Another summer over, another nitrous oxide media panic. Recent months saw reports of an “epidemic” of hospitalisations thanks to the drug – also called laughing gas, NOS, or “hippy crack” by the Daily Mail – alongside daily Twitter missives from local police about deserted canisters, plus an apparently “mindblowing” 3.5 tonne haul from Notting Hill Carnival.
We should handle any tabloid drug scare with care, particularly regarding a substance attributed to just 56 UK deaths between 2001 and 2020. Nevertheless, the emergence of bigger canisters – costing around £30 online, around the size of a forearm and enough for 60 to 80 balloons – has lent the annual NOS furore a different tenor, with one article in the British Medical Journal stating that “doctors are concerned after seeing more users presenting neurological complications after inhaling often from large canisters of the gas”.
Should users be worried? Where did these bigger canisters come from – and are they better than whippits for the planet?
The most familiar larger canister is probably Smartwhip. Founded in Amsterdam in 2019 and part of Rainbow Commerce, which describes itself as “a food and non-food wholesale distributor and incubator” with a portfolio of precisely two products: Smartwhip and Cream Deluxe, another NOS brand. Apparently, Smartwhip “quickly acquired market share across United Kingdom”, where it now vies for space in our nation’s park bins and Twitter feeds with FastGas, another Dutch company which was formed in 2018 and claim to have over 200 employees.
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Neither business replied to requests for comment, though it’s important to note that nitrous oxide remains legal for recreational use in the Netherlands, despite recent attempts of lawmakers.
Supply for recreational purposes in the UK was made illegal under 2016’s Psychoactive Substances Act, though possession is decriminalised and it’s still legally used within the catering, medical and automation industries. This somewhat nebulous categorisation helped it become the country’s second most popular drug for people aged between 16-24 after cannabis, according to the 2019-20 National Crime Survey. Then-Home Secretary Priti Patel even ordered a Home Office review into its effects last year.
Nevertheless, a three-year review of Global Drug Survey data found that it is relatively non-harmful for infrequent, non-heavy users. So what’s propelling the new tabloid fuss?
Dr David Nicholl is a Birmingham-based consultant neurologist with 20 years’ experience. “Things started to change in 2020,” he tells VICE. “Before that I’d see someone [with a nitrous oxide-related presentation] every 10 years. Something like that. Then I started seeing someone every couple of months or so. Now it’s essentially most weeks.”
The neurological problems Nicholl relays are caused mainly by a nitrous oxide-induced deficiency of vitamin B12, which can affect the brain, spinal cord and nerves. “Slurred speech, confusion, maybe problems with walking; or sensory symptoms like not being able to feel hands or feet,” he lists. “I have seen people that have been left long-term disabled – walking with crutches at best – and this wasn’t the case before. That is an absolute tragedy.”
The Independent recently reported that “calls [relating to laughing gas] to the National Poisons Information Service have increased by 257 per cent in 2021-22, according to data due to be published later this year” – though it also notes that there were only 37 callers the year before.
“Around 600,000 people report nitrous oxide use in the UK each year,” says Harry Sumnall, a professor in substance use at the Public Health Institute. “Neurological problems after nitrous are typically associated with frequent consumption of very large amounts, sometimes the equivalent of hundreds of canisters over a relatively short period of time,” he says. “It depends on the individual but medical case reports suggest periods of that level of use per day, or per week, and it’s often prolonged over several weeks or months. This is clearly not a typical use pattern.”
Sumnall acknowledges the concerns of Nicholl and other clinicians, but says that “it’s not possible to quantify this rise [in NOS-related hospital admissions] because the data we have… in the UK is generally of poor quality”. This isn’t the only potential issue: “The right sort of questions about drug use are not routinely asked of patients, so one reason for the [anecdotal] rise might be that clinicians might be more tuned into nitrous oxide being a potential cause and are beginning to investigate this more consistently.”
He doesn’t discount the potential risk of larger canisters, though. “The increased availability of disproportionately large canisters… suggest that it is becoming cheaper and easier to be exposed to very high levels of nitrous.”
These larger products tend to hold around 600g of nitrous oxide, compared to the average 8g in a regular canister. “Whippits are a bit fussy and inconvenient for users but this can actually act as a barrier to more intensive use,” says Steve Rolles, the senior policy analyst at Transform Drug Policy Foundation. “If you have a Smartwhip you can just do another instantly, and five people can too.”
As the GDS data shows, NOS is relatively risk-free for most – but Rolles flags that the research also found what it describes as a “strong dose-response relationship” with paraesthesia, a condition that involves tingling or numbness in extremities and is often associated with vitamin B12 depletion, for heavy users who have a minimum of 100 balloons in a single sesh.
“I think these dangers have been undersold – particularly with large canisters,” Rolles says. “Because nitrous oxide has been correctly identified as relatively safe in small amounts, some people just assume they can use as much as they like.”
Right now, Smartwhip and other products are widely available in the UK everywhere from eBay to Amazon, not to mention many specialist websites and social media vendors. Sumnall and Rolles both agree that there should be regulatory tweaks to deter the availability of the large canisters, but that prohibition isn’t the answer.
“The demand is there – so if you restrict sales completely, you risk setting up secondary, illegal markets,” says Rolles. He advocates a harm reduction-focused approach: “Harm reduction information should be included on the product itself. It would make sense that every cylinder, package and website should have very clear, mandated risk and harm reduction information.”
There are no hard-and-fast guidelines on a “safe” amount of laughing gas, but both suggest keeping in the single figures of balloons, and to stop immediately if you feel tingling or numbness. There’s also bad news for the dedicated NOS nitties taking Vitamin B12 supplements to ward off the effects of heavy use: “I’m not aware of any evidence that suggests taking over-the-counter B12 would work,” Sumnall says.
Another issue traditionally clouds any conversation around nitrous oxide: the abandoned whippits on our streets, parks and rave floors which, despite being made of steel so theoretically recyclable, are often sent to landfill due to the risks involved in recycling them in non-specialist facilities.
Are these larger canisters any better for the planet? Dr. Tim Rotheray, the director of environmental social governance at Viridor, a recycling, renewable energy and waste management company, told VICE that they have “seen an extraordinary increase in the number of gas canisters being thrown out as general waste”.
“Even if empty, these gas canisters explode when they go through an Energy from Waste (EfW) facility, creating a risk to the health and safety of those who make sure our bins are taken away and processed safely every day.”
This explosion often damages the EfW causing “waste processing to stop and be sent to landfill”, says Rotheray. “These gas canisters must be disposed of appropriately at licensed facilities, preventing them from going to non-recyclable waste streams.”
If your local council won’t process them, you could try a metal scrap yard. Steve Rolles says he would introduce a deposit scheme for the larger canisters. “I would legislate that there’s a £5 deposit on each one sold. You pay that, then drop them back [to a centralised drop-off point] and get your deposit back,” he says. “It would be an actual silver bullet for the littering problem.”
