Nitrous oxide (street name nangs, hippy crack, whippets or whippits) is a gas which can induce euphoria, hallucinogenic states and relaxation when inhaled.^[1] Nitrous oxide is a neurotoxin and excessive use can cause long-term neurological damage.^[2][3]

First recorded in the 18th century at upper-class "laughing gas parties", the experience was largely limited to medical students until the late 20th century when laws limiting access to the gas were loosened to supply dentists and hospitals. By the 2010s, nitrous oxide had become a moderately popular recreational drug in some countries.^[4]

Increasing recreational use has become a public health concern internationally due to the potential for long-term neurological damage following excessive use.^[1][2] Recreational users are often unaware of the risks associated with excessive use.^[5] Possession of nitrous oxide is legal in many countries, although some have criminalised supplying it for recreational purposes.

Effects

Nitrous oxide is used recreationally, as inhalation can induce euphoria, relaxation and a hallucinogenic state.^[1] Long-term or habitual use can lead to severe neurological damage.^[3]

Since nitrous oxide can cause dizziness, dissociation, and temporary loss of motor control, it is unsafe to inhale while standing up. Safer use can involve inhalation while seated to decrease risks of injury by falling. Inhalation directly from a tank poses serious health risks, as it can cause frostbite since the gas is very cold when released. For those reasons, most recreational users will discharge the gas into a balloon or whipped cream dispenser before inhaling.^[6]

It is not known if nitrous oxide causes drug dependency but its use can be habit-forming.^[1] Death can result if it is inhaled in such a way that not enough oxygen is breathed in. While the pure gas is not acutely toxic, it inactivates vitamin B₁₂, with continued use causing neurological damage due to peripheral and central demyelination.^[3] Symptoms are similar to B₁₂ deficiency: anemia due to reduced hemopoiesis, neuropathy, tinnitus, and numbness in extremities. As such, a two week course of vitamin B₁₂ injection (not oral supplementation) is recommended as a first-line treatment, combined with abstinence;^[3] oral supplementation may be phased-in later.^[7] Pregnant women should not use nitrous oxide recreationally, because chronic use is also teratogenic and foetotoxic.^{[medical citation needed]}

Inhaling industrial-grade nitrous oxide is also dangerous, as it contains many impurities and is not intended for use on humans. Food grade nitrous oxide is also not meant to be inhaled; the bulbs commonly have industrial lubricants from their manufacturing process on and in them. When the bulb is punctured, these solvents can aerosolize, introducing unknown particles into the gas. These lubricants commonly leave an oily residue on the bulb "cracker" or inside the whipped cream dispenser.^[8]

Nitrous oxide related disabilities

In 2023, a Portland, Oregon couple became unable to walk due to spinal nerve damage caused by the recreational use of nitrous oxide.^[9]

Nitrous oxide related deaths

From 1993 to 2016, only 30 death certificates in England and Wales mentioned nitrous oxide. Of those, 6 were in the 17-year period from 1993 through 2009, and 24 were in the 7-year period from 2010 through 2016. ^[10]

In 2018, an Ohio University freshman died of asphyxiation as a result of nitrous oxide ingestion from whipped-cream chargers, allegedly as part of a hazing ritual.^[11]

In 2020, a fifteen-year-old Irish boy died after ingesting nitrous oxide,^[12] leading to Ireland's Health Service Executive classing it as a dangerous drug.^[13]

Culture and society

Discovery and early use

Inhalation of nitrous oxide for recreational use, with the purpose of causing euphoria or slight hallucinations, began as a phenomenon for the British upper class in 1799, known as "laughing gas parties".^[14] English chemist Humphry Davy offered the gas to party guests in a silken bag, and documented its effects in his 1800 book Researches, Chemical and Philosophical which investigated "nitrous oxide, or diphlogisticated nitrous air, and its respiration".^[15] Poet Samuel Taylor Coleridge described the effect as "like returning from a walk in the snow into a warm room".^[14]

During the 19th century, William James and many contemporaries found that inhalation of nitrous oxide resulted in a powerful spiritual and mystical experience for the user. James claimed to experience the fusing of dichotomies into unity and a revelation of ultimate truth during the inhalation of nitrous oxide. The memory of this experience, however, quickly faded and any attempt to communicate was difficult at best. James described a man who, when under the influence of the gas, claimed to know the secret of the universe.^[16]

Until at least 1863, low availability of equipment to produce the gas, combined with low usage of the gas for medical purposes, meant it was a relatively rare phenomenon that mainly happened among students at medical universities. When equipment became more widely available for dentistry and hospitals, most countries also restricted the legal access to buy pure nitrous oxide gas cylinders to those sectors. Even so, its use in parties continued, with gas provided by medical professionals or restaurant workers,^[17][18] and by other legal or illegal sources.

