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Singh H, Beriwal N, Minhas JS, Robinson C. Subacute combined degeneration from nitrous oxide abuse. Radiol Case Rep 2024; 19:5600-5604. [PMID: 39296751 PMCID: PMC11406348 DOI: 10.1016/j.radcr.2024.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/21/2024] Open
Abstract
Nitrous oxide is an anesthetic medication which can also be recreationally abused in the form of whippet canisters. Its prolonged abuse can interfere with Vitamin B12 metabolism and lead to its functional deficiency. We report a case of a 30-year-old male who presented with generalized weakness and was found to have subacute combined degeneration (SCD) of the spinal cord. His laboratory workup showed low Vitamin B12 with elevated homocysteine and methylmalonic Co-A levels, and further questioning revealed prolonged nitrous oxide abuse. Nitrous oxide causes functional inactivation of methylcobalamin by rendering it unable to function as a coenzyme for methionine synthase enzyme. This leads to the decreased production of methionine and subsequent production of myelin. This case describes nitrous oxide abuse as an important etiology to be considered in patients presenting with weakness and myeloneuropathy and describes important imaging findings.
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Affiliation(s)
- Harjinder Singh
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA
| | - Nitya Beriwal
- Department of Neurology, The University of Chicago Medical Center, Chicago, IL, USA
| | - Jasdeep Singh Minhas
- Department of Internal Medicine, St. George's University School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Ciji Robinson
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA
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2
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Thevenin M, Malmartel A, Karila L, Camus Jacqmin M. High lifetime prevalence of regular nitrous oxide use in French medical students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-8. [PMID: 39348597 DOI: 10.1080/00952990.2024.2392566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 07/05/2024] [Accepted: 08/12/2024] [Indexed: 10/02/2024]
Abstract
Background: Although nitrous oxide (N₂O) is increasingly misused recreationally, its use and risks among medical students who have professional access to it are rarely explored.Objectives: To investigate the recreational use of N₂O among medical students in Paris Region (France).Methods: This cross-sectional study used an online questionnaire distributed in 2022 through social networks, to all medical students (undergraduate student from the 2nd year of medical studies to residents until the end of the residency) from the six medical universities in Paris Region. We collected demographic characteristics, patterns of N₂O consumption, co-consumptions, and N₂O training (academic course or self-training). Factors associated with N₂O consumption and complications were analyzed using multivariable logistic regressions.Results: The questionnaires of 444 students (mean age: 25.9 years (SD = 2.69), 75.5% female, and 63.74% residents) were analyzed. Recreational N₂O consumption was reported by 71.85% of students and 20.50% consumed at least monthly. N₂O consumption was associated with being a resident (versus undergraduate student) (adjusted OR (aOR) = 3.07[1.45-6.72]; p < .01), receiving training on N₂O (aOR) = 3.13[1.84-6.24]; p < .01), and consumption of cannabis (aOR = 18.21[3.47-104.26]; p < .01), ecstasy (aOR = NA, p = .048) and poppers (aOR = 13.9[2.64-77.94]; p < .01). Complications (mainly dizziness, paresthesia and burns) were reported in 8.15% of students consuming N₂O. They were associated with consuming more than 10 balloons per intake (aOR = 6.04[1.32-25.00); p < .01) and inversely associated with receiving training (aOR = 0.35[0.14-0.86]; p = .01).Conclusions: Almost three-quarters of medical students experienced recreational N₂O consumption, particularly with poly-drug use. Given that complications were associated with high consumption and lack of education, risk training and screening for N₂O consumption could be beneficial.
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Affiliation(s)
- Mathilde Thevenin
- Département de médecine générale, Université Paris Cité, Paris, France
| | - Alexandre Malmartel
- Département de médecine générale, Université Paris Cité, Paris, France
- METHODS Team, CRESS, INSERM, INRA, Université Paris Cité, Paris, France
| | - Laurent Karila
- Centre d'enseignement, de recherche et de traitement des addictions, Hôpital universitaire Paul-Brousse (AP-HP), Université Paris-Saclay, Villejuif, France
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3
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Mohammed H, Sara E, Bouchra O. Acute psychotic and vitamin B12 deficiency in patient with nitrous oxide misuse: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241269577. [PMID: 39131582 PMCID: PMC11311192 DOI: 10.1177/2050313x241269577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/25/2024] [Indexed: 08/13/2024] Open
Abstract
Nitrous oxide, also called nitrous monoxide, or nitrous oxide, is a colorless and odorless gas, without toxicological effect, but it can be asphyxiating at high concentration, its misuse is increasing especially among young people. Chronic use of N2O may cause psychiatric complications, including depression, hypomania, and paranoid psychosis with visual and auditory hallucinations. We present a case of nitrous oxide abuse "laughing gas" in 25 years old woman with bizarre behavior delusions and hallucinations with a normal neurological examination. The patient had low levels of vitamin B12 (135 pmol/L). Treatment with antipsychotics and vitamin B12 (cobalamin) resolved her psychosis. In addition to the hematological and neurological effects, rare cases of acute psychosis, especially in young people with or without psychiatric history, use varies from 1 month to years. Clinicians are increasingly in need of knowledge regarding the misuse of nitrous oxide.
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Affiliation(s)
- Hasnaoui Mohammed
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Echater Sara
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Psychiatry Department, Faculty of Medicine and Pharmacy of Tangier, Université Abdelmalek Essaadi, CHU Mohammed VI, Tangier, Morocco
| | - Oneib Bouchra
- Department of Psychiatry, University Hospital of Mohammed VI-Oujda, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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Verboeket SO, van den Bergh J, van Amsterdam J, Nabben T, van den Brink W, Goudriaan AE. Treatment Seeking Nitrous Oxide Users in Addiction Care: A Comparison with Cocaine Users on Clinical and Treatment Characteristics. Eur Addict Res 2024; 30:223-232. [PMID: 39004071 PMCID: PMC11309065 DOI: 10.1159/000539860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Over the past decade, frequent use of large quantities of nitrous oxide (N2O) has become more common in the Netherlands. Although N2O poses several negative health consequences for a subgroup of problematic N2O users, there is a lack of knowledge on what characterizes these intensive users. This study therefore aims to provide the demographic and substance use characteristics and experiences during treatment of treatment seeking problematic N2O users and to compare this with a matched group of treatment-seeking problematic cocaine users. METHODS A retrospective chart review was performed of patients who were referred for treatment of problematic N2O use at a large Dutch addiction care facility from January 2020 to September 2022, extracting demographics, pattern of use and follow-up data. Additionally, a subgroup of N2O users was propensity-score matched (1:1) with a subgroup of treatment seeking problematic cocaine users, both groups excluding users with substance use disorders or frequent use of substances other than N2O and cocaine, respectively. RESULTS 128 patients with a N2O use disorder were included in the total sample and a subgroup of 77 N2O-only users was propensity-score matched on age and sex to 77 cocaine-only users. N2O users were typically young (mean age 26.2 years), male (66.4%), unmarried (82.9%), with a low education level (59.0%) and born in the Netherlands (88.2%), with parents born in Morocco (45.3%). N2O was used intermittently (median 10 days/month, IQR 4.0-17.5 days) and often in very large quantities (median 5 kg [ca. 750 balloons] per average using day, IQR 2-10 kg). Compared to the patients with a cocaine use disorder, matched N2O users were lower educated, more often from Moroccan descent, and less likely to be alcohol or polysubstance users. Despite receiving similar treatments, N2O users were twice as likely to discontinue treatment before completion compared to cocaine users (63 vs. 35%, p = 0.004). CONCLUSION Treatment-seeking problematic N2O users are demographically different from treatment-seeking problematic cocaine users and are much more likely to dropout from psychological treatment. Further research is needed into the needs and other factors of problematic N2O users that relate to poor treatment adherence in problematic N2O users.
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Affiliation(s)
- Sebastiaan O. Verboeket
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Jellinek, Arkin, Amsterdam, The Netherlands
| | | | - Jan van Amsterdam
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Ton Nabben
- Urban Governance and Social Innovation, University of Applied Sciences, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Jellinek, Arkin, Amsterdam, The Netherlands
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5
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Allen O, Keating M. Nitrous oxide tank cold burn to the forearm: a case study and discussion of the literature. Emerg Nurse 2024; 32:22-27. [PMID: 38268417 DOI: 10.7748/en.2024.e2191] [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] [Accepted: 11/21/2023] [Indexed: 01/26/2024]
Abstract
Nitrous oxide (N 2 O) has become one of the most popular recreational drugs in Europe. While N 2 O is often used in medical settings as an analgesic and anaesthetic agent, its recreational use was documented many years before its introduction into clinical practice. The desired effects from inhaling N 2 O for recreational purposes include rapid feelings of relaxation, calmness and euphoria, which can be accompanied by giddiness and laughter. There are various adverse effects associated with N 2 O use, including headache, nausea, vomiting, drowsiness and the development of permanent neurological damage. Furthermore, its use is associated with cold burns and road accidents. This article details the case of a patient who sustained an N 2 O tank burn to his forearm from recreational use. It also discusses the prevalence, legal status and adverse effects of N 2 O use as well as the pathophysiology and management of cold burn injuries.
