7 October 2022
A new study published in the Royal Australasian College of Physicians’ (RACP) Internal Medicine Journal has found that many young people who engage in “nanging” – inhaling nitrous oxide for a euphoric high – suffer adverse neurological damage with chronic use.
Physicians say that young people and their parents need to be aware of the serious side effects of this dangerous recreational activity.
“Nanging” involves recreationally inhaling bulbs of nitrous oxide (N2O) easily sourced through whipped cream bulbs. It has a rapid 20-second onset of action with clinical effects lasting only minutes, making some users inhale hundreds of bulbs a day to maintain the effect.
The study involved 22 participants who presented to hospital as a result of N2O abuse. The average age of participants was 22 years old, with a majority being of student-age.
Author of the paper, Clinical Toxicologist Dr Angela Chiew says, “The potential adverse neurological and psychiatric effects of N2O inhalation in those who partake in chronic ‘nanging’ is cause for concern among our younger population.”
“We have seen an increase in presentations in young adults presenting with adverse effects from chronic nanging. One of the most common effects was decreased mobility. Out of the 22 patients, 18 underwent an MRI and it was concerning to find that 10 of them showed signs of subacute combined degeneration of the spinal cord.
“Five participants also suffered psychiatric effects such as hallucinations, paranoid thoughts, and depression.
“The statistics are worrying and highlight and urgent need to ensure young people are properly informed of the effects of nanging.”
Since 2017, internet and social media searches for N2O have increased rapidly. The occurrences of people presenting to medical units as a result of nanging is compounded by the fact that N2O bulbs can be easily purchased legally over the internet for food preparation.
“It’s concerning that a substance so easily obtained is seeing a surge in internet searches and orders by these young students.
“These young people may not have been properly educated on the consequences of recreational use of N2O and other substances, and this is a gap that must be fixed.
“Education is vital to mitigating risks of further students suffering the aftereffects. This includes targeted public health messaging, identification of high-risk groups, alongside restrictive policy measures that better regulate the selling and distribution of N2O cannisters.”
Key findings
The median peak number of bulbs inhaled per day was 300.
Out of 22 study participants:
- 15 had decreased mobility or unsteady gait (68%)
- 5 had psychiatric symptoms (23%)
- 10 out of 18 (55.5%) who had an MRI had subacute combined degeneration of the spinal cord
- 11 had decreased sensation
- 8 experienced a loss of distal lower limb joint proprioception and/or vibration
- 9 required walking aids once discharged from prolonged rehabilitation
- All 7 who did nerve conduction studies had sensorimotor neuropathy
- Other symptoms included problems with urine retention and incontinence, Vitamin B12 deficiency,
The National Coronial Information System database has officially recorded 36 deaths from N2O inhalation:
- 12 deaths unintentional (due to recreational drug use)
- 4 were traumatic
- 20 deaths intentional for the purposes of self-harm