Nitrous oxide (laughing gas)

Nitrous oxide (dinitrogen oxide, N₂O) is a heavy, colorless gas with a sweet smell and taste. It is used for anesthesia and pain relief and is listed on the WHO's list of essential medicines. It is illegal to sell as a recreational drug in Norway, but not a controlled substance and may be purchased as a propellant for cream dispensers.

When inhaled, nitrous oxide has a dissociative hallucinogenic effect, meaning that it gives users a feeling of distancing themselves from reality. The high is very brief, typically only a couple of minutes in duration, but is very intense and can cause strongly distorted auditory perceptions and mild visual effects [1].

Nitrous oxide is minimally harmful with moderate use, but excessive use can cause serious neurological problems due to B12 deficiency. Prolonged excessive use can also directly damage the brain [2]. Nitrous oxide displaces oxygen in the lungs, and it is therefore dangerous to inhale nitrous oxide for extended periods [3]. Combining nitrous oxide with alcohol or vasodilators like Viagra or poppers should be avoided, as this can lead to a drop in blood pressure and dizziness, unsteadiness or fainting [1].

Please see our 10 general rules for sensible drug use. You should also be mindful of the following:

• Never inhale nitrous oxide directly from the gas container, as this can cause serious frost or pressure injuries to the lungs. Always use a balloon of normal size

• Never use masks, mouthpieces, or similar devices that attach to the face, as these can be deadly if you faint. Also avoid bags. A balloon is the safest method of intake.

• Avoid nitrous oxide marketed for purposes other than cooking or medical use, as it may contain dangerous additives.

• Never use nitrous oxide while standing, as you may lose balance or faint.

• Take plenty of B12 supplements if you use nitrous oxide. Methionine and betaine can also be useful to take before and after use.

• Avoid using nitrous oxide if you have low blood pressure or a B12 deficiency.

• Avoid combining nitrous oxide with alcohol, potency drugs, or poppers.

• Be cautious when combining nitrous oxide with other dissociatives, such as ketamine. The substances can then enhance each other's harmful effects

• Make sure you get enough oxygen. Unless you have access to medical nitrous oxide, you should breathe in and out through your nose each time the gas is in the balloon.

• Avoid breathing in and out in the balloon for more than 20-30 seconds, and take proper breaks between each balloon.

• Avoid using nitrous oxide every week or more frequently, and take a long break if you have used a lot of nitrous oxide recently.

• Wait at least half an hour to drive after using nitrous oxide, and preferably much longer after using a larger amount.

We employ a five-step risk scale with values ranging from "very low" to "very high" within six categories: Acute toxicity, Long-term toxicity, Dependence, Cognitive problems, Unpleasant events, and Interactions.

These values are based on qualitative reviews of available knowledge, and should only be viewed as guidelines. They are also relative, so a score of "very low risk" does not mean the substance is risk-free. The scale assumes users are normal, healthy individuals; beware that even drugs which are well-tolerated by most people may nevertheless be harmful to some users. It also assumes normal use patterns; that is, if a given drug is only harmful when used in a certain way, yet is almost never used in that way, then the drug will be considered less harmful compared to a similar drug which is commonly used in a harmful way.


ACUTE LETHALITY

⦿⦿⦾⦾⦾ (Low risk)

The risk of death from nitrous oxide use is low. In the UK, 9 percent of young people aged 16 to 24 have used nitrous oxide in the past year, yet only 5 Britons die annually in connection with its use [5]. Most deaths are due to accidents caused by gas under pressure or lack of oxygen after prolonged inhalation of the gas. The latter typically occurs when someone attaches a breathing mask to their face or inhales gas from a bag over their head—continuing to breathe in the gas without getting enough oxygen when they lose consciousness. With balloon use, such deaths are rare, if not impossible, since loss of consciousness normally occurs several minutes before brain damage. One would normally drop the balloon and breathe in air from the surroundings, quickly normalizing oxygen levels.

People with heart problems should be cautious with non-medical nitrous oxide, as a drop in blood oxygen levels from its use can cause a significant increase in heart rate. In vulnerable individuals, this could lead to heart rhythm disturbances and, in the worst case, trigger a heart attack.

LONG-TERM HARMFULNESS

⦿⦿⦿⦾⦾ (Moderate risk)

Nitrous oxide is likely toxic to the brain in the same way as similar dissociative drugs, by making the brain overly sensitive to the neurotransmitter glutamate with excessive use [6]. This can cause brain cells to accumulate too much calcium and die. Such effects are likely seen only with highly excessive use over an extended period. However, nitrous oxide can relatively easily lead to B12 deficiency with frequent use, which can cause serious neurological damage over time if untreated. Therefore, one should take ample B12 supplements if using nitrous oxide, possibly also methionine and betaine before and after use, and excessive use should be avoided anyway.

