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The Impact of Nitrous Oxide Misuse

January 18, 20233 min read

“Understanding Nitrous Oxide: The Dangers and Effects of Nangs


Welcome to another episode of Cracking Addiction, where Dr. Thileepan Naren and Dr. Ferghal Armstrong delve into the world of substance misuse. In this episode, the focus is on nitrous oxide, colloquially known as nangs, a popular inhalant among the adolescent age group. The conversation delves into its widespread availability, medical uses, and the potential harms associated with its misuse.


The Science of Nitrous Oxide:

Nitrous oxide, or laughing gas, was originally invented as a gaseous anaesthetic agent. It acts as an NMDA receptor antagonist, contributing to sedation and relaxation by blocking rapid glutaminergic signalling in the brain. Its medical use still persists in anaesthesiology, highlighting its potency as an anaesthetic agent.

Availability and Misuse:

The ready availability of nitrous oxide, often in the form of canisters used for inflating balloons and whipping cream, exposes it to misuse. The speed of onset after inhalation, typically within 15 to 30 seconds, also contributes to its appeal as a recreational drug. However, the need for repeated inhalations leads to potential harm from its misuse.

Neurological Effects:

One of the key dangers associated with nitrous oxide misuse is its impact on vitamin B12. Nitrous oxide oxidizes cobalt in vitamin B12, rendering it inactive. This leads to functional B12 deficiency, affecting important enzymes in key biochemical pathways. The resulting deficiencies can cause subacute combined degeneration of the cord, leading to neurological degenerative disorders that manifest as loss of balance, reflexes, and spinal cord pain.

Diagnostic Challenges:

Diagnosing B12 deficiency resulting from nitrous oxide use presents challenges. Although conventional blood tests for B12 levels might indicate normalcy, the functionality of B12 might be compromised. As a result, elevated methylmalonic acid and homocysteine levels become critical in identifying functional B12 deficiency. It's important to recognise that functional deficiency might not be captured through routine blood tests, necessitating a comprehensive clinical approach to diagnosis and treatment.

Treatment and Management:

The discussion reveals that treatment of subacute combined degeneration secondary to nitrous oxide misuse often involves abstinence from the inhalant and parenteral B12 supplementation. However, the effectiveness of the treatment remains uncertain, highlighting the lack of a robust evidence base. In some cases, supplementation with methionine and synthetic folic acid might also be considered to address the resulting deficiencies.

Harms and Risks:

The pervasive availability of nitrous oxide and its misuse pose multiple risks, including the potential for irreversible neurological damage and hematological disorders. Additionally, the method of administration, involving the cracking of canisters and inhalation, can lead to serious injuries such as third-degree cold burns and barotrauma. These risks underscore the urgent need for awareness and intervention to mitigate the hazards associated with nitrous oxide misuse.


The dialogue on Cracking Addiction sheds light on the multifaceted nature of nitrous oxide misuse. From its medical uses to the potential neurological and systemic harms resulting from its illicit use, the episode presents a comprehensive understanding of the dangers associated with nangs. As the conversation concludes, it emphasizes the critical need for informed interventions and public awareness campaigns to address the widespread availability and misuse of nitrous oxide among vulnerable populations, particularly adolescents.

In conclusion, the blog post provides an insightful and comprehensive overview of the dangers and effects of nitrous oxide, drawing from the detailed exploration and expert insights shared in the Cracking Addiction episode.

nitrous oxidenangsinhalantsadolescent drug useneurodegenerative disorder drug addictionmegaloblastic anemia
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