20th century

A report from Consumers Union report from 1972 (based upon reports of its use in Maryland 1971, Vancouver 1972, and a survey made by Edward J. Lynn of its non-medical use in Michigan 1970) found that use of the gas for recreational purposes was then prevalent in the US and Canada.^[17][18]

It was not uncommon [in the interviews] to hear from individuals who had been to parties where a professional (doctor, nurse, scientist, inhalation therapist, researcher) had provided nitrous oxide. There also were those who work in restaurants who used the N
₂O stored in tanks for the preparation of whip cream. Reports were received from people who used the gas contained in aerosol cans both of food and non-food products. At a recent rock festival, nitrous oxide was widely sold for 25 cents a balloon. Contact was made with a "mystical-religious" group that used the gas to accelerate arriving at their transcendental-meditative state of choice. Although a few, more sophisticated users employed nitrous oxide-oxygen mixes with elaborate equipment, most users used balloons or plastic bags. They either held a breath of N
₂O or rebreathed the gas. There were no adverse effects reported in the more than one hundred individuals surveyed.^[18]

21st century

As of 2019^[update], the gas enjoys moderate popularity in some countries as a recreational drug. Nitrous oxide has the street names hippy crack and whippets (or whippits).^[1] In Australia and New Zealand, nitrous oxide bulbs are known as nangs, possibly derived from the sound distortion perceived by consumers.^[19][20] In China, recreational nitrous oxide use is on the rise and has become a social issue.^[21][22]

In the United Kingdom, as of 2014^[update], nitrous oxide is estimated to be used by almost half a million young people at nightspots, festivals and parties. Officials in Norfolk, Hertfordshire and Thames Valley had reported increasing numbers of discarded whipped-cream chargers being found.^[23]

Recreational users generally use 8 gram (¼ oz) containers of nitrous oxide "whippets", which they use to fill balloons or whipped cream dispensers. The gas is then inhaled from the balloon or dispenser.^[24] This is necessary because nitrous oxide is very cold when it undergoes adiabatic decompression on exit from a canister; inhalation directly from a tank is dangerous and can cause frostbite of the larynx and bronchi.^[25]

Legality

Australia

Supply of nitrous oxide for recreational purposes is illegal; however, it is permissible to supply it for cooking and baking purposes. As a deleterious substance, the supply of the substance for the purposes of inhalation can result in a two-year period of imprisonment.^[26]

The canisters are commonly referred to in Australia as nangs.^[27]

Netherlands

Since 1 January 2023, the possession, importing, and sale of nitrous oxide is banned in the Netherlands, with exceptions for medical use, and the food industry.^[28] It is illegal under the Opium Act.^[29]

Sweden

Using nitrous oxide for recreational use is called "boffning" as slang. It is not illegal, and whipped cream chargers with nitous oxide can be purchased as kitchen supply.^[30][31] Most retailers have a voluntary age restriction of 18 years for purchase. At festivals or bigger events, sales have been stopped, referring to "environmental hazardous chemical handling".^[32]

United Kingdom

Supply of nitrous oxide for recreational purposes is illegal under the Psychoactive Substances Act 2016. This means anyone found to be selling or giving away nitrous oxide for illicit purposes could face up to 7 years in prison and/or an unlimited fine.^[33] On 3 March 2023, it was announced that nitrous oxide will be prohibited under the Misuse of Drugs Act 1971.^[34]

On 5 September 2023, it was announced by the British government that nitrous oxide will be categorised as a class C drug by the end of 2023, in an effort to crack down on anti-social behaviour.^[35]

Slang terms used for the canisters in the United Kingdom include balloons, nos, whippits, laughing gas, hippie crack, chargers and noz.^[36]

United States

Under United States federal law, possession of nitrous oxide is legal and is not subject to DEA purview. It is, however, regulated by the Food and Drug Administration under the Food Drug and Cosmetics Act. Prosecution is possible under its "misbranding" clauses, prohibiting the sale or distribution of nitrous oxide for the purpose of human consumption (the recreational drug use market). Given the necessity of proving the intent of either buyer or seller in this case, though, such prosecutions are rare.

Many states have laws regulating the possession, sale, and distribution of nitrous oxide; but these are normally limited to either banning distribution to minors, or to setting an upper limit for the amount of nitrous oxide that may be sold without a special license, rather than banning possession or distribution completely. In most jurisdictions, like at the federal level, sale or distribution for the purpose of human consumption is illegal. In California, for instance, inhalation of nitrous oxide "for the purpose of causing euphoria, or for the purpose of changing in any manner one’s mental processes," is a criminal offense under its criminal code (Cal. Pen. Code, Sec. 381b). In most jurisdictions, small N₂O cartridges, used to make whipped cream, can be legally purchased by anyone. In some jurisdictions, sales of canned whipped cream using nitrous oxide are limited to adults.^[37]

In all US jurisdictions, however, distribution, possession, and inhalation are legal when done under the supervision and direction of licensed medical professional such as a physician or dentist.