Nitrous Oxide Abuse: Clinical Outcomes, Pharmacology, Pharmacokinetics, Toxicity and Impact on Metabolism.

Recreational use of nitrous oxide (N2O), or laughing gas, has risen sharply, with the European Monitoring Centre for Drugs and Drug Addiction listing it as one of the most prevalent psychoactive substances in Europe in 2022. Chronic N2O exposure causes neurological symptoms most often, such as sensory or motor disorders, along with psychiatric issues and cardiovascular events like thrombosis. N2O is difficult to measure directly in biological samples, so indirect biomarkers—vitamin B12, plasma homocysteine, and plasma methylmalonic acid—should be used for diagnosis and assessment. Oxidative stress markers may become useful but require further study.

Study at a glance

Abstract

The recreational use of nitrous oxide (N2O), also called laughing gas, has increased significantly in recent years. In 2022, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) recognized it as one of the most prevalent psychoactive substances used in Europe. Chronic nitrous oxide (N2O) exposure can lead to various clinical manifestations. The most frequent symptoms are neurological (sensitive or motor disorders), but there are also other manifestations like psychiatric manifestations or cardiovascular disorders (thrombosis events). N2O also affects various neurotransmitter systems, leading to its anesthetic, analgesic, anxiolytic and antidepressant properties. N2O is very challenging to measure in biological matrices. Thus, in cases of N2O intoxication, indirect biomarkers such as vitamin B12, plasma homocysteine and plasma MMA should be explored for diagnosis and assessment. Others markers, like oxidative stress markers, could be promising but need to be further investigated.