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Affiliation(s)
- Oliver Allen
- emergency department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Muireann Keating
- Royal College of Surgeons in Ireland, plastic and reconstructive surgery, St James's Hospital, Dublin, Ireland
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Li Z, Li Z, Qiang H, Xie W, Su M, Xiang P, Shi Y. Quantitative determination of nitrous oxide in human blood by HS-GC-MS: forensic application of two fatal poisoning cases. Forensic Sci Int 2024; 360:112067. [PMID: 38821023 DOI: 10.1016/j.forsciint.2024.112067] [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: 11/06/2023] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024]
Abstract
Nitrous oxide (N2O), also known as laughing gas, has a euphoric effect and is becoming increasingly popular as a recreational inhalant drug. Deaths caused by recreational nitrous oxide abuse are rare, but may still occur. Although some methods for the quantification of N2O by GC-MS have been reported, elimination of carbon dioxide interference and the choice of a suitable internal standard remain current limitations to accurate N2O quantification. Here, a validated method using headspace-gas chromatography-mass spectrometry (HS-GC-MS) is described that allows the quantification of N2O in human blood samples: sodium hydroxide is used to remove carbon dioxide, and n-pentane is chosen as a suitable internal standard. Collectively, the validation results show a good linear relationship of N2O in blood within the concentration range of 0.02 ∼ 0.5 mL/mL and an LOD of 0.005 mL/mL. Subsequent application of the validated method to two real mortality cases due to N2O intoxication provided reference values for blood concentrations in forensic cases. Other biological specimens (gaseous samples and tissues) of the deceased were also analyzed to demonstrate that the deaths were caused by asphyxia due to the inhalation of N2O.
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Affiliation(s)
- Zehong Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Ziyi Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Huosheng Qiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China
| | - Wanting Xie
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Mengxiang Su
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, PR China
| | - Ping Xiang
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
| | - Yan Shi
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai 200063, PR China.
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Ryder H, Mosalski S, Bramah V, Page R, Faux SG, Shiner CT. Multidisciplinary rehabilitation following recreational nitrous oxide (N 2O) misuse: evaluating service provision and rehabilitation outcomes in a cohort with serious disability. Disabil Rehabil 2024:1-10. [PMID: 38950561 DOI: 10.1080/09638288.2024.2365987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
Purpose: Recreational nitrous oxide (N2O) misuse is increasing globally. Chronic misuse can cause neurological impairments that require rehabilitation, though literature characterising rehabilitation is limited. This study aimed to evaluate rehabilitation service provision for impairments resulting from N2O misuse. Methods: A retrospective audit of hospitalised patients referred for rehabilitation for N2O toxicity was conducted between 2015 and 2022 at a single metropolitan hospital. Data were collected via medical record audit and analysed via descriptive and non-parametric statistics. Results: 16 eligible cases were identified, aged 18-43 years (50% female/male), with increasing case frequency. 12 cases received inpatient rehabilitation episodes for multifactorial sensorimotor, cognitive and psychosocial impairments. Cases articulated diverse rehabilitation goals and received intervention from a median of 6 clinical disciplines. All cases required assistance to mobilise or perform self-care activities on admission. Functional Independence Measure (FIM) scores significantly improved with rehabilitation (median FIM 84[75-93] to 117[112-123], p < .001). Despite gains in independence, all cases required referral for ongoing rehabilitation post-discharge. Conclusions: Demand for inpatient rehabilitation for disabling N2O toxicity appears to be increasing. In this series, cases were young, exhibited serious impairments, and had multidisciplinary rehabilitation needs. Inpatient rehabilitation led to significant functional improvements, though ongoing disability was evident post-discharge.
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Affiliation(s)
- Hannah Ryder
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Simon Mosalski
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, University of Notre Dame, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
| | - Robert Page
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
- School of Medicine, Sydney Campus, University of Notre Dame, Australia
| | - Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
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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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Dawudi Y, Azoyan L, Broucker TDE, Gendre T, Miloudi A, Echaniz-Laguna A, Mazoyer J, Zanin A, Kubis N, Dubessy AL, Gorza L, Ben Nasr H, Caré W, d'Izarny-Gargas T, Formoso A, Vilcu AM, Bonnan M. Marked increase in severe neurological disorders after nitrous oxide abuse: a retrospective study in the Greater Paris area. J Neurol 2024; 271:3340-3346. [PMID: 38478030 PMCID: PMC11136741 DOI: 10.1007/s00415-024-12264-w] [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: 12/20/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Recreational nitrous oxide (N2O) use has become more widespread worldwide, leading to an increase in myelopathies and peripheral neuropathies. The aim of this study was to describe clinical and socioeconomical characteristics of severe N2O-induced (NI) neurological disorders (NI-NDs), to determine its incidence in the Greater Paris area and to compare it with that of similar inflammatory neurological disorders. METHODS We performed a retrospective multicentric cohort study of all adult patients with severe NI-NDs in the neurology and general internal medicine departments of the Greater Paris area from 2018 to 2021. The incidence was compared with that of non-NI-myelitis and Guillain-Barré syndrome (GBS) using a sample of 91,000 hospitalized patients sourced from health insurance data. RESULTS Among 181 patients, 25% had myelopathy, 37% had peripheral neuropathy and 38% had mixed disease. Most were aged between 20 and 25 years, lived in socially disadvantaged urban areas, and exhibited high rates of unemployment (37%). The incidence of NI-NDs increased during 2020 and reached a peak mid-2021. The 2021 incidence in 20-25-year-olds was 6.15 [4.72; 8.24] per 100,000 persons for NI-myelopathy and 7.48 [5.59; 9.37] for NI-peripheral neuropathy. This was significantly higher than for non-NI-myelitis (0.35 [0.02; 2.00]) and GBS (2.47 [0.64; 4.30]). The incidence of NI-NDs was two to three times higher in the most socially disadvantaged areas. CONCLUSION The recent increase in recreational N2O use has led to a rise in the incidence of severe NI-NDs, particularly in young adults with low socioeconomic status for whom NI-NDs strongly outweigh similar neurological disorders.
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Affiliation(s)
- Yachar Dawudi
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France.
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France.
| | - Loris Azoyan
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France
| | - Thomas D E Broucker
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
| | - Thierry Gendre
- Neurology Department, Hôpital Henri-Mondor, 1 Rue Gustave Eiffel, 94000, Créteil, France
| | - Amal Miloudi
- Neurology Department, Centre Hospitalier Intercommunal Robert Ballanger, Bd Robert Ballanger, 93600, Aulnay-Sous-Bois, France
| | - Andoni Echaniz-Laguna
- Neurology Department, Hôpital Bicêtre, 78 Rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Julie Mazoyer
- Neurology Department, Hôpital Avicenne, 125 Route de Stalingrad, 93009, Bobigny, France
| | - Adrien Zanin
- Clinical Physiology Department, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Nathalie Kubis
- Clinical Physiology Department, Hôpital Lariboisière, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Anne-Laure Dubessy
- Neurology Department, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Lucas Gorza
- Neurology Department, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Haifa Ben Nasr
- Neurology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91100, Corbeil-Essonnes, France
| | - Weniko Caré
- Department of Internal Medicine, Bégin Military Teaching Hospital, Saint-Mandé, France
- Paris Poison Control Center, Toxicology Federation (FeTox), Hôpital Fernand Widal, AP-HP, Paris, France
| | | | - Aude Formoso
- Neurology Department, Hôpital de La Pitié Salpêtrière, 47-83 Bd de L'Hôpital, 75013, Paris, France
| | - Ana-Maria Vilcu
- Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136, Sorbonne Université INSERM, Paris, France
| | - Mickael Bonnan
- Neurology Department, Centre Hospitalier de Saint-Denis, 2 Rue du Dr Delafontaine, 93200, Saint-Denis, France
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Sepahvand M, Rashidi S, Emamikhah M, Rohani M, Yazdi N. Laughing Ceased, Nitrous Oxide-Induced Myelopathy Evolved. Can J Neurol Sci 2024; 51:469-471. [PMID: 37066709 DOI: 10.1017/cjn.2023.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Affiliation(s)
- Mahsa Sepahvand
- Department of neurology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sirwan Rashidi
- Department of neurology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Emamikhah
- Department of neurology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Rohani
- Department of neurology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Yazdi
- Department of neurology, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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11
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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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12
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Victorri-Vigneau C, Grall Bronnec M. Yes, nitrous oxide addiction undeniably exists! Addiction 2024; 119:625-626. [PMID: 38196069 DOI: 10.1111/add.16430] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Affiliation(s)
- Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes - Service de pharmacologie clinique - Centre d'Evaluation et d'Information sur la Pharmacodependence - Addictovigilance (CEIP-A), Nantes, France
- INSERM UMR1246, SPHERE methodS in Patients-centered outcomes and Health REsearch, Université de Nantes et de Tours, Nantes, France
| | - Marie Grall Bronnec
- INSERM UMR1246, SPHERE methodS in Patients-centered outcomes and Health REsearch, Université de Nantes et de Tours, Nantes, France
- Nantes université, CHU Nantes, Service d'Addictologie et de Psychiatrie de liaison, Nantes, France
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13
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Winstock AR. Nitrous oxide: The label 'potentially addictive' may do more harm than good. Addiction 2024; 119:623-624. [PMID: 38183384 DOI: 10.1111/add.16426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Adam Rohan Winstock
- University College London, Institute of Epidemiology and Health Care, London, UK
- Global Drug Survey, London, UK
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14
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Back S, Kroon E, Colyer-Patel K, Cousijn J. Does nitrous oxide addiction exist? An evaluation of the evidence for the presence and prevalence of substance use disorder symptoms in recreational nitrous oxide users. Addiction 2024; 119:609-618. [PMID: 37904333 DOI: 10.1111/add.16380] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Prevalence of nitrous oxide (N2 O) use appears to be increasing in numerous countries worldwide, and excessive use has been associated with physical and mental problems. Because there currently is no consensus whether N2 O has addictive potential, we aimed to evaluate the evidence for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in N2 O users. ANALYSIS A literature search was conducted to assess the evidence for the presence of any of the 11 DSM-5 SUD symptoms in N2 O users and the prevalence experiencing those symptoms. A substantial part of the studied N2 O users use more than intended (i.e. 46% to 98%) and spend a substantial amount of time using N2 O. At least some of the studied N2 O users experience interpersonal problems (i.e. 13% to 80%) and use N2 O in risky situations, such as driving under the influence. Evidence for the other criteria is either insufficient or inconclusive. CONCLUSIONS The literature base for the presence and prevalence of DSM-5 substance use disorder (SUD) symptoms in nitrous oxide (N2 O) users is limited and largely consists of qualitative studies and case studies, but it provides consistent evidence for the presence of at least four SUD criteria in heavy N2 O users. N2 O could well be addictive and should be treated as a potentially addictive substance until systematic assessments can provide evidence-based guidance to users, healthcare professionals and legislators.
