Laughing gas, a term often bound to evoke curiosity, pertains to nitrous oxide, a substance with legitimate uses in medicine and food production, tinged by its recreational notoriety. This guide uncovers the dual nature of laughing gas explaining its proper applications, analyzing its effects, discussing its legal status, and addressing the public health concerns it brings forth.
Key Takeaways
Nitrous oxide is a versatile gas used medically for analgesia and anesthesia, evidenced by its inclusion in the WHO’s List of Essential Medicines, and also popularly misused in recreational settings, leading to potential health risks.
Recreational abuse of nitrous oxide can lead to severe neurological and physical consequences, including dependence and withdrawal symptoms, necessitating targeted treatment options for addiction such as behavioral therapies and pharmacological treatments.
Beyond health effects, nitrous oxide significantly impacts the environment as a potent greenhouse gas, with its emissions primarily driven by agricultural practices, highlighting the need for improved management strategies.
Understanding Laughing Gas
Nitrous oxide, commonly known as laughing gas, nitrous, nitro, or NOS, is a colourless gas, with no odor. It has the following properties:
It supports combustion
It provides a euphoric feeling, which contributes to its nickname ‘laughing gas’
It acts as a powerful oxidizer at elevated temperatures, similar to molecular oxygen.
Nitrous oxide, also known as laughing gas, has the following properties:
Chemical formula: N2O
Molar mass: 44.013 g/mol
Melting point: -90.86 °C
Boiling point: -88.48 °C
Solubility: soluble in alcohol, ether, and sulfuric acid.
Medical Applications
Nitrous oxide holds a vital position in the medical world, featured on the World Health Organization’s List of Essential Medicines as a testament to its significance in medical treatments. Nitrous oxide is used for labor analgesia, dental procedures, and as an anesthetic agent to calm patients and alleviate pain.
For these medical purposes, nitrous oxide inhalation is administered via an automated relative analgesia machine with an anaesthetic vaporiser and a medical ventilator. This ensures controlled doses with a minimum of 30% oxygen and a maximum of 70% nitrous oxide. For the safety and effectiveness of nitrous oxide use in medical settings, such careful dosage control is indispensable.
One notable application of nitrous oxide is in childbirth. Nitrous oxide serves as a safe and effective aid for birthing women, offering significant pain relief during labor. This equips medical professionals with a valuable tool for managing the pain and stress of childbirth.
Non-Medical Uses
Apart from the medical field, there are a plethora of non-medical applications for nitrous oxide. In vehicle racing, pure nitrous oxide is used as an oxidizer in rocket propellants and to increase engine power output by injecting the compressed liquid into the intake manifold. The use of nitrous oxide in engines is surrounded by myths; it does not inevitably lead to engine explosions when used responsibly, nor does it cause engines to rev higher than normal or wear out much faster.
Nitrous oxide serves multiple purposes, including:
Acting as a propellant in aerosol products, commonly found in nitrous oxide canisters used for whipped cream and cooking sprays
Being used recreationally, with nearly half a million young people using it at events in the UK
Being encouraged by factors like low cost, ease of availability, and innocuous packaging
The Science Behind Nitrous Oxide
Complex interactions within the central nervous system govern the effects of nitrous oxide on the human body. Nitrous oxide produces its anesthetic, analgesic, and anxiolytic effects by interacting with various targets within the central nervous system, including NMDA receptors and the endogenous opioid system. The anesthetic effect is achieved by non-competitively inhibiting NMDA in the central nervous system. This inhibition paves the way for the anesthetic effect.
The pharmacological effects of nitrous oxide include modulation of ligand-gated ion channels, inhibition of NMDA receptor-mediated currents, and possible imitation of nitric oxide actions. These effects endow nitrous oxide with its pain-relieving and calming properties.
In particular, nitrous oxide’s analgesic effect is mediated by modulation of opioid receptors in the periaqueductal gray (PAG) area of the midbrain, involving opioid peptides like methionine-enkephalin (ME) and dynorphins (DYNs). Nitrous oxide induces the neuronal release of endogenous opioid peptides and stimulates opioid receptors, activating descending pathways that modulate nociceptive processing in the spinal cord.
