easier access means wider abuse among younger demographics.
What Are the Effects of Nitrous?
Nitrous oxide is not as tightly regulated as other chemicals or analgesics because it is considered very safe to use in small doses. It has a rapid onset and quickly metabolizes out of the body. However, chronic abuse of nitrous oxide can be very dangerous, causing physical harm, coma, and death.
Like some other drugs, nitrous oxide binds to the gamma-aminobutyric acid (GABA) receptors in the brain and spinal cord. The GABA neurotransmitter is involved in how quickly neurons fire, so a drug that binds to the receptors will allow GABA to stay in the brain for longer, slowing down how quickly the neurons send signals.
This induces a sense of relaxation and slowness; other drugs that bind to the GABA receptors include alcohol and benzodiazepines.
Nitrous oxide is considered a safe sedative in many medical practices, especially dental practices. It is primarily used to reduce anxiety before specific procedures, including larger surgeries that may involve other forms of anesthesia. However, there are some short-term negative side effects of nitrous oxide, including:
- Nausea and vomiting
- Abdominal pain
- Excessive drowsiness or sleepiness
- Shortness of breath
- Burning sensations in the extremities
Because nitrous oxide causes oxygen deprivation and changes to brain chemistry, it is possible to overdose on this drug. If a person is overdosing on nitrous oxide, it is very important to call 911; the individual needs emergency medical attention to survive. Signs of an overdose include:
- Bluish tint to the lips, nose, and fingertips
- Dark urine
- Intense headache
- Pale, clammy skin
- Rapid heartbeat
- Sore throat
- Unusual bruising or bleeding
Nitrous Oxide Abuse Statistics
Nitrous oxide is most often abused in the form of whippets, or rapid huffing of the drug through cannisters of the compressed gas. These cannisters are found in some food items, like whipped cream. Other methods of abusing nitrous oxide include sniffing or huffing it from a paper or fabric bag, or inhaling it directly.
A 2011 study reported that 22 million Americans ages 12 and older abuse inhalants, including nitrous oxide, with 750,000 people abusing these intoxicating and dangerous substances for the first time every year. While inhalant abuse is less prevalent in the US, 23.7% of respondents to one survey in the United Kingdom reported abusing the substance in the past year, making laughing gas the second most popular drug in the UK.
One study of teenagers’ nitrous oxide abuse in 2009 involved Missouri Division of Youth Services (DYS) administering a survey to adolescents between the ages of 13 and 17, who were committed to one of 27 facilities through juvenile court; there were 723 interviewed as part of the study. Of those:
- 15.8% had ever abused nitrous oxide in any form
- 57% of those who abused nitrous oxide did so via whippets (whipped cream chargers)
- 38.6% abused nitrous oxide directly from whipped cream cans
- 39.5% inhaled the gas through another form, like a balloon
- Multiple methods of abuse were reported by those who abused nitrous on several occasions
- 77.2% of the lifetime nitrous oxide users reported abusing the substance in the year prior to entering the facility
Dentists are at unique risk for substance abuse struggles in general, and access to nitrous oxide is a prominent problem for this group. In general, 10%-12% of the general population will struggle with drug or alcohol addiction at some point, but 12%-19% of dentists and physicians struggle with substance abuse. The most commonly abused drugs among dentists struggling with substance abuse include:
- Alcohol: 37%
- Prescription drugs: 31%
- Nitrous oxide: 5%
People who abuse nitrous oxide may abuse other drugs, or they may believe that nitrous alone is safe. However, the drug can lead to overdose and asphyxiation if abused, and it can cause serious, long-term damage to a person’s brain and body.