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Affiliation(s)
- Sammie Back
- Neuroscience of Addiction (NofA) Lab, Center for Substance use and Addiction Research (CESAR), Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Emese Kroon
- Neuroscience of Addiction (NofA) Lab, Center for Substance use and Addiction Research (CESAR), Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Karis Colyer-Patel
- Neuroscience of Addiction (NofA) Lab, Center for Substance use and Addiction Research (CESAR), Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Janna Cousijn
- Neuroscience of Addiction (NofA) Lab, Center for Substance use and Addiction Research (CESAR), Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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15
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Gérardin M, Rousselet M, Couec ML, Masseau A, Aquizerate A, Authier N, Deheul S, Roussin A, Micallef J, Djezzar S, Feuillet F, Jolliet P, Grall-Bronnec M, Victorri-Vigneau C. Substance use disorder of equimolar oxygen-nitrous oxide mixture in French sickle-cell patients: results of the PHEDRE study. Orphanet J Rare Dis 2024; 19:124. [PMID: 38500184 PMCID: PMC10949610 DOI: 10.1186/s13023-024-03133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND In many countries, nitrous oxide is used in a gas mixture (EMONO) for short-term analgesia. Cases of addiction, with significant misuse, have been reported in hospitalized patients. Patients suffering from sickle cell disease (SCD) could represent a high-risk population for substance use disorder (SUD) due to their significant pain crisis and repeated use of EMONO. The objective of the PHEDRE study was to assess the prevalence of SUD for EMONO in French SCD patients. RESULTS A total of 993 patients were included. Among 339 EMONO consumers, only 38 (11%) had a SUD, with very few criteria, corresponding mainly to a mild SUD due to a use higher than expected (in quantity or duration) and relational tensions with the care teams. Almost all patients (99.7%) were looking for an analgesic effect, but 68% of patients were also looking for other effects. The independent risks factors associated with at least one SUD criterion were: the feeling of effects different from the expected therapeutic effects of EMONO, at least one hospitalization for vaso occlusive crisis in the past 12 months and the presence of a SUD for at least one other analgesic drug. CONCLUSIONS The use of EMONO was not problematic for the majority of patients. Manifestations of SUD that led to tensions with healthcare teams should alert and lead to an evaluation, to distinguish a true addiction from a pseudoaddiction which may be linked to an insufficient analgesic treatment related to an underestimation of pain in SCD patients. TRIAL REGISTRATION Clinical Trials, NCT02580565. Registered 16 October 2015, https://clinicaltrials.gov/.
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Affiliation(s)
- Marie Gérardin
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Morgane Rousselet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie-Laure Couec
- CHU Nantes, Service de Pédiatrie et d'Oncologie Pédiatrique, Nantes Université, Nantes, France
| | - Agathe Masseau
- CHU Nantes, Service de Médecine Interne, Nantes Université, Nantes, France
| | - Aurélie Aquizerate
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
| | - Nicolas Authier
- CHU Clermont-Ferrand, Service de Pharmacologie Médicale, Clermont Auvergne Université, Clermont-Ferrand, France
| | - Sylvie Deheul
- CHU Lille, Service de Pharmacologie, Lille Université, Lille, France
| | - Anne Roussin
- CHU Toulouse, Service de Pharmacologie Médicale et Clinique, Toulouse Université, Toulouse, France
| | - Joelle Micallef
- APHM, Service de Pharmacologie Clinique, Hôpital de La Timone, Institut de Neurosciences Des Systèmes, Aix-Marseille Université, Marseille, France
| | - Samira Djezzar
- APHP Paris, Centre d'Evaluation et d'Information sur la Pharmacodependence-Addictovigilance de Paris, Hôpital Fernand Widal, APHP Paris, Paris, France
| | - Fanny Feuillet
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
- CHU Nantes, DRI, Plateforme de Méthodologie et Biostatistique, Nantes Université, Nantes, France
| | - Pascale Jolliet
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Marie Grall-Bronnec
- CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes Université, Nantes, France
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France
| | - Caroline Victorri-Vigneau
- CHU Nantes, Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance (CEIP-A), Service de Pharmacologie Clinique, Nantes Université, 9 Quai Moncousu, 44 093, Nantes Cedex 1, France.
- CHU Nantes, CHU Tours, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes Université, Tours Université, Nantes, France.
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16
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Wang S, Li Z, Shi Y, Wang T, Jin W. Nitrous oxide induced subacute combined degeneration of the spine cord: A case report. Medicine (Baltimore) 2024; 103:e37032. [PMID: 38335379 PMCID: PMC10860927 DOI: 10.1097/md.0000000000037032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE In recent years, recreational use of inhaled nitrous oxide (N2O) is on the increase among young people, accompanied by a corresponding rise in reports about its toxicity. Subacute combined degeneration of the spine cord (SCD) is the typical clinical picture of the nervous system disorder caused by N2O intoxication, as a result of metabolic disturbance of vitamin B12. PATIENT CONCERNS, DIAGNOSES, INTERVENTIONS AND OUTCOMES We report a 28-year-old female of SCD due to prolonged use of N2O, presented with paresthesia and unsteady in walking progressing within 1 month. Symptoms gradually improved with the treatment of intramuscular injections of hydroxocobalamin combined with N2O abstinence, and the patient recovered completely with normal neurological examination after 4 months of follow-up. LESSONS Clinicians should be aware of the clinical features and pathogenesis of SCD caused by N2O intoxication in order to lead effective treatment as soon as possible. Recreational N2O use should always be considered as an etiology when dealing with patients presented with myelopathy and/or neuropathy suspected of vitamin B12 deficiency.
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Affiliation(s)
- Shuo Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Zhe Li
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yuanyuan Shi
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Tianjun Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wei Jin
- Department of Neurology, Hebei General Hospital, Shijiazhuang, Hebei, China
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17
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Murray BP, Kiernan EA. Physiologic Effects of Substance Use. Emerg Med Clin North Am 2024; 42:69-91. [PMID: 37977754 DOI: 10.1016/j.emc.2023.06.022] [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] [Indexed: 11/19/2023]
Abstract
Physiologic and psychological effects of substance use are common occurrences. They may be the proximate purpose of the exposure or related to an unintended complication. Acute short-term exposure effects may not be the same as long-term effects. These effects are mediated by different receptors they act on and the homeostatic changes that occur due to repeat exposure. We review in this article the physiologic and psychological effects from exposure to commonly encountered drugs, ethanol, sedative hypnotics, cocaine, amphetamines, marijuana, opioids, nicotine, hydrocarbons (halogenated and non-halogenated), and nitrous oxide.