Anxiolytic Effects
The anxiolytic, or anxiety-relieving, effects of nitrous oxide are due to the facilitation of GABAergic inhibitory neurotransmission, specifically involving selected subunits of the GABAA receptor. This means that nitrous oxide enhances the activity of GABAA receptors, a type of neurotransmitter receptor that responds to the neurotransmitter GABA, the chief inhibitory compound in the mature vertebrate central nervous system.
Interestingly, the anxiolytic effects of nitrous oxide sedation are comparable to those of benzodiazepines, a type of medication known for its sedative properties. Behaviors induced by nitrous oxide are sensitive to antagonism by flumazenil, a benzodiazepine binding site blocker, suggesting a possible overlap in the mechanisms of action of these two substances.
However, while nitrous oxide enhances the activity of GABAA receptors, the precise molecular interactions involved are not completely understood. This includes the stimulation of the benzodiazepine binding site or potential release of endogenous benzodiazepine factors. This is an area of ongoing research in the field of neuroscience.
Analgesic Effects
Nitrous oxide’s analgesic, or pain-relieving, effects are due to its interaction with the endogenous opioid system, which may involve triggering the release of endogenous opioids or direct action at opioid receptors. This means that nitrous oxide can modulate the body’s own pain relief system to produce its analgesic effects.
In more detail, nitrous oxide modulates neuromodulators in the spinal cord and involves opioid receptors in the periaqueductal gray area of the brain, a crucial area for pain modulation. Dynorphins and methionine-enkephalin are the opioid peptides released by nitrous oxide, serving as endogenous ligands for kappa and mu opioid receptors, respectively.
However, continuous administration of nitrous oxide can lead to tolerance to its antinociceptive effect, linked to changes in the sensitivity of opioid receptors or levels of opioid peptides. This means that repeated use of nitrous oxide can lead to reduced effectiveness of its pain-relieving effects, a common issue in the use of analgesic drugs.
Dangers of Recreational Use
Despite the beneficial effects of nitrous oxide when used properly, recreational use can lead to a range of serious issues. Neurological problems can include:
dizziness
dissociation
disorientation
impaired memory and cognition
weakness in the legs
memory loss
limb spasms
weakened immune systems
incontinence
possible psychosis
Physical dangers associated with inhaling nitrous oxide can be life-threatening. These can include:
Fatal accidents due to asphyxiation (hypoxia)
Frostbite to exposed tissues when directly inhaled from tanks or crackers
Lung tissue ruptures
Overdose symptoms such as loss of consciousness, irregular heartbeat, and seizures.
Furthermore, heavy or sustained nitrous oxide use may result in a functional vitamin B12 deficiency. This can potentially cause:
numbness in fingers
peripheral neuropathy
megaloblastic anemia
neurologic deterioration or death without treatment
A serious potential risk of receiving nitrous oxide is its impact on blood pressure due to nitrous oxide abuse when nitrous oxide leaves the system, often overlooked as a consequence of too much nitrous oxide exposure.
The combination of nitrous oxide with other substances can also increase risks and lead to unpredictable and hazardous effects. This challenges the misconception that nitrous oxide is harmless and safe to mix with other substances.
Nitrous Oxide Addiction and Treatment
Psychological dependence on nitrous oxide is a risk with regular use, and some users may develop physical dependence and withdrawal symptoms. This means that nitrous oxide, despite its medical uses, can lead to addiction when abused.
Treatment for nitrous oxide addiction typically involves a combination of behavioral therapies, counseling, and support groups. These treatments aim to help the individual understand their addiction, identify triggers, and develop coping strategies to manage cravings and prevent relapse.
In some cases, treatment for nitrous oxide addiction may involve:
Inpatient rehab programs
Outpatient rehab programs
Pharmacological treatments like lamotrigine therapy to help manage withdrawal symptoms and cravings associated with nitrous oxide addiction.
These treatment options can be specifically tailored to treat individuals with nitrous oxide addiction, a form of drug addiction.
Premier League Player's Rehab Story
In a recent high-profile case, an unnamed Premier League footballer checked into rehab for nitrous oxide addiction, a substance often used as a recreational drug. This occurred after family members became concerned and contacted his club. The use of nitrous oxide is reportedly widespread among top-level footballers, suggesting that more players may seek rehab in the future.
This case serves as a stark reminder of the risks of nitrous oxide abuse. It also highlights the importance of seeking help early and the potential for recovery with the right support and treatment.