Non-medical nitrous oxide also exposes the brain to suffocation by pulling out oxygen. Although this effect is brief, many frequent intakes during the same session can potentially be harmful. Most risks related to oxygen deprivation can likely be eliminated by inhaling the gas from a balloon of normal size and taking longer breaks between each balloon.

DEPENDENCE

⦿⦿⦾⦾⦾ (Low risk)

The use of nitrous oxide is rarely associated with a withdrawal syndrome, as the substance is not present in the body long enough at a time for the brain to make lasting adjustments. However, animal studies show that nitrous oxide stimulates the release of dopamine in the brain's reward center, as well as endogenous opioids [1]. This is normally associated with a risk of addiction with excessive use. Some may use nitrous oxide more often than they should to alleviate anxiety or depression, or for escapism. Since the intoxication is so brief and typically does not result in a hangover the next day, nitrous oxide can be tempting to use on a daily basis, which can lead to B12 deficiency.

COGNITIVE PROBLEMS

⦿⦿⦿⦾⦾ (Moderate risk)

Sporadic, moderate use of nitrous oxide is not associated with cognitive problems, but excessive use over time can lead to depression, memory problems, and eventually serious neurological damage due to B12 deficiency [7]. Therefore, one should take ample B12 supplements for a few days after using nitrous oxide, possibly also methionine and betaine before and after use, and excessive use should be avoided in any case.


UNWANTED INCIDENTS

⦿⦿⦿⦾⦾ (Moderate risk)

Using nitrous oxide can cause dizziness or loss of consciousness and lead to injuries related to falls or other accidents [1, 4]. Therefore, one should always sit or lie down when using nitrous oxide, and avoid using it in unsafe environments or with people one does not trust. If one does not use a balloon but instead breathes nitrous oxide directly from the valve, one risks both frost and pressure injuries to the lungs [1]. Therefore, a balloon should always be used. Note that psychomotor functioning, including the ability to drive, may be impaired for at least half an hour after using nitrous oxide, and possibly longer after using a larger amount [10].

INTERACTIONS

⦿⦿⦾⦾⦾ (Low risk)

Nitrous oxide has no known very dangerous interactions with other drugs, and its effect is so brief that most interactions will be transient. Nevertheless, nitrous oxide should ideally not be used together with alcohol, potency drugs, or "poppers," as this increases the risk of dizziness, blood pressure drop, and accidents. Using nitrous oxide with cannabis also increases the risk of blood pressure drop and heart rhythm disturbances in people with heart problems.

Nitrous oxide has few known interactions with legal medications, but likely enhances the effects of benzodiazepines. Caution should also be exercised when combining it with other dissociatives, such as ketamine, as these substances can strongly enhance each other's effects.

DOSAGE

A typical dose of nitrous oxide is one small canister, which contains about 8 grams of gas and fills one regular-sized balloon.

FORMAT

Nitrous oxide used for recreational purposes is usually found in canisters sold legally in hardware and kitchen supply stores. Unlike medical nitrous oxide mixtures, these do not contain oxygen, making it dangerous to inhale the gas they contain for prolonged periods.

Beware! Ensure that the canister actually contains nitrous oxide and not, for example, carbon dioxide. Nitrous oxide is more sought after for cream making because it has a sweet taste.

Avoid using nitrous oxide sold for purposes other than cooking or medical use, as it may contain harmful additives. Some cooking nitrous oxide cartridges may also contain traces of lubricant which can be harmful to inhale, but the normal method of using a siphon and balloon is assumed to reduce the amount of lubricant the user risks inhaling.

ROUTE OF ADMINISTRATION

The most common and safest way to dose non-medical nitrous oxide is to insert a nitrous oxide cream charger into a siphon (a device used to make whipped cream) and attach a balloon over the nozzle of the siphon. The cartridge is pierced as it is screwed into the siphon, which has a valve that controls how quickly the gas escapes. Most nitrous oxide chargers contain enough gas to fill one standard balloon.

Since nitrous oxide is not absorbed very efficiently, the gas must be inhaled multiple times to achieve the maximum effect of the dose. Therefore, it is common to breathe in and out of the same balloon a few times before finally exhaling. This should not be necessary for more than 20-30 seconds if one breathes in and out at a moderate pace without stopping.

Beware! Continuous inhalation of nitrous oxide can lead to the user passing out, as well as cause dizziness and a drop in blood pressure. It may therefore be wise to inhale and exhale through the nose every time the gas is in the balloon, and sit or lie down on a couch or bed for the duration of the effects.

