‘Laughing gas’ abusers run risk of mental problems, leading psychiatrist warns

Experts say avoidable harm from the gas — usually released into balloons from small silver canisters before being inhaled — has been observed worldwide.

In a new medical paper, doctors describe how a 22-year-old man presented at an Irish hospital with psychotic symptoms that included delusions, auditory hallucinations, and disorganised cognition.

He thought gardaí had implanted a microchip in his right arm to transmit his thoughts

He told the doctors he inhaled nitrous oxide — which is regularly used in childbirth — to experience rapid euphoria.

The young man with no previous psychiatric history arrived at A&E believing he was under surveillance by his neighbours and gardaí, who were looking to implicate him in a drug ring.

“He also thought gardaí had implanted a microchip in his right arm which was transmitting his thoughts.

“He was convinced that gardaí had placed cameras in his home and tracked his phone. He was also troubled by thoughts of worthlessness, which he believed were inserted into his mind by his neighbour.”

Doctors said he had become increasingly distressed and preoccupied with third-person auditory hallucinations, persecutory delusions, and delusions of control in the six months leading to his presentation at the hospital.

Dr Shaeraine Raaj, consultant liaison psychiatrist at Connolly Hospital in Blanchardstown, is one of the study authors. He has seen a rise in cases of nitrous oxide abuse since the pandemic.

“I have been working as a psychiatrist in Ireland since 2014 and only observed people abusing nitrous oxide since the pandemic and increasingly since.

“I want to highlight the marked urgency of improving awareness and education on the implications of nitrous oxide in three tiers, which include healthcare professionals, the health system, and the wider public.

“The lack of insight regarding the potential adverse effect — from a mental health and neurological point of view — is resulting to an increase use of nitrous oxide within a younger age cohort.”

The patient did not believe he was unwell and was perplexed by his admission

​The man in the study had a history of using cannabis since age 19, with his intake gradually rising from one to five joints a day.

But he stopped smoking cannabis and started using nitrous oxide during the pandemic lockdown, due to the challenge of buying cannabis.

He told doctors he inhaled approximately 75 to 100 canisters of the gas every day for nearly six to nine months.

The gas, which is used during childbirth, dental surgery, and emergency settings due to its short-lived effects, is nicknamed “laughing gas” or “hippy crack” for its hallucinogenic effects that disappear in minutes.

The young man said the canisters were easy to buy online and were shipped directly to his doorstep.

“He said the wholesale provider sells canisters of varying sizes and encourages bulk purchases at discounted prices.

“The patient was unaware of the psychiatric risk factors involved with inhaling N2O,” said the report. “He said the canisters were not sold for inhalation purposes but for balloon inflation.”

He told doctors he had last used nitrous oxide three days before he presented to A&E, and was subsequently admitted to the psychiatry unit as a voluntary patient.

“He presented as well-groomed and neat. He was cooperative but guarded, suspicious, and demonstrated intermittent eye contact. He had a blunted affect with a euthymic mood and smiled incongruently during the review”, reported the study.

“His speech was coherent with a high-pitched tone. He described a systematised persecutory delusion and reported third-person auditory hallucination, including running commentary.”

The doctors noted the patient did “not believe he was unwell and was perplexed by his admission”.

They added: “He gradually became less preoccupied with his delusional belief system, less suspicious, and less guarded. Over time, he maintained stability in his mental state wherein hallucination and delusion stopped with anti-psychotic medications.”

The study, published in the Cureus journal, reported that the patient was discharged after four weeks of inpatient treatment, and was linked up with local addiction services.

The sale of nitrous oxide for its psychoactive properties is prohibited in many countries, including Ireland — but it is not a controlled drug, which means it is not a crime to possess it.

“Nitrous oxide abuse is widespread in EU countries, and its chronic use puts one at a higher risk of developing psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy,” concluded the study,

Dr Shaeraine Raaj said the Department of Health is responsible for identifying, planning, and delivering awareness campaigns to the broader public on the psychological and neurological adversity of medium to longer use of nitrous oxide.