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Dai Q, Chen S, Zhang X, Fan K, Zhang J, Zheng J. Nitrous oxide abuse in a 21-year-old female: a case report and review of literature. Front Neurol 2024; 15:1416557. [PMID: 38994489 PMCID: PMC11236749 DOI: 10.3389/fneur.2024.1416557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024] Open
Abstract
The abuse of nitrous oxide (N2O) poses a substantial public health challenge. In many countries, including China, regulations governing the utilization and accessibility to N2O remain ambiguous, particularly within the food industry. Here, we report a case of a 21-year-old female who presented with symptoms of subacute combined degeneration (SCD) of the spinal cord due to N2O abuse. The patient exhibited bilateral lower limb numbness and weakness, low serum vitamin B12 levels with elevated homocysteine levels, and lumbar spine magnetic resonance imaging (MRI) revealed abnormal signals of the spinal cord. Following cessation of N2O and comprehensive therapy including methylcobalamin and nerve growth factor, the symptoms significantly improved. A follow-up examination 3 months later showed good progress in gait stability. At a 5-year follow-up, the patient's previous clinical symptoms had completely disappeared, and her quality of life had returned to normal. This case underscores the urgency of raising awareness and prevention of N2O abuse, emphasizing the importance of timely diagnosis and comprehensive treatment for patient recovery. Clear formulation and enforcement of relevant regulatory measures are equally crucial in reducing instances of abuse.
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Affiliation(s)
- Qi Dai
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
| | - Shutong Chen
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, China
| | - Xiaodan Zhang
- Department of Emergency Medicine, The University of Hong Kong, Hong Kong, China
| | - Kuixin Fan
- Department of Emergency Medicine, Ningbo No.2 Hospital, Ningbo, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospital, Ningbo, China
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Raaj S, Ahmed MS, Warren E, Farrelly R. An Episode of Psychosis After Nitrous Oxide Abuse During a Pandemic: A Case Report. Cureus 2024; 16:e60634. [PMID: 38903353 PMCID: PMC11187452 DOI: 10.7759/cureus.60634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
The abuse of inhalants like nitrous oxide (N2O), readily available worldwide, has remained a prominent public health problem during the last few decades. Literature reveals increased use during the previous pandemic, particularly regarding recreational use. There is limited evidence-based data available to relate the abuse of N2O with psychosis. Therefore, this case report of a 22-year-old adult with no previous psychiatry history, reportedly abusing 75-100 canisters of N2O per day during the last pandemic COVID-19 lockdown, highlights the relationship between (N2O) abuse and the symptoms evolved including delusions, auditory hallucinations, and disorganized cognition. All the laboratory findings and results from imaging modalities were inconsistent for any organic cause of the symptoms. The case then underwent treatment with antipsychotic medications and a multidisciplinary model, which improved the symptoms gradually. The case, in particular, discusses N2O abuse, which is widespread in European Union countries, including the UK and the Republic of Ireland, and its chronic use puts one at a higher risk of developing psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy. The sale of N2O for its psychoactive properties is prohibited in many countries, including the Republic of Ireland, as per legislation. However, N2O is not a controlled drug, meaning it is not a crime to possess N2O. This case report manifests the psychopathy caused by abuse of N2O, which would further attract specialists in the field to conduct epidemiological studies for prevention at the primary level.