MECHANISM OF ACTION

Like other dissociative substances, nitrous oxide is an antagonist at the brain's NMDA receptors. This means that the nitrous oxide molecule blocks the action of the neurotransmitter glutamate. It also enhances the effect of the neurotransmitter GABA and leads to the release of dopamine and endogenous opioids [1].

DURATION

Nitrous oxide has a half-life of about 5 minutes, and most of the noticeable high will be gone after this period. The main effects typically last only 2-3 minutes.

SUBJECTIVE EFFECTS

Nitrous oxide is a dissociative hallucinogen, creating a sense of increased distance from reality and one's own body. It also has hallucinogenic properties in that it can cause mild changes in visual impressions and sometimes strong changes in auditory impressions. It is not uncommon when using nitrous oxide to experience sounds having a metallic ring or becoming choppy, as if they are distorted through a large fan. (Some have described sounds under the influence of nitrous oxide as "helicopter-like.") [8] When nitrous oxide is used with psychedelics, similar distortions can also be experienced in terms of synesthetic effects, so that the soundscapes one "sees" with closed eyes become grainy or pixelated.

Nitrous oxide is fundamentally anxiolytic and analgesic, but the intoxication experience can also be uncomfortable if one does not like to be confused. It is common to experience slight dizziness or a feeling that one might faint, but this is normally harmless as long as one is sitting or lying down during the intoxication.

SIDE EFFECTS

Nitrous oxide increases heart rate and lowers blood pressure, but these effects diminish quickly with the intoxication [3].

Some may become nauseous or vomit from nitrous oxide, and it is common to feel dizzy or unsteady while intoxicated.

Nitrous oxide deactivates an enzyme the body needs to utilize vitamin B12, and this effect can last for many days after using larger amounts. With frequent use of nitrous oxide, it is therefore possible to develop a B12 deficiency, which is a potentially serious condition if left untreated [7]. Therefore, one should avoid frequent use of nitrous oxide and take methionine and betaine supplements before and after using larger amounts of nitrous oxide, as well as B12 supplements a few days after use.

It is common for one's voice to have a lower pitch when nitrous oxide is in the lungs, as the gas is heavier than air.

Nitrous oxide for cooking and industrial purposes is sold legally over the counter and online in Norway. It is not allowed to sell these products for use as recreational drugs, however, as this would classify them as medicines subject to special regulation. However, it is legal to acquire and use them as recreational drugs as long as they have been sold legally.

Medical grade nitrous oxide, on the other hand, is a prescription drug in prescription group C in Norway.

It is illegal for private individuals to import a prescription drug into Norway by mail. This is stipulated by the Medicines Act § 31, cf. the regulation on the manufacture and import of medicinal products § 3-2 sixth paragraph and the Medicines Act § 13 fourth paragraph. However, one can legally bring up to one year's supply of a prescription drug from another EEA country—or three months' supply from a non-EEA country—as long as it can be documented that the medicine was legally acquired in the country of purchase for personal use, and the medicine is not listed as a narcotic in Norway. This follows from § 3-2 first paragraph of the regulation on the manufacture and import of medicinal products.

The sale of medicines, or the production of medicines intended for sale, is punishable without permission from the Ministry of Health and Care Services. This is stipulated by the Medicines Act § 31 cf. §§ 13 and 16, and the regulation on the manufacture and import of medicinal products § 3-2. Production for personal use, however, is not regulated by law. Any transfer (with or without payment) of a prescription drug can also be punished under the Medicines Act § 31 third paragraph if there are "particularly aggravating circumstances." According to Ot. prp. 23 (1983-1984), this depends on the drug's danger and potential for dependency and other circumstances—for example, the amount and whether the drug is transferred to children. It is unclear to what extent this provision affects the transfer of smaller amounts to adults, and it is very rarely used in practice.

It is also punishable under the Penal Code § 334 (minor receiving of stolen goods) to receive or acquire a small amount of prescription drugs for one's own use if one knows or accepts the possibility that they have been illegally produced, imported, or sold/transferred—or that they stem from another criminal act, e.g., theft/embezzlement.

When dealing with a larger amount of drugs of criminal origin, the Penal Code §§ 332 or 333 (ordinary or gross receiving of stolen goods) may also apply, and one can then also be punished under the Penal Code § 335 (negligent receiving of stolen goods) for receiving or acquiring drugs that one should have understood stemmed from a criminal act. If one stores drugs of criminal origin to sell them, the Penal Code § 332 can likely also apply even if the quantity is small.