In England and Wales, it is not illegal to possess nitrous oxide – but that could soon change. The UK’s home secretary, Priti Patel, has asked her scientific advisers to review the evidence on the harm associated with its use.
Commonly known as “laughing gas”, this odourless substance is used in medicine, as an anaesthetic, and in catering to make whipped cream. It is the whipped-cream chargers that people buy for recreational use. The gas is usually inhaled by discharging a canister containing small amounts of the gas into a balloon.
It takes effect quickly and produces brief euphoria. Some users will want to repeat this, but for the vast majority of people, use is restricted to a few episodes a year. Some clinical case reports suggest very heavy patterns of use, but these are rare and may be more likely in those able to source large amounts of the gas, including diversion from legitimate medical supplies.
Patel has made it clear that she is ready to take “tough action” on its use, arguing that young people are at risk of physical harm when using the drug and that it has “devastating” effects on communities. This is part of a new strategy of paying closer attention to so-called “recreational” use of substances. It appears that she intends to make possession a criminal offence.
Supplying this drug for approved non-medical uses is already illegal under legislation introduced in 2016 under the Psychoactive Substances Act. The better known Misuse of Drugs Act 1971 (the ABC classification system) introduces possession offences and affords police and regulators greater powers.
Existing legislation was meant to restrict the availability to medical and catering uses, but many loopholes exist, which means it is easy to buy the drug online. The law currently only applies to anyone supplying the drug for psychoactive use. As a result, catering suppliers warn customers that it is illegal to supply products if it’s going to be inhaled for its psychoactive effects, but this approach has been ineffective.
The UK government’s Advisory Council on the Misuse of Drugs (ACMD) reviewed the harms of nitrous oxide in 2015 and advised that it did not warrant control under the 1971 Misuse of Drugs Act. Since 2015, there is better awareness and clarification of potential harms, but no new evidence has emerged that would necessarily warrant a new review.
Repeated and heavy use of nitrous oxide can cause vitamin B12 deficiency, which can lead to nerve damage. These cases seem to be mostly associated with very heavy use (dozens of canisters consumed a day over several months), or occupational exposure (dentists and anaesthetists).
On average, five people die every year using nitrous oxide, with an increase in deaths recorded as the number of people using it has increased in recent years. But most deaths are a result of accidental suffocation and have resulted after plastic bags or other devices have been placed over the head when inhaling the gas, or inhaling directly from large highly pressurised canisters. While no drug is without harm, inhaling nitrous oxide through balloons significantly reduces the risk of suffocation.
What would a new law achieve?
Tightening access to nitrous oxide in 2016 doesn’t appear to have had any effect on demand, as almost one in ten 16 to 24-year-olds reported using nitrous oxide in 2019-20. In this light, it might be understandable that the government wants to take a new approach. This raises important questions as to the purpose and function of drug laws.
Discarded canisters are a visible and unpleasant littering problem, but this should be seen in the context of existing littering laws, cuts to local littering budgets , and the lack of places to recycle the canisters at nighttime venues.
If reduction of harm is the main concern, then this is rarely achieved through drug laws. These often lead to the emergence of potentially more harmful substances, more risky use behaviour, and hesitancy in seeking help as users fear legal repercussions. There will also be tricky regulatory pathways to navigate if the catering industry faces burdensome new barriers.
It may be reasonable to conclude that a focus on nitrous oxide may be more about appearing “tough on drugs” than addressing serious drug harm. There are several ways this could be done without ratcheting up penal sanctions. The giant online retailers could actively remove listings. Catering suppliers could clamp down on bulk purchases by limiting how many nitrous oxide canisters can be bought at once, and restricting sales to approved or registered purchasers.
There is scope to improve medical professionals’ knowledge of harm associated with the gas so that timely treatment can be offered. Local authorities could also be encouraged to use existing powers on anti-social behaviour. Although with cuts to local enforcement and environmental health teams it may be tempting to offload enforcement to equally stretched police forces.
The ACMD will no doubt provide a thorough and considered review of the harms of nitrous oxide in their recommendations to the home secretary, but it is then the minister’s decision on how to act on this advice.
The recent Dame Carol Black Review identified a drug treatment system that was “on its knees”, with record high numbers of drug deaths. Many people are struggling to achieve meaningful recovery from drug use, and there are worrying signs of increases in the use of the most harmful substances in young people as drug prevention and education activities have disappeared.
Facing this ongoing public health crisis, is it right that so much resource and effort will be expended on nitrous oxide?