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Affiliation(s)
- Shaeraine Raaj
- Psychiatry, Connolly Hospital Blanchardstown, Dublin, IRL
- Psychiatry, Phoenix Care Centre, Dublin, IRL
| | | | - Emma Warren
- Medicine, Trinity College Dublin, Dublin, IRL
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3
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Brunt TM. Nitrous oxide: A difficult case for classification as an addictive substance. Addiction 2024; 119:621-622. [PMID: 38123187 DOI: 10.1111/add.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Tibor Markus Brunt
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ruijter BJ, de Mooij MJ, Bruijnes JE, van Oosterhout WPJ, Kwa VIH. Neurological complications of excessive recreational nitrous oxide use: a case series based on a text mining algorithm. J Neurol 2024; 271:1267-1276. [PMID: 37914912 DOI: 10.1007/s00415-023-12061-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND The recreational use of nitrous oxide (N2O) has gained popularity over recent years. We present a case series of excessive N2O users with neurological complications. METHODS In this retrospective three-centre study, we used a text mining algorithm to search for patients who used N2O recreationally and visited a neurologist. RESULTS We identified 251 patients. The median duration of N2O use was 11 months (interquartile range [IQR], 3-24) and the median amount of N2O used per occasion 1.6 kg (IQR 0.5-4.0). Clinically, polyneuropathy (78%), myelopathy (41%), and encephalopathy (14%) were the most common diagnoses. An absolute vitamin B12 deficiency of < 150 pmol/L was found in 40% of cases. In 90%, at least one indicator of functional vitamin B12 status (vitamin B12, homocysteine, or methylmalonic acid) was abnormal. MRI showed signs of myelopathy in 30/55 (55%) of cases. In 28/44 (64%) of those who underwent electromyography, evidence of axonal polyneuropathy was found. Most (83%) patients were treated with vitamin B12 supplementation, and 23% were admitted to the hospital. Only 41% had follow-up for ≥ 30 days, and 79% of those showed partial or complete recovery. CONCLUSIONS In this case series of excessive N2O users, we describe a high prevalence of polyneuropathy, myelopathy, and encephalopathy. Stepwise testing for serum levels of vitamin B12, homocysteine, and methylmalonic acid may support the clinical diagnosis. Due to low sensitivity, MRI of the spinal cord and electromyography have limited value. Effective treatment should incorporate supplementation of vitamin B12 and strategies to prevent relapses in N2O use.
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Affiliation(s)
- B J Ruijter
- Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - M J de Mooij
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - J E Bruijnes
- Department of Neurology, Zuyderland Medical Centre, Heerlen, the Netherlands
- Department of Neurology, Maastricht UMC+, Maastricht, the Netherlands
| | | | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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Sutherland R, Man N, Brown J, Cairns R, Raubenheimer J, Grigg J, Dawson A, Jamshidi N, Peacock A. Has there been an increase in nitrous oxide use and associated harms in Australia? An analysis of triangulated data sources, 2003-2020. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 121:104178. [PMID: 37776604 DOI: 10.1016/j.drugpo.2023.104178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND There is growing concern, globally, regarding use of nitrous oxide (N2O) for intoxication purposes. This paper aims to examine trends in: (i) past six month N2O use among a sample of people who use regularly use ecstasy and/or other illicit stimulants (2003-2020); (ii) volume of N2O-related Google searches and social media posts (2009-2020); and (iii) N2O-related calls to Poisons Information Centres (PIC) (2004-2020). METHODS Data were obtained from annual interviews with sentinel samples of Australians aged ≥16 years who used ecstasy and/or other illicit stimulants ≥monthly and resided in a capital city (∼800 each year); Google search activity; social media posts; and exposure calls to four PIC. RESULTS Among samples of people who regularly use ecstasy and/or other illicit stimulants, past six-month N2O use increased 10% each year from 2009 to 2020, with the sharpest increase observed between 2015 and 2018 (25.4% p/year; 95% CI: 14.6-37.1). Frequency and quantity of N2O use remained stable and low. Google search probabilities increased by 1.8% each month from January 2009 and December 2019 (95% CI: 1.5-2.2), with the sharpest increase observed between July 2016 to December 2017 (6.0% p/month; 95% CI: 4.4-7.5). Social media posts increased 2.0% per month from January 2009 and December 2019 (95% CI: 1.1-3.0), with the sharpest increase observed between March and October 2017 (19.2% p/month; 95% CI: 1.7-39.7). The number of N2O-related calls to Australian PIC increased sixfold between 2016 (16) and 2020 (111). CONCLUSIONS Triangulation of various data sources indicate significant shifts in N2O use and harms in Australia. This includes increases in use, Google searches and social media posts, although these have plateaued in recent years, coupled with increased rates of harm. These findings correspond with evidence of a global increase in N2O use and harm, highlighting the need for education of both people who use N2O and health professionals.