Legal Status and Regulations
The legal status and regulations surrounding nitrous oxide use vary by country. As of 2023, nitrous oxide is classified as a Class C drug in the UK, punishable by jail sentences, fines, or community punishments for possession. In the UK, repeat users may face up to two years in jail, with dealers risking up to 14 years imprisonment, along with fines and other penalties for the illicit supply or possession of nitrous oxide.
In the United States, while possession of nitrous oxide is legal under federal law, it’s regulated by the FDA. States have specific laws such as banning distribution to minors or requiring special licenses for sale above certain amounts.
In New Zealand, nitrous oxide is considered a prescription medicine, and unauthorized sale or possession is an offense under the Medicines Act. These laws reflect the potential risks of nitrous oxide abuse and aim to control its use to legitimate medical and industrial applications.
Safety Measures and Guidelines
Given the potential risks of nitrous oxide use, having safety measures and guidelines in place is of paramount importance. In occupational settings, the following safety measures should be implemented:
Upgrading gas manifolds
Enhancing security
Improving stock control
Monitoring pin-index safety systems
These measures are crucial to prevent leaks, expired stock, and incorrect gas delivery.
Effective ventilation is also essential, ensuring a minimum of 10 air changes per hour in areas where nitrous oxide is used. Additionally, waste gas scavenging systems should be installed to dilute the concentration and manage excess gas.
Staff must be adequately trained on the contraindications and potential adverse effects of nitrous oxide. This includes COSHH risk assessment controls and hazard communication to manage complications and mitigate risks.
Moreover, regular checks of delivery devices, annual occupational exposure sampling measures, and in-line oxygen analyzers with alarms are essential monitoring measures to validate safety measures and ensure accurate gas mixtures.
Debunking Myths About Nitrous Oxide
Despite its analgesic and anxiolytic properties, inappropriate use of nitrous oxide can trigger negative side effects such as nausea, vomiting, and fatigue. This debunks the myth that nitrous oxide is a harmless substance with no side effects.
Neurological deficits due to vitamin B12 depletion can result from chronic exposure to nitrous oxide. This is a serious potential risk of nitrous oxide abuse that is often overlooked.
Moreover, while nitrous oxide provides partial pain relief, it is often combined with other drugs to achieve full anesthesia because it is not potent enough on its own to serve as a sole anesthetic agent. This debunks the myth that nitrous oxide alone is sufficient for anesthesia.
Summary
Nitrous oxide, also known as “laughing gas,” is a versatile substance with a wide range of medical and non-medical uses. However, misuse of nitrous oxide can lead to serious health and environmental consequences. From neurological issues to addiction, the dangers of nitrous oxide abuse are real and significant.
Understanding the risks and realities of nitrous oxide use is crucial. It is our hope that this blog post has shed light on the complexities of nitrous oxide, debunked common myths, and highlighted the importance of safety measures and guidelines. Remember, while nitrous oxide may induce laughter, its misuse is no laughing matter.
Frequently Asked Questions
Can you still feel pain with laughing gas?
Yes, while on laughing gas, you may still feel sensations that would be perceived as painful, but it can help increase your pain threshold and make you more relaxed, which may lessen the sensation of pain.
Why is laughing gas not used anymore?
Laughing gas is not used by many dentists and clinicians anymore due to the risk it poses to patients, as it can be fatal in rare cases by causing hypoxia.
Are you awake with laughing gas?
No, laughing gas won’t put you to sleep like general anesthesia. Instead, it will make you feel a slight light tingling sensation while you remain awake.
Why is n2o called laughing gas?
Nitrous oxide is called “laughing gas” due to the euphoric effects it has when inhaled, causing feelings of relaxation and calmness, and often resulting in fits of giggles and laughter. This colloquial name was coined by Humphry Davy, and it is also used as a dissociative anaesthetic.
Author
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Dr Otulana is PCP’s longest-serving doctor. He is an experienced Physician with Specialist Interest in Substance Misuse Management and he has a wide range of experience in the assessment and management (including detoxification) of clients with various drug and substance addiction problems. Dr Otulana started practising as a doctor in 2000 and with over 10 years as an Addiction Physician. He is an Advanced Addiction Practitioner Member of Addiction Professionals and also holds the Certificate in Clinical Psychopharmacology (Part 1) of the British Association for Psychopharmacology. He is additionally a strong healthcare services professional with a Master of Business Administration (M.B.A.) degree from Cambridge University Judge Business School.