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Affiliation(s)
- Brian Patrick Murray
- Department of Emergency Medicine, Wright State Boonshoft School of Medicine, 2555 University Boulevard, Suite 110, Dayton, OH 45324, USA.
| | - Emily Anne Kiernan
- Department of Emergency Medicine, Emory University School of Medicine, 50 Hurtz Plaza Southeast, Suite 600, Atlanta, GA, USA; Georgia Poison Center, 50 Hurtz Plaza Southeast, Suite 600, Atlanta, GA, USA
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18
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Hassing LT, Jiang FY, Zutt R, Arends S. Nitrous-oxide-induced polyneuropathy and subacute combined degeneration of the spine: clinical and diagnostic characteristics in 70 patients, with focus on electrodiagnostic studies. Eur J Neurol 2024; 31:e16076. [PMID: 37754673 PMCID: PMC11235686 DOI: 10.1111/ene.16076] [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: 05/13/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Nitrous oxide (N2 O) induced neurological symptoms are increasingly encountered. Our aim is to provide clinical and diagnostic characteristics with a focus on electrodiagnostic studies. METHODS Patients with neurological sequelae due to N2 O presenting in our hospital between November 2018 and December 2021 reporting clinical and diagnostic data were retrospectively reviewed. RESULTS Seventy patients (median 22 years) were included. Median N2 O usage was 4 kg/week during 12 months. Patients' history revealed a higher rate of sensory symptoms compared to motor (97% vs. 57%) and 77% walking difficulties. Clinical diagnosis was polyneuropathy (PNP) in 44%, subacute combined degeneration (SCD) of the spine in 19%, both in 37%. Median vitamin B12 level was low (159 pmol/L), normal in 16%. The median methylmalonic acid was increased (2.66 μmol/L). Electrodiagnostic abnormalities were observed in 91%, with 72% fulfilling axonal PNP criteria, 20% showing mild to intermediate slowing. One patient fulfilled demyelinating PNP criteria not related to N2 O abuse (Charcot-Marie-Tooth type 1a). More prominent motor nerve conduction abnormalities were found; lower limbs were more affected. In 64% with normal conduction, myography showed signs of axonal loss. Magnetic resonance imaging showed cervical myelopathy in 58% involving generally five to six segments. CONCLUSIONS Nitrous oxide (N2 O) leads to neurological symptoms by causing PNP and/or SCD primarily involving the legs. Distinguishing PNP and SCD clinically was shown to be insufficient. Electrodiagnostic studies showed axonal PNP. Demyelinating PNP due to N2 O abuse was not present in our cohort. Therefore, further diagnostic work-up is warranted if demyelinating features are present.
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Affiliation(s)
- L. T. Hassing
- HagaZiekenhuis, Department of NeurologyThe HagueThe Netherlands
| | - F. Y. Jiang
- HagaZiekenhuis, Department of RadiologyThe HagueThe Netherlands
| | - R. Zutt
- HagaZiekenhuis, Department of NeurologyThe HagueThe Netherlands
| | - S. Arends
- HagaZiekenhuis, Department of NeurologyThe HagueThe Netherlands
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19
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Desmedt B, Verleysen E, Demaegdt H, van Campenhout P, van Miert E, Deconinck E. The use of nitrous oxide whippets as a recreational drug: Hidden health risks. Drug Test Anal 2024; 16:99-104. [PMID: 37173289 DOI: 10.1002/dta.3518] [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: 03/02/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
Whipped cream canisters, also known as nitrous oxide whippets, are traditionally used in the culinary arts to prepare food foams. In recent years, however, these gas canisters have been cracked open and inhaled to produce a "legal" high. Users of these whippets have reported the presence of an oily residue containing metallic particles. This contamination was investigated using liquid chromatography-, gas chromatography- and inductively coupled plasma-mass spectrometry (ICP-MS) and optical emission spectrometry (ICP-OES). The particulate matter was also analyzed by scanning transmission electron microscopy (STEM) combined with energy-dispersive X-ray spectroscopy (EDX). The presence of cyclohexyl isothiocyanate was confirmed at a maximum concentration of 67 μg per whippet. ICP-MS and ICP-OES analysis revealed the presence of mainly iron and zinc, but also, traces of aluminum, chromium, cobalt, nickel, and lead were found. STEM-EDX analysis confirmed the presence of nano-sized particles containing iron and zinc. When simulating inhalation, using the multiple path particle dosimetry model, it was confirmed that these nano-sized particles can reach the deeper parts of the lungs. Most users assume that inhaling a food-grade nitrous oxide whippet for a "legal" high poses no risks. However, this research shows that users are exposed to cyclohexyl isothiocyanate, a substance classified as a respiratory sensitizer. The presence of zinc in the particulate matter could potentially be linked to lung lesions.
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Affiliation(s)
- Bart Desmedt
- Medicines and Health Products, Scientific Direction Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Eveline Verleysen
- EM-Unit, Service Trace Elements and Nanomaterials, Scientific Direction Physical and Chemical Health Risks, Sciensano, Uccle, Belgium
| | - Heidi Demaegdt
- Trace Elements Unit, Service Trace Elements and Nanomaterials, Scientific Direction Physical and Chemical Health Risks, Sciensano, Tervuren, Belgium
| | - Peter van Campenhout
- Medicines and Health Products, Scientific Direction Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Erik van Miert
- Risk Assessment Unit, Risk and Health Impact Assessment Service, Scientific Direction Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
| | - Eric Deconinck
- Medicines and Health Products, Scientific Direction Physical and Chemical Health Risks, Sciensano, Brussels, Belgium
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20
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Glasper EA. Nitrous Oxide Deaths Among Children and Young People is No Laughing Matter! Compr Child Adolesc Nurs 2023; 46:259-261. [PMID: 37750756 DOI: 10.1080/24694193.2023.2230798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Edward Alan Glasper
- Emeritus Professor, Children's and Young People's Nursing, University of Southampton, Southampton, UK
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21
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Agrawal AN, Alagarsamy F, Owen PJ, Klein AA. Is the future of nitrous oxide as volatile as the gas itself? Anaesthesia 2023; 78:1315-1319. [PMID: 37415287 DOI: 10.1111/anae.16086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 07/08/2023]
Affiliation(s)
- A N Agrawal
- Department of Anaesthesia, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - F Alagarsamy
- Department of Anaesthesia, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - P J Owen
- Department of Trauma and Orthopaedics, Addenbrookes Cambridge University Hospitals, Cambridge, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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22
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Riccò M, Ferraro P, Corrado S, Bottazzoli M, Marchesi F. Nitrous Oxide Inhalant Abuse: Preliminary Results from a Cross-Sectional Study on Knowledge, Attitudes, and Practices of Italian Physicians (2023). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1820. [PMID: 37893538 PMCID: PMC10608448 DOI: 10.3390/medicina59101820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
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.
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Affiliation(s)
- Matteo Riccò
- Occupational Health and Safety Service on the Workplace/Servizio di Prevenzione e Sicurezza Ambienti di Lavoro (SPSAL), Department of Public Health, AUSL–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Pietro Ferraro
- Occupational Medicine Unit, Direzione Sanità, Italian Railways’ Infrastructure Division, RFI SpA, 00161 Rome, Italy;
| | - Silvia Corrado
- ASST Rhodense, Dipartimento della donna e Area Materno-Infantile, UOC Pediatria, 20024 Garbagnate Milanese, Italy;
| | - Marco Bottazzoli
- Department of Otorhinolaryngology, APSS Trento, 31223 Trento, Italy;
| | - Federico Marchesi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy;
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23
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Corrêa DG, da Cruz LCH, da Rocha AJ, Pacheco FT. Imaging Aspects of Toxic and Metabolic Myelopathies. Semin Ultrasound CT MR 2023; 44:452-463. [PMID: 37555682 DOI: 10.1053/j.sult.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Metabolic and toxic myelopathies usually occurs due to several different causes. Metabolic myelopathy usually occurs due to deficiency of a nutrient, such as vitamin B12. Toxic myelopathy occurs secondary to the exposure to an external toxic agent. Although they may have a difficult diagnosis, determination of the specific cause of myelopathy is of utmost importance, because many causes are amenable to treatment. Although they have many clinical, electrophysiologic, and neuropathologic similarities, imaging may aid in the suspicion of toxic or metabolic myelopathy. The aim of this article, is to review the imaging features of the main toxic and metabolic myelopathies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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24
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Castellucci G, Figueroa M, Sivaswamy L. Hereditary Neuropathy With Liability to Pressure Palsy Detected During the Use of Recreational Drugs. Neurohospitalist 2023; 13:376-380. [PMID: 37701266 PMCID: PMC10494818 DOI: 10.1177/19418744231174396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background: Nitrous oxide (N2O) has been an increasingly popular recreational drug over the past few years. Abuse is associated with severe neurological complications and even fatal outcomes. Purpose: Here we present a case of chronic nitric oxide abuse in a teenager presenting with rapidly progressive mixed sensory and motor polyneuropathy. Results: The initial diagnostic workup excluded electrolyte derangement, heavy metal intoxication, autoimmune neuropathy, myopathy, hematological disorders, and thyroid disease. On further questioning, patient reported 8-months of inhalation of nitrous oxide, commonly known as "whippets". Subsequent tests revealed low Vitamin B12 and elevated homocysteine level. Eventual genetic test demonstrated a heterozygous deletion in the gene that encodes the peripheral myelin protein 22 (PMP22), consistent with a diagnosis of Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). Conclusion: The association of neurologic and genetic findings with the timeline of nitrous oxide inhalation suggests a multifactorial etiology of her symptoms, with the N2O acting as a trigger to the axonal degeneration and demyelination detected on electrodiagnostic studies.
