The recreational use of nitrous oxide (N2O; laughing gas) has largely expanded in recent years. Although incidental use of nitrous oxide hardly causes any health damage, problematic or heavy use of nitrous oxide can lead to serious adverse effects. Amsterdam care centres noticed that Moroccan–Dutch young adults reported neurological symptoms, including severe paralysis, as a result of problematic nitrous oxide use. In this qualitative exploratory study, thirteen young adult Moroccan–Dutch excessive nitrous oxide users were interviewed. The determinants of problematic nitrous oxide use in this ethnic group are discussed, including their low treatment demand with respect to nitrous oxide abuse related medical–psychological problems. Motives for using nitrous oxide are to relieve boredom, to seek out relaxation with friends and to suppress psychosocial stress and negative thoughts. Other motives are depression, discrimination and conflict with friends or parents. The taboo culture surrounding substance use—mistrust, shame and macho culture—frustrates timely medical/psychological treatment of Moroccan–Dutch problematic nitrous oxide users. It is recommended to use influencers in media campaigns with the aim to decrease the risks of heavy nitrous oxide use and improve treatment access. Outreach youth workers can also play an important role in motivating socially isolated users to seek medical and or psychological help.
Background: Since 2000, the prevalence of recreational nitrous oxide (N 2O) use has increased in the Western world. Although N 2O is a relatively safe drug, the overall increase in the use of N 2O has concomitantly also initiated a modest but important increase in the number of young excessive users. The recent introduction of large 2 kg N 2O tanks, allowing high and prolonged dosing, has facilitated this excessive use. This is of concern, because repeated exposure to high doses of N 2O for a prolonged time is known to induce neurological damage, such as (irreversible) neuropathy and paralysis due to N 2O-induced vitamin B 12 deficiency. The increasing trend of recreational users with N 2O-induced neurological damage at emergency departments confirms the urgency of this development. Objective/Methods: This narrative review describes recent trends in N 2O use and misuse, the adverse health effects associated with excessive use and the risk factors of excessive use. Results: Considering the rising trend in N 2O use, particularly among young and other vulnerable people, we propose to take legislative action to limit the availability of N 2O, and also advocate for better and timely education of non-users, users and medical professionals about the serious side-effects associated with excessive N 2O use. Conclusion: It is concluded that the increase in excessive N 2O use is of serious concern.
