A cross-sectional study: Nitrous oxide abuse in Parisian medical students

Preventing new substance use behaviors in youth: evaluation of a two-year comprehensive program

Introduction

The Avenir Santé Association implemented a comprehensive prevention program targeting the consumption of the emerging psychoactive substances ecstasy (MDMA), cannabidiol (CBD), and nitrous oxide (N2O).

Methods

The program was evaluated through four actions: (i) training for association workers (n = 84) (ii) on-site student party interventions (n = 248), (iii) social network-based prevention (n = 186), and (iv) provision of prevention tools for party organizers (n = 148).

Results

Results showed a significant increase in understanding of emerging substances among association workers, with a pre-training score of M = 15.76 (SD = 3.65) and a post-training score of M = 18.29 (SD = 2.50). Increased awareness and reflective attitudes toward substance use were observed among young people participating in field actions, with pre- and post-intervention scores for MDMA use intentions being M = 15.89 (SD = 4.60) and M = 19.17 (SD = 3.33), respectively. Similarly, awareness of CBD effects increased from M = 14.18 (SD = 4.14) to M = 17.60 (SD = 3.31). Exposure to Instagram posts on N2O led to more negative attitudes toward N2O among young people, with a significant change in scores from M = 8.16 (SD = 1.57) to M = 8.42 (SD = 1.26). However, exposure to a website providing information about emerging substances did not produce any significant effect.

Discussion

In conclusion, this initiative underscores the usefulness of facilitator training, field interventions, and certain online information strategies for substance judgment and usage intentions. Future prevention programs can advantageously incorporate these actions.

Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023)

Background and Objectives: Nitrous oxide (N2O) has recently emerged as a cheap alternative to other recreational substances. Although legally available, its chronic use is associated with severe neurological and hematological complications due to the irreversible inactivation of vitamin B12. While no reliable data on abuse of N2O in Italy have been provided to date, we assessed the knowledge, attitudes, and practices of Italian medical professionals on the management of N2O abuse cases. Materials and Methods: A cross-sectional study was performed as a web-based survey through a series of Facebook discussion groups (targeted medical professionals: 12,103), and participants were specifically asked about their previous understanding of N2O abuse and whether they had or not any previous experience in this topic. Results: A total 396 medical professionals participated in the survey. Overall, 115 participants had previous knowledge about N2O abuse (29.04%), with higher odds for professionals with a background in emergency medicine (adjusted odds ratio (aOR) 3.075; 95% confidence intervals (95%CI) 1.071 to 8.828) and lower for specialists in psychiatry (aOR 0.328; 95%CI 0.130 to 0.825). Knowledge status on N2O abuse was largely unsatisfying, as knowledge status, reported as a percent value, was estimated to 45.33% ± 24.71. Having previously managed a case of N2O abuse was associated with higher risk perception of the actual severity of this condition (aOR 5.070; 95%CI 1.520 to 16.980). Conclusions: Our study suggests that N2O poisoning cases are occurring in Italian settings but are not reasonably reported to national authorities. As substantial knowledge gaps of Italian medical workforces were identified, we cannot rule out that the actual abuse of N2O in the population may be far larger than currently suspected.

Functional vitamin B12 deficiency is a consistent feature in hospital admissions for neurological disorders due to the use of nitrous oxide

Introduction: Misuse of inhaled nitrous oxide is a growing concern in France. It is known to alter concentrations of vitamin B12, which is required as a cofactor for methionine synthase and methylmalonyl-CoA mutase activity. Hence, measurement of the concentrations of cobalamin metabolism biomarkers, including vitamin B12, homocysteine, and methylmalonic acid, could assist in the management of patients with a complex clinical presentation or in those who deny the consumption of nitrous oxide.Methods: We retrospectively collected clinical and biological data in patients hospitalized for nitrous oxide use in a university hospital in southern France between January 2020 and October 2022.Results: Thirty-one patients were identified during 34 months; 79% were men with a median age of 23.7 years. Most (97%) presented with peripheral polyneuropathy and/or myelopathy. The median vitamin B12 concentration was 134.6 pmol/L, with 17 of 31 patients having values less than 145 pmol/L (the lower limit of the normal range). The median plasma folate concentration was 20.1 nmol/L, which is within the normal range. The median plasma homocysteine concentration was 87.7 µmol/L (normal range <15 µmol/L), and the median plasma methylmalonic acid concentration was 3.8 µmol/L (normal range <0.5 µmol/L).Conclusion: Nitrous oxide use is an emerging public health problem in France, as shown by the number of patients admitted to our hospital. The presence of a functional vitamin B12 deficiency was a consistent feature that could be helpful in diagnosis in complex cases.