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Affiliation(s)
| | - Michelle Figueroa
- Detroit Medical Center, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Lalitha Sivaswamy
- Detroit Medical Center, Children’s Hospital of Michigan, Detroit, MI, USA
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25
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Meißner JN, Hill K, Lakghomi A, Nitsch L. [Inhaled nitrous oxide-induced subacute combined degeneration-A differential diagnosis of Guillain-Barré syndrome]. DER NERVENARZT 2023; 94:951-955. [PMID: 36799957 PMCID: PMC10575797 DOI: 10.1007/s00115-023-01443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 02/18/2023]
Affiliation(s)
- Julius N Meißner
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - Katharina Hill
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Asadeh Lakghomi
- Klinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Louisa Nitsch
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
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Qiu Y, Li L, Duan A, Wang M, Xie M, Chen Z, Wang Z. The efficacy and tolerability of inhaled nitrous oxide in major depressive disorder: a systematic review and meta-analysis. Psychopharmacology (Berl) 2023; 240:2033-2043. [PMID: 37608194 DOI: 10.1007/s00213-023-06449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Nitrous oxide (N2O) has been initially confirmed by clinical trials to benefit to patients with major depressive disorder (MDD). However, there needs to be a meta-analysis to compare the efficacy and tolerability of N2O in MDD. METHODS PubMed, EMBASE, and Cochrane Library were searched for relevant studies up to Jan 1st, 2023. The meta-analysis mainly compared the outcome of the change in depression severity scores, response, remission, and adverse events in patients with MDD receiving 50% N2O and placebo. RESULTS Four studies with 133 patients were eventually identified. We found that the N2O group and control group showed an overall significant difference in the change in depression severity score for patients at 2 h, 24 h, and 2 weeks or more (2 h, SMD = - 0.64, 95% CI - 0.01 to - 0.28, p < 0.0001) (24 h, SMD = - 0.65, 95% CI - 1.01 to - 0.29, p < 0.0001) (2 weeks, SMD = - 0.76, 95% CI - 1.16 to - 0.36, p < 0.0001). For the response and remission rate, the long-term effect of N2O was also statistically significant (for the response, RR = 2.33, 95% CI 1.23 to 4.44, p = 0.01) (for the remission, RR = 4.68, 95% CI 1.49 to 14.68, p = 0.008). For safety outcomes, patients treated with N2O had higher odds of nausea or vomiting (RR = 10.15, 95% CI 1.96 to 52.59, p = 0.009). CONCLUSION Our study suggested that N2O has a rapid and long-lasting antidepressant effect in patients with MDD. However, the efficacy of lower or titrated concentration of N2O should be further investigated.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Longyuan Li
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Aojie Duan
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Menghan Wang
- Suzhou Medical College of Soochow USniversity, Suzhou, 215002, Jiangsu Province, China
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
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Mondesert E, Eiden C, Peyriere H, Formoso A, Corti L, Cristol JP, Badiou S. Functional vitamin B 12 deficiency is a consistent feature in hospital admissions for neurological disorders due to the use of nitrous oxide. Clin Toxicol (Phila) 2023; 61:674-679. [PMID: 37917184 DOI: 10.1080/15563650.2023.2274282] [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: 04/10/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023]
Abstract
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.
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Affiliation(s)
- Etienne Mondesert
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
| | - Céline Eiden
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Hélène Peyriere
- Addictovigilance Center, Department of Pharmacology and Toxicology, University Hospital of Montpellier, Montpellier, France
| | - Aude Formoso
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Lucas Corti
- Department of Neurology, University Hospital of Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stéphanie Badiou
- Department of Biochemistry, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
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H Moussa A, Mohamed W, Zidouh S. From Medical Analgesic to Recreational Use: A Rare Case of Acute Myelitis Caused by Laughing Gas Abuse. Cureus 2023; 15:e41018. [PMID: 37519576 PMCID: PMC10372704 DOI: 10.7759/cureus.41018] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Nitrous oxide, commonly known as laughing gas, which is originally intended to be used in various industries as well as for legitimate medical purposes, has unfortunately come to be used recreationally. However, it is crucial to recognize that the seemingly innocent recreational use of nitrous oxide can have serious repercussions on one's health. When consumed in excessive quantities and for prolonged periods, this substance can lead to serious adverse effects. In this article, we shed light on the abuse potential of the substance by discussing a distressing case of a young nitrous oxide user who developed severe myelitis.
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Affiliation(s)
- Aicha H Moussa
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
| | - Walid Mohamed
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
| | - Saad Zidouh
- Emergency Department, Faculty of Medicine and Pharmacy, Military Hospital Mohamed V, Rabat, MAR
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Affiliation(s)
- Adam Winstock
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - David Nutt
- Neuropsychopharmacology Unit, Division of Brain Sciences, Imperial College London, London, UK
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30
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Frank VA, Herold MD. Pushing boundaries or adding a gimmick to the party? Young people's experiences of nitrous oxide use in Denmark. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023:104020. [PMID: 37032283 DOI: 10.1016/j.drugpo.2023.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/11/2023]
Abstract
Nitrous oxide (N2O) use for intoxication among young people has increased in many parts of the Western world, including Denmark. The literature, however, primarily focusses on harms related to N2O use, and not on other aspects, for example modes of administration or effects such as different forms of pleasure or fun. Therefore, despite this increase, we still know very little about how and why young people use nitrous oxide for intoxication, including their experiences of N2O intoxication. Based on 45 qualitative interviews with young Danes age 18-25 years, who all were former or present N2O users, we explore their experiences of N2O intoxication. We do this by analyzing in-depth descriptions of where, how and with whom they use N2O. When analyzing these descriptions in relation to different modes of administration, intensity of use, combination with other substances (e.g. alcohol, cannabis), and use in different settings, we argue that N2O intoxication is experienced differently by the young participants. Some of the participants also searched for particular intoxication experiences with N2O. We unfold the participants' various descriptions of intoxication by differentiating between moderate and intensive use. Overall, our study shows that these differences in N2O use for intoxication are not equally risky or harmful. In general, young people's own perspectives and experiences with (illegal) drug use is increasingly emphasized as important to include when developing preventive interventions. Our analysis of the young participants' differing experiences with N2O for intoxication can inform future prevention initiatives in relation to harms of N2O intoxication.
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Affiliation(s)
- Vibeke A Frank
- Research Centre for Management, Organisation and Social Sciences, VIA University College, Aarhus N, Denmark.
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31
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Dimic N, Djuric M, Nenadic I, Bojic S, Bobos M, Janicijevic A, Bojanic M, Mijovic M, Stevanovic P. Nitrous Oxide — Application in Modern Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2023. [DOI: 10.1007/s40140-023-00554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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32
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Bonev V, Wyatt M, Barton MJ, Leitch MA. Severe length-dependent peripheral polyneuropathy in a patient with subacute combined spinal cord degeneration secondary to recreational nitrous oxide abuse: A case report and literature review. Clin Case Rep 2023; 11:e6881. [PMID: 36794039 PMCID: PMC9923462 DOI: 10.1002/ccr3.6881] [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: 10/11/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 02/15/2023] Open
Abstract
Nitrous oxide abuse can have detrimental effects on the central and peripheral nervous systems. This case study report aims to demonstrate a combination of severe generalized sensorimotor polyneuropathy and cervical myelopathy related to vitamin B12 deficiency following nitrous oxide abuse. We present a clinical case study and literature review examining primary research-published between 2012 and 2022-reporting nitrous oxide abuse affecting the spinal cord (myelopathy) and peripheral nerves (polyneuropathy); 35 articles were included in the review with a total of 96 patients, where the mean "patients" age was 23.9 years and were in a 2:1 male/female ratio. Of the 96 cases, within the review, 56% of patients were diagnosed with polyneuropathy, most commonly impacting the nerves of the lower limb (62%), while 70% of patients were diagnosed with myelopathy, most commonly impacting the cervical region (78%) on the spinal cord. In our clinical case study, a 28-year-old male underwent a multitude of diagnostic investigations for bilateral "foot drop" and sense of lower limb stiffness as ongoing complications of a vitamin B12 deficiency secondary to recreational nitrous oxide abuse. Both the literature review and our case report emphasize the dangers of recreational nitrous oxide inhalation, colloquially termed "nanging" and the risks it presents to both the central and peripheral nervous systems, which is erroneously considered by many recreational drug users to be less harmful than other illicit substances.
