Young people harmed by nitrous oxide use most likely to be Asian men

Jan 09, 2024

Study of patients in England with neurological damage related to laughing gas finds group overrepresented

Young people experiencing neurological harm after using laughing gas are most likely to be male and Asian, according to a small study of patients admitted to hospital in England.

Nitrous oxide is the second most common drug used by 16- to 24-year-olds in the UK. It is typically released into balloons from small silver canisters before being inhaled. Rishi Sunak recently announced plans to criminalise the drug.

Experts say avoidable harm from laughing gas abuse is increasingly being observed worldwide. Now the largest complete clinical case series of recreational users of laughing gas to date has revealed a predominance of young men of Asian ethnicity among those experiencing neurological harm.

This may indicate genetic susceptibility to nerve damage caused by exposure to the gas, or other as yet unidentified social factors, according to the research led by Alastair Noyce, a professor of neurology at Queen Mary University of London. The findings were published in the Journal of Neurology, Neurosurgery & Psychiatry.

The most common symptoms were pins and needles in the arms and legs, caused by spinal cord and peripheral nerve damage seen on MRI imaging, the study found. Other symptoms included bladder and bowel difficulties, poor balance, involuntary arm movements, erectile dysfunction, memory and speech problems, visual disturbances and nausea or vomiting.

"Given what we’ve found, my strong advice to anyone who develops symptoms is to stop using nitrous oxide and present to hospital so treatment can be started as quickly as possible," Noyce told the Guardian.

The study looked at 119 young people with neurological issues caused by laughing gas. All were admitted to hospitals in three of England's largest cities – London (56), Birmingham (35), and Manchester (28) – between 2014 and 2022.

The average age of those requiring treatment was 22, but ranged from 14 to 39. Three out of four were male, although a third of the patients in London were female.

Most patients were of Asian or Asian British ethnicity (57%), the researchers found, with the highest proportion in London (73%). White patients made up 19% of the total, black patients 7.5% and mixed race people 6%. In one in 10 cases, ethnicity was not known or recorded.

"Individuals of Asian or Asian British ethnicity made up a large proportion of cases in east London (73%), Birmingham (54%) and Manchester (29%)," the researchers wrote.

"As such, Asian or Asian British individuals presenting with N2O-related harm appear to be overrepresented relative to the proportion of the population that is Asian or Asian British in each region.

"We and others have speculated that N2O is a drug of choice for individuals not engaging with other substances for cultural or religious reasons. This study does not necessarily support this idea, with the consumption of N2O along with other substances demonstrated across ethnic groups.

"However, the predominance of cases with Asian ethnicity may highlight genetic, dietary, or nutritional predispositions to neurological damage from N2O exposure, but also may indicate social circumstances predicating use."