Nitrous oxide is a colorless gas that medicine uses as an inhaled anesthetic, a painkiller and an anti-anxiety agent. It's also the propellant in steel whipped-cream canisters, from which people inhale it — "whippets." The high comes on fast — euphoria, calm, hallucinations — and fades within minutes.
It's increasingly popular with teenagers and young adults: cheap, currently legal, sold online and in vape shops, grocery and convenience stores and gas stations. Many users think it's harmless. It isn't: frequent or long-term use can cause disabling nerve damage, including loss of the nerves' protective coating (demyelination) and subacute combined degeneration of the spinal cord, by knocking out vitamin B12. Treatment means stopping for good plus high-dose vitamin B12 injections, and recovery is often slow and incomplete.
What Michigan saw
In late 2023, the Michigan Poison & Drug Information Center noticed more patients hospitalized with neurologic problems from nitrous oxide, alongside a rise in poisoning consultations. With the Michigan Department of Health and Human Services, it reviewed poison center cases, emergency department (ED) visits and emergency medical service (EMS) responses from 2019 through 2023.
Nitrous oxide–related encounters in Michigan by year. Image from CDC's report
| 2019 | 2023 | Total, 2019–2023 | |
|---|---|---|---|
| Poison center cases | 10 | 48 | 144 |
| ED visits | 7 | 60 | 132 |
| EMS responses | 15 | 78 | 192 |
- Most events involved people aged 20–39; median ages were 26 (poison center), 29 (ED) and 32 (EMS).
- Nearly all happened in metropolitan counties: 91.7% of poison center cases, 94.7% of ED visits and 94.3% of EMS responses.
- 14 EMS responses (7.3%) involved a death, including three suspected suicides. EMS data can't establish cause of death, but nitrous oxide was documented in each.
- 30% of poison center cases involved other substances too — most often benzodiazepines (9.7%), cannabis (9.0%) and alcohol (8.3%).
- The most common effects in poison center cases were a racing heart (19.4%), other neurologic effects (18.8%) and numbness (16.7%).
Why it's likely undercounted
Doctors often don't suspect nitrous oxide, and no reliable screening test exists. Diagnosis depends on a detailed recreational drug history and on indirect blood markers, read alongside other tests and symptoms.
What long-term misuse does
| Effects | |
|---|---|
| Nerves | weakness, unsteady walking and pins and needles, which can progress to polyneuropathy with or without spinal cord degeneration |
| Mind | hallucinations, anxiety, depression, delirium, memory problems |
| Blood | changes resembling megaloblastic or pernicious anemia, and suppressed bone marrow |
Recent evidence also suggests a possible role in pulmonary embolism and deep vein thrombosis.
What should happen
Nitrous oxide isn't a federally controlled substance, but some states — Michigan among them — have passed or are considering laws on its possession, sale and distribution. The authors call for:
- better surveillance, using poison center and health care data
- targeted education for users, parents and caregivers, and clinicians
- prevention campaigns warning the public of the dangers
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
Sources
Based on Varun Vohra (Michigan Poison & Drug Information Center, Wayne State University), Hannah Matthews and Gabrielle Stroh-Steiner (Michigan Department of Health and Human Services), "Notes from the Field: Recreational Nitrous Oxide Misuse — Michigan, 2019–2023," MMWR, volume 74, Centers for Disease Control and Prevention; a work of the United States government in the public domain; rewritten in hubnx's own words. The report's summary calls the 2023 counts four to five times those of 2019, but its ED counts (7 and 60) rise further, so no multiple is given here.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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