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Affiliation(s)
- Ventzislav Bonev
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia,Coastal Neurophysiology ServicesGold CoastQueenslandAustralia
| | - Mark Wyatt
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia,Coastal Neurophysiology ServicesGold CoastQueenslandAustralia
| | - Matthew J. Barton
- School of Nursing and MidwiferyGriffith UniversityGold CoastQueenslandAustralia,Menzies Health Institute QueenslandGold CoastQueenslandAustralia
| | - Michael A. Leitch
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia,Neurosciences QueenslandBrisbaneQueenslandAustralia
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33
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Buttery C, Birns J, Gibson J, Jones GD. Use of the Rehabilitation Treatment Specification System (RTSS) in the management of nitrous oxide (N 2O)-induced spinal cord injury. BMJ Case Rep 2023; 16:16/2/e252529. [PMID: 36750296 PMCID: PMC9906271 DOI: 10.1136/bcr-2022-252529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Nitrous oxide (N2O) is an inhaled anaesthetic gas and a popular intoxicant. Excessive recreational use can cause spinal cord myelopathy. Previous studies have discussed the medical management. However, none have specified the sensorimotor rehabilitation management. This case report documents the investigations, physical rehabilitation and functional outcomes in two cases of N2O-associated myelopathy. Both presented with lower limb strength and sensorimotor integration impairments resulting in ataxic ambulation. Dorsal column signal abnormality was observed on T2-weighted MRI in one case. Myelopathy was diagnosed based on clinical presentation and both were treated with vitamin B12 Rehabilitation was conceived and specified using the Rehabilitation Treatment Specification System (RTSS). Both cases achieved independent indoor gait on hospital discharge, and full function at 9 months in one case. Appropriate and timely medical management and reasoned rehabilitation provided excellent functional outcomes for N2O-related myelopathy. By using the RTSS, reasoned rehabilitation efficacy can be tested in the future.
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Affiliation(s)
- Charlotte Buttery
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Physiotherapy Department, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - Jonathan Birns
- Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jamie Gibson
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK,Workforce Transformation, Health Education England (HEE), Leeds, UK
| | - Gareth David Jones
- Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK .,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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Nitrous oxide abuse leading to extreme homocysteine levels and thrombosis in young adults: a case series. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:276-283. [PMID: 36700505 DOI: 10.1016/j.jtha.2022.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Neurologic complications from recreational use of nitrous oxide (N2O), which are attributed to vitamin B12 deficiency, have been well documented. With increasing dosages and frequency of N2O use, an additional association with thromboembolisms is becoming apparent. OBJECTIVES To assess thrombotic complications of recreational N2O use. METHODS All medical charts at the largest hospital in Amsterdam were searched for N2O use and subsequent neurologic and/or thrombotic events. For patients with thrombotic events, we extracted data on the risk factors for arterial and venous thrombosis as well as serum vitamin B12 and homocysteine concentrations. RESULTS Between January 2015 and May 2021, 326 patients who reported recreational use of N2O were identified; of these, 17 (5%) patients presented with severe thrombotic events associated with N2O (71% men; median age, 26 years [range, 18-53 years]), 5 patients presented with arterial thrombosis (3 with acute coronary syndrome, 1 with femoral artery thrombosis, and 1 with middle cerebral artery thrombus), and 12 patients presented with venous thromboembolisms (10 with pulmonary embolisms, 1 with portal vein thrombosis and 1 with cerebral vein thrombosis). Additionally, homocysteine were concentrations severely increased (median, 125 μmol/L [range, 22-253 μmol/L]; reference, <15 μmol/L). Patients reported use of 400 to 6000 g (ie, 50-750 balloons) of N2O in 1 day. Fifty percent of these patients had experienced neurologic symptoms before the thrombotic event. CONCLUSION We describe an alarming incidence of serious thrombotic events among young adults after excessive recreational use of N2O, accompanied by extremely high homocysteine concentrations. The upward trend in the recreational use of N2O warrants more awareness of its dangers among both users and medical professionals. Furthermore, these findings could reopen the discussion on possible associations between hyperhomocysteinemia and thrombosis mediated through N2O.
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35
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Muacevic A, Adler JR, Moya M, Menowsky M, Cruz RA. A Case Report of Subacute Combined Degeneration Due to Nitrous Oxide-Induced Vitamin B12 Deficiency. Cureus 2023; 15:e34514. [PMID: 36788992 PMCID: PMC9912992 DOI: 10.7759/cureus.34514] [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: 02/01/2023] [Indexed: 02/04/2023] Open
Abstract
Nitrous oxide, also known as "laughing gas," is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.
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Hermansen MV, Kleggetveit IP, Ulvin LB, Chawla MS, König M. A man in his twenties with weakness and numbness in his legs. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 142:22-0642. [PMID: 36655972 DOI: 10.4045/tidsskr.22.0642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Neuropathy can have many causes, some less well known than others. In this article, we present the case of a young man with progressive neurological deficit over several months. The cause was found to be an increasing social problem.
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Affiliation(s)
| | | | - Line Bédos Ulvin
- Seksjon for klinisk nevrofysiologi, Oslo universitetssykehus, Ullevål og Rikshospitalet
| | | | - Marton König
- Nevrologisk avdeling, Oslo universitetssykehus, Ullevål
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Sharma S, Benatar M, Herskovitz S, Granit V. The Inverse Lhermitte Phenomenon Suggests Nitrous Oxide-Induced Myelopathy: Case Report and Review of the Literature. Case Rep Neurol 2023; 15:81-86. [PMID: 37384038 PMCID: PMC10294243 DOI: 10.1159/000529325] [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: 08/29/2022] [Accepted: 01/16/2023] [Indexed: 06/30/2023] Open
Abstract
Nitrous oxide-induced myelopathy is a relatively well-known clinical entity. Less well-known, however, is the rare inverse Lhermitte phenomenon, where neck flexion elicits an ascending, rather than descending, electric shock-like sensation. This is a characteristic symptom and sign that may occur in nitrous oxide toxicity. In this article, we present the case of a patient who was admitted to our hospital with suspected Guillain-Barré syndrome due to her ascending numbness and unsteady gait. We describe her examination and laboratory features leading to the correct diagnosis, along with a historical review of the various subtypes of the Lhermitte phenomenon and the pathophysiology of nitrous oxide-induced myelopathy.
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Affiliation(s)
- Sonali Sharma
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, USA
| | - Steven Herskovitz
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Volkan Granit
- Department of Neurology, University of Miami, Miami, FL, USA
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Cohen L, Duroy D, Perozziello A, Sasportes A, Lejoyeux M, Geoffroy PA. A cross-sectional study: Nitrous oxide abuse in Parisian medical students. Am J Addict 2023; 32:60-65. [PMID: 36412981 DOI: 10.1111/ajad.13363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Nitrous oxide (N2 O) has euphoric properties, which are associated with an alarming increasing misuse. A lack of data exists regarding medical students. The objectives are: (i) evaluate the prevalence of N2 O use and N2 O use disorder (NUD) among French medical students, (ii) assess whether education about addictions has an impact on consumption, (iii) draw up clinical profiles of N2 O users with or without NUD, (iv) identify factors associated with use and NUD. METHODS A cross-sectional study among medical students at Université de Paris, using an online questionnaire. RESULTS Out of the 981 medical students (29% of the total medical students) who completed the questionnaire, 80% had used N2 O. 19% had a mild use disorder, 4% moderate, and 1% severe. N2 O use was significantly associated with the use of poppers (p < .0005), alcohol (p < .0005), and cocaine (p = .004). Factors significantly associated with NUD were alcohol use disorder (p = .017), male gender (p = .006), and being part of a student association (p = .0130). DISCUSSION AND CONCLUSION This survey shows a high prevalence of N2 O use and NUD among medical students. It could be explained by the N2 O pharmacokinetic profile or by a perception of "harmlessness." We also identified associated risk factors that may be useful to better identify and treat students seeking help. SCIENTIFIC SIGNIFICANCE This is the first study to evaluate the use of this product among medical students. The evaluation of factors impacting use and dependence is also new in this population, which is at risk of misuse of substances.
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Affiliation(s)
- Laury Cohen
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat, Paris, France
| | - David Duroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat, Paris, France
| | - Anne Perozziello
- Department of Psychiatry, GHU Paris-Psychiatry & Neurosciences, Paris, France
| | - Adrien Sasportes
- Strategy and Business Policy Department, HEC Paris, Jouy-en-Josas, France
| | - Michel Lejoyeux
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat, Paris, France.,Department of Psychiatry, GHU Paris-Psychiatry & Neurosciences, Paris, France.,Université de Paris, NeuroDiderot, Paris, France
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat, Paris, France.,Department of Psychiatry, GHU Paris-Psychiatry & Neurosciences, Paris, France
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Guerlais M, Aquizerate A, Lionnet A, Daveluy A, Duval M, Gérardin M, Istvan M, Laforgue EJ, Victorri-Vigneau C. Nitrous oxide: a unique official French addictovigilance national survey. Front Public Health 2023; 11:1167746. [PMID: 37206871 PMCID: PMC10189051 DOI: 10.3389/fpubh.2023.1167746] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/31/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Nitrous oxide has become over the last few years a public health problem in many countries. France has a dedicated health monitoring system dedicated to the surveillance of the abuse, dependence and consequences associated with the use of psychoactive substances coordinated by the French National Agency for the Safety of Medicines and Health Products.We present the French national survey of nitrous oxide. Materials and methods We analyzed all the cases with nitrous oxide from 2012 to 2021: number of notifications, characteristics of the subjects and consumption, consequences reported and their evolutions over time. In addition, we have made a special focus on the four main complications reported. Results A total of 525 cases were received with an exponential increase since 2019. We observed changes in the characteristics of the notifications with an increase in the proportion of women [42.7% in 2021 vs. 30.8% in 2020 (p = 0.02)]; an increase in the quantities consumed (use of cylinders); a negative evolution of the contexts of use with a search for self-therapeutic effects and use in violent contexts; an increasing trend of the severity of cases [78.1% in 2021 vs. 70.0% in 2020 (p = 0.07)].The main effects were substance use disorders and/or associated criteria (82.5%), neurological disorders (75.4%), psychiatric symptoms (15.4%) and cardiovascular events (8.6%). In terms of evolution, we observed a significant increase in cases with a use disorder and an increase in neurological complications. Moreover, new serious effects, notably cardiovascular events were reported. Discussion The combination of high availability, varied effects from euphoria to relief of discomfort in a stressful global pandemic context and the development of dependence could explain the rapid growth of consumption and the seriousness of the cases.It must now be taken into account that (i) Substance use disorders are associated with nitrous oxide consumption; (ii) clinicians must consider "nitrous oxide" in young subjects presenting different types of manifestations; and (iii) stopping consumption is imperative and is the first treatment. In this context, an addictological assessment must also be carried out.