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Affiliation(s)
- Rachel Sutherland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Nicola Man
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Jared Brown
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia
| | - Rose Cairns
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia
| | - Jacques Raubenheimer
- The University of Sydney, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia
| | - Jodie Grigg
- National Drug Research Institute and enAble Institute, Curtin University, Perth, Australia
| | - Andrew Dawson
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia; Drug Health Services, Sydney Local Health District, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia
| | - Nazila Jamshidi
- The University of Sydney, Sydney, Australia; Drug Health Services, Sydney Local Health District, Sydney, Australia; New South Wales Poisons Information Centre, Sydney Children Hospital Network, Australia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychological Sciences, University of Tasmania, Hobart, Australia
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MacLean SJ, Riddell O, Herold MD, Frank VA. Becoming a nitrous oxide user on social media: Learning to maximise pleasures and minimise harms. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103861. [PMID: 36162207 DOI: 10.1016/j.drugpo.2022.103861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/16/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In his classic work 'Becoming a marihuana user', Howard Becker (1953) showed how drug use learning occurred in social interactions and settings, which in turn shape drug use. Today, social media offers people opportunities to learn about drugs without physical proximity. In this paper, we identify nitrous oxide (N2O) users' key concerns about how to maximise pleasures and minimise harms, as expressed on the social media platform Reddit. In doing so, we consider what learning about N2O online might mean for the provision of drug education in an era of internet technology. METHOD Data are drawn from a Reddit page (subreddit) dedicated to N2O use. We undertook thematic analysis of 655 threads contributed in late-2020. The subreddit is conceptualised as an internet-mediated social world that constitutes drug user knowledges, practices and identities, rather than simply reflecting them. RESULTS Our analysis uncovers practices not previously been reported in academic literature or health information on N2O, such as breathing techniques to maximise the effects and use of filters to reduce exposure to oil residue. While education resources often describe effects as 'mild', users recounted intense pleasures including euphoria, anaesthesia, sensory distortion, hallucination and epiphanies, especially when N2O was used with other drugs. Subreddit members were deeply concerned to minimise the risk of harms. Yet official health advice regarding N2O was not referenced, some misinterpretation of scientific literature was apparent and drug treatment was almost never suggested when people recounted harms. CONCLUSION In contrast to official health resources, the subreddit offers members practical advice on harm reduction. It provides opportunities for users of N2O to position themselves as playful, informed and caring curators of drug use pleasures. We highlight the need for those formulating drug education to engage with the knowledge, practices and identities that emerge within internet-mediated social worlds.
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Affiliation(s)
- Sarah J MacLean
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3083, Australia.
| | - Oscar Riddell
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Maria Dich Herold
- Center for Alcohol and Drug Research, Aarhus University, Bartholins Alle 10, 3. Aarhus C, 8000, Denmark
| | - Vibeke Asmussen Frank
- Center for Alcohol and Drug Research, Aarhus University, Bartholins Alle 10, 3. Aarhus C, 8000, Denmark
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van Amsterdam JG, Nabben T, van den Brink W. Increasing recreational nitrous oxide use: Should we worry? A narrative review. J Psychopharmacol 2022; 36:943-950. [PMID: 35678512 DOI: 10.1177/02698811221082442] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Since 2000, the prevalence of recreational nitrous oxide (N2O) use has increased in the Western world. Although N2O is a relatively safe drug, the overall increase in the use of N2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N2O-induced vitamin B12 deficiency. The increasing trend of recreational users with N2O-induced neurological damage at emergency departments confirms the urgency of this development. OBJECTIVE/METHODS This narrative review describes recent trends in N2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. RESULTS Considering the rising trend in N2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N2O use. CONCLUSION It is concluded that the increase in excessive N2O use is of serious concern.
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Affiliation(s)
- Jan Gc van Amsterdam
- Department of Psychiatry, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ton Nabben
- Urban Governance and Social Innovation, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
BACKGROUND Nitrous oxide (N2O) is a frequently used anaesthetic. Since the year 2000, recreational use of N2O, also known as 'laughing gas', became popular as a recreational drug due to its mild psychedelic effect. In the 1980s, several reports warned against N2O-induced reproductive risks among healthcare personnel, questioning the occupational safety of N2O in health care. METHODS Data about the reproductive risks of N2O were collected from literature. RESULTS Particularly in the past, professionals working in dental and midwifery practices, operating theatres and ambulance transport were exposed to high levels of N2O. Adverse reproduction effects included congenital anomalies, spontaneous abortion and reduced fertility rates in females. Following occupational measures, like maximal exposure limits for ambient N2O, this occupational risk was considerably reduced. Recreational users of N2O, however, voluntarily and repeatedly expose themselves to (very) high doses of N2O. As such, they exceed the health exposure limits some hundred times, but they are fully unaware of the related reproductive risks. CONCLUSION We advocate to increase the awareness in recreational N2O-users about its potential reproductive risks, especially in heavy users, pregnant users or those who intend to become pregnant.
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Affiliation(s)
- Jan van Amsterdam
- Jan van Amsterdam, Department of
Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box
22660, 1100 DD Amsterdam, The Netherlands. Emails:
;
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