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Affiliation(s)
- Marylène Guerlais
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Aurélie Aquizerate
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Arthur Lionnet
- Nantes Université, CHU Nantes, Service de Neurologie, Nantes, France
- Inserm, U1235, Nantes, France
| | - Amélie Daveluy
- Centre d’Addictovigilance, Département de Pharmacologie Médicale, INSERM, BPH, U1219, CHU de Bordeaux, Bordeaux, France
| | - Mélanie Duval
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Marie Gérardin
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
| | - Marion Istvan
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Edouard-Jules Laforgue
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
| | - Caroline Victorri-Vigneau
- Nantes Université, CHU Nantes, Service de Pharmacologie Clinique – Centre d’Evaluation et d’Information sur la Pharmacodépendance-Addictovigilance, Nantes, France
- Nantes Université, CHU Nantes, INSERM, methodS in Patient-centered outcomes and HEalth ResEarch, Nantes, France
- *Correspondence: Caroline Victorri-Vigneau,
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Luigi C, Stefania DS. Nitrous oxide intoxication: systematic literature review and proposal of new diagnostic possibilities. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2022. [DOI: 10.1186/s41935-022-00315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Nitrous oxide (N2O), also called “laughing gas,” is the most commonly used inhalation anesthetic in dentistry. The N2O is no longer used, because of the long-term neurologic and cardiovascular sequelae. Due to its sedative and euphoric properties, N2O is often used for recreational use or in some erotic activities. Accidental deaths are mainly associated with the uses of N2O: death can occur from sudden cardiac arrhythmia or, most commonly, acute asphyxiation due to hypoxia. This paper aims to study the literature concerning deaths due to N2O intoxication and highlight pathological findings useful for diagnosis when the crime scene investigation does not reveal any evidence.
Materials and methods
The authors conducted the literature search by PubMed and Scopus databases, searching for articles from 1 January 1970 to 1 March 2020 using the key terms: “Nitrous oxide,” “Laughing gas,” “Hypoxic damage,” “Nitrous oxide anesthesia,” and “Nitrous oxide death.”
Results and discussion
A total of 244 articles were collected. Only 26 articles were included in the systematic review. Most of the deaths from intoxication are due to asphyxiation; the diagnosis is often difficult and immunohistochemistry could be helpful. Nitrous oxide increases the intracellular adhesion molecule expression, E- and P-Selectin (markers of the early inflammatory response), and HIF-1 α (indicative of oxidative stress during ischemia-reperfusion).
Conclusion
The macroscopic and microscopic signs of N2O intoxication are non-specific, but N2O has been proven to cause hypoxic damage to the brain. The suspicion of the presence of the gas in the environment should guide the pathologist. Tissue analyzes provide important information; immunohistochemical stains can confirm hypoxic damage through the use of markers such as HIF-1 α, E-Selectin, and P-Selectin.
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Muacevic A, Adler JR. Co-Occurring Subacute Combined Degeneration and Guillain-Barré Syndrome Resulting From Nitrous Oxide Abuse: A Case Report. Cureus 2022; 14:e32756. [PMID: 36686110 PMCID: PMC9851792 DOI: 10.7759/cureus.32756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/24/2023] Open
Abstract
Growing in prevalence as a recreational drug of abuse across a broad scope of people, nitrous oxide (N2O) has proven to be a public health concern. Side effects of its abuse have a great degree of variation among people ranging from neurologic, psychiatric, and medical symptoms. We present a rare case of a 23-year-old female with a history of N2O abuse, who presented with symptoms of both subacute combined degeneration syndrome (SCD) and Guillain-Barré syndrome (GBS). She presented with three weeks history of progressive bilateral lower extremity weakness, burning and tingling sensation, difficulty walking, and falls. This patient underwent an extensive medical workup upon hospitalization. Notable findings of the magnetic resonance imaging (MRI) of her cervical spine showed an abnormal cervical cord signal intensity pattern typical for vitamin B12 deficiency and her lumbar puncture showed albuminocytological dissociation, which confirmed the diagnosis of GBS. For these conditions, this patient was successfully treated with weekly vitamin B12 injections and five treatments of plasmapheresis. Her condition was additionally complicated by worsening anxiety and depression, which were treated with gabapentin, escitalopram, trazodone, hydroxyzine, and melatonin. She demonstrated great clinical improvement with almost complete resolution of her symptoms at the time of her hospital discharge. This case highlights the easy accessibility, addiction potential, and adverse consequences related to N2O abuse.
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Mechanisms Involved in the Neurotoxicity and Abuse Liability of Nitrous Oxide: A Narrative Review. Int J Mol Sci 2022; 23:ijms232314747. [PMID: 36499072 PMCID: PMC9738214 DOI: 10.3390/ijms232314747] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The recreational use of nitrous oxide (N2O) has increased over the years. At the same time, more N2O intoxications are presented to hospitals. The incidental use of N2O is relatively harmless, but heavy, frequent and chronic use comes with considerable health risks. Most importantly, N2O can inactivate the co-factor cobalamin, which, in turn, leads to paresthesia's, partial paralysis and generalized demyelinating polyneuropathy. In some patients, these disorders are irreversible. Several metabolic cascades have been identified by which N2O can cause harmful effects. Because these effects mostly occur after prolonged use, it raises the question of whether N2O has addictive properties, explaining its prolonged and frequent use at high dose. Several lines of evidence for N2O's dependence liability can be found in the literature, but the underlying mechanism of action remains controversial. N2O interacts with the opioid system, but N2O also acts as an N-methyl-D-aspartate (NMDA) receptor antagonist, by which it can cause dopamine disinhibition. In this narrative review, we provide a detailed description of animal and human evidence for N2O-induced abuse/dependence and for N2O-induced neurotoxicity.
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Dong MX, Wang Q, Xu JF, Hu L, Yu Y, Li T. Case report: Recreational nitrous oxide abuse triggered peripheral neuropathy possibly through the immune-mediated pathogenesis. Front Neurol 2022; 13:1033327. [PMID: 36452172 PMCID: PMC9702802 DOI: 10.3389/fneur.2022.1033327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 10/17/2023] Open
Abstract
Nitrous oxide (N2O), commonly known as laughing gas, is widely used in clinical practice and food industry. However, an increasing number of young people have been abusing N2O for recreational purpose, resulting in many functional disorders and sometimes irreversible nerve damage. We present the case of a 20-year-old N2O abuser who gradually developed peripheral neuropathy after continuously inhaling N2O for 2 months. The neurological symptoms of the patient had kept exacerbation for the next 2 months until she came for medical care sitting in a wheelchair. We suggested the patient halting N2O intake and supplementing methylcobalamine according to the standardized protocol. Her symptoms had partly recovered during the following 2 weeks but remained unchanged in another 2 weeks. Antibodies against ganglioside complexes were detected and anti-GM1 IgM antibodies were positive in both cerebrospinal fluid and serum. Intravenous immunoglobulin was given as an additional treatment and the patient's symptoms had significantly recovered further. The patient discharged walking by herself. Then she has been continuously followed up in outpatient department for the next 4 months and taking steroid hormone as well as methylcobalamine. Her symptoms gradually disappeared and all the electrophysiological parameters significantly improved. With this case we were able to show that N2O-related peripheral neuropathy is not only a metabolic disorder but also an immune-mediated disease. N2O intake can trigger a mimic Guillain-Barré syndrome.
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Affiliation(s)
- Mei-Xue Dong
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Qing Wang
- Department of Neurology, Wuhan No. 9 Hospital, Wuhan, China
| | - Jun-Feng Xu
- Department of Neurology, Ezhou Central Hospital, Ezhou, China
| | - Ling Hu
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Ying Yu
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
| | - Tao Li
- Department of Neurology, Renmin Hospital of Wuhan University, Hubei General Hospital, Wuhan, China
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Wiesmann M. Strukturelle Gehirnveränderungen und Läsionen durch
den Konsum illegaler Drogen und Psychedelika. KLIN NEUROPHYSIOL 2022. [DOI: 10.1055/a-1888-8984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ZusammenfassungDrogen können sowohl die Funktion wie auch die Struktur des Gehirns
verändern. Gelegentlicher oder regelmäßiger Drogenkonsum
ist in der Bevölkerung weit verbreitet. Daher ist die Kenntnis
möglicher Nebenwirkungen und charakteristischer Bildbefunde bei
Untersuchungen des Gehirns für den klinischen Alltag wichtig. Dieser
Artikel beschreibt die für die am weitesten verbreiteten Substanzen
typischen Komplikationen und morphologisch-radiologischen Veränderungen.
Zu den möglichen Pathomechnismen gehören neurotoxische Effekte,
die zu Leukenzephalopathie oder Hirnatrophie führen können, und
vaskuläre Komplikationen wie Vasokonstriktion, Vaskulitis oder
Hypertonus, durch die es zu intrazerebralen Blutungen oder Infarkten kommen
kann. Da die klinische Präsentation oft unspezifisch ist, und die
betroffenen Patienten ihren Drogenkonsum häufig verschweigen, ist das
Erkennen typischer Bildbefunde essentiell für eine zuverlässige
Diagnosestellung und zielgerichtete Therapie.
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Affiliation(s)
- Martin Wiesmann
- Klinik für Diagnostische und Interventionelle Neuroradiologie,
Uniklinik RWTH Aachen, Germany
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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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Wang Q, Duan X, Dong M, Sun S, Zhang P, Liu F, Wang L, Wang R. Clinical feature and sural biopsy study in nitrous oxide-induced peripheral neuropathy. PLoS One 2022; 17:e0274765. [PMID: 36112660 PMCID: PMC9481023 DOI: 10.1371/journal.pone.0274765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 09/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The objective was to analyze the clinical characteristics and pathological characteristics of sural biopsy in nitrous oxide (N2O) -induced peripheral neuropathy. Methods We recruited 18 patients with N2O abuse-induced neurological disorders and reported their demographic data, clinical manifestations, laboratory examinations, and nerve conduction studies. Seven patients underwent sural nerve biopsy pathologic examination. Results All 18 patients had polyneuropathy, the nerve conduction results showed significant reductions in motor and sensory amplitudes, slowing of conduction velocities, and prolongation of latencies in most tested nerves compared to the controls. Toluidine blue staining of semi-thin sections of sural nerve biopsy showed decreased myelinated nerve fiber density, increased thin myelinated nerve fiber density, and axonal regeneration. Electron microscopy showed axonal degeneration and nerve regeneration. Conclusion The main manifestations of peripheral nerve damage caused by the abuse of N2O are lower limb weakness and distal sensory disorder. The nerve conduction study results demonstrated that mixed axonal and demyelinating neuropathy was the most common type of neuropathy. Sural biopsy showed the main pathological change was chronic axonal degeneration.
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Affiliation(s)
- Qian Wang
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Xiaohui Duan
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Mingrui Dong
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Shaojie Sun
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Pan Zhang
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Fang Liu
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Li Wang
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (LW); (RW)
| | - Renbin Wang
- Department of Neurology, China-Japan Friendship Hospital, Beijing, China
- * E-mail: (LW); (RW)
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Allan J, Cameron J, Bruno J. A Systematic Review of Recreational Nitrous Oxide Use: Implications for Policy, Service Delivery and Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11567. [PMID: 36141850 PMCID: PMC9517250 DOI: 10.3390/ijerph191811567] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nitrous oxide (N2O) is a dissociative anaesthetic that is sometimes used recreationally. The prevalence of N2O use is difficult to quantify but appears to be increasing. Research on N2O harms and application of harm reduction strategies are limited. The aim of this mixed method systematic review was to collate and synthesise the disparate body of research on recreational nitrous oxide use to inform harm reduction approaches tailored for young people. METHODS To identify publications reporting the recreational use of N2O, a search of public health, psychology and social science databases was conducted. Databases included PubMed, CIHNAL, PsycINFO, Scopus and Web of Science. Grey literature and Google advanced search were also used. Due to limited published literature on the recreational use of N2O, no limit was placed on publication date or study type. A thematic synthesis extracted descriptive and analytical themes from the selected studies. Quality appraisal was conducted using the CASP Tool for Qualitative studies and the Joanna Briggs Institute case report assessment tool. RESULTS The search retrieved 407 reports. Thirty-four were included in the final analysis, including sixteen case reports. The included studies were primarily concerned with raising awareness of the apparently increasing use and subsequently increasing harms of recreational N2O use. There was limited reference to policy or legislative responses in any published studies, no suggestions for harm reduction strategies or application of service level responses. In general, individuals lack awareness of N2O-related harms. CONCLUSION The review found three key areas that deserve further consideration including: (1) policy, (2) service delivery, and (3) harm associated with N2O use. We recommend a top-down (policy) and bottom-up (services delivery/services users) approach to harm reduction for N2O use which also includes further consultation and research with both groups. Future research could explore young people's experience of N2O use including benefits and problems to inform contextually relevant harm reduction strategies.
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Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Jacqui Cameron
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
- Department of Social Work, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Juliana Bruno
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia
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Sood R, Parent T. Peripheral polyneuropathy and acute psychosis from chronic nitrous oxide poisoning: A case report with literature review. Medicine (Baltimore) 2022; 101:e28611. [PMID: 35945749 PMCID: PMC9351869 DOI: 10.1097/md.0000000000028611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Nitrous oxide (NO) is a commonly used drug in medical practice, restoration, and the automobile industry. Recreational abuse is an emerging public health problem owing to its accessibility and drug properties. PATIENT CONCERNS A 25-year-old male was hospitalized with acute psychosis and lower-extremity sensorimotor proprioceptive ataxia due to nitrous oxide abuse. DIAGNOSIS Laboratory studies confirmed a vitamin B12 deficiency. Magnetic resonance imaging of the spinal cord showed normal findings. Electrophysiological testing confirmed length-dependent sensorimotor polyneuropathy, with a predominant motor component and axonal degeneration. INTERVENTION AND OUTCOMES Abstinence from toxic substances was suggested, and vitamin B12 substitution was introduced. The patient was lost to follow up. LESSONS Nitrous oxide toxicity is multisystemic and is thought to result from vitamin B12 inactivation. Recent case reports postulated direct paranodal lesions resulting from nitrous oxide consumption. Neurological, neuropsychiatric, and hematological toxicities are among those explored in this case report. Correction of the functional vitamin B12 status and nitrous oxide abstinence are essential in the treatment process.
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Affiliation(s)
- Radhika Sood
- Department of Internal Medicine, Hôpitaux Universitaires de Genève, HUG, Geneva, Switzerland
- *Correspondence: Radhika Sood, Department of internal medicine, Hôpitaux universitaires de Genève, HUG, Rue Gabrielle Perret Gentil 4, 1205 Genève, Switzerland (e-mail: )
| | - Thibault Parent
- Department of Internal Medicine, Hôpitaux Universitaires de Genève, HUG, Geneva, Switzerland
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49
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Liu H, Kerzner J, Demchenko I, Wijeysundera DN, Kennedy SH, Ladha KS, Bhat V. Nitrous oxide for the treatment of psychiatric disorders: A systematic review of the clinical trial landscape. Acta Psychiatr Scand 2022; 146:126-138. [PMID: 35353901 DOI: 10.1111/acps.13432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 03/05/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To systematically review published research studies and ongoing clinical trials investigating nitrous oxide (N2 O) in psychiatric disorders, providing an up-to-date snapshot of the clinical research landscape. METHODS A comprehensive literature search was conducted for studies published until June 2021 using the OVID databases (MEDLINE, Embase, APA PsycInfo) and the clinical trial registries (ClinicalTrials.gov, ICTRP). RESULTS In total, five relevant published articles were identified, among which four investigated N2 O for depression. One single-dose randomized controlled trial (RCT) for treatment-resistant depression (TRD), one triple crossover RCT comparing 50% vs. 25% N2 O for TRD, and one repeated-dose RCT for major depressive disorder (MDD) suggest that N2 O has preliminary feasibility with rapid-acting effects on symptoms of depression. From the public registries, 10 relevant ongoing clinical trials were identified. They aim to explore the use of N2 O for MDD, post-traumatic stress disorder, bipolar disorder, obsessive-compulsive disorder, and suicidal ideation. To date, the typical treatment protocol parameters were a single session of 50% N2 O delivered for 60 min, although the concentration of 25% is also being explored. Projected enrolment numbers for ongoing trials (M = 55.0) were much higher than sample sizes for published studies (M = 13.0), suggesting that there potentially will be more large-scale RCTs published in the next few years. CONCLUSION Preliminary studies support the feasibility of administering N2 O for depression; however, appropriate blinding is a critical challenge. Larger-scale RCTs with repeated doses of N2 O and follow-up times beyond 1 month are needed to confirm the feasibility, therapeutic efficacy, and sustainability of response.
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Affiliation(s)
- Helen Liu
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jaimie Kerzner
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ilya Demchenko
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Duminda N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, Mental Health and Addictions Service, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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50
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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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