Chronic recreational inhalation of nitrous oxide causes long term neurological and cardiovascular damage.
Of MO students aged 12-17, 2.4% reported trying inhalants in their lifetime, including nitrous oxide.
Twelve states specifically prohibit possession and sale of nitrous oxide for recreational use, but MO does not.
Nitrous oxide inhalation causes neurological, psychiatric, and cardiovascular issues
Inhalants are chemicals found in household products that release vapors, producing mind-altering effects when inhaled (NIDA 2024). They are categorized into volatile solvents, aerosols, gases, and nitrites.
Nitrous oxide, also known as laughing gas, is a colorless, sweet-tasting gas (Wong et al. 2014). It is used in healthcare as an anesthetic, in the food industry as a propellant in whipped cream canisters, and in the automotive industry as an engine booster. It is cheap and can be purchased as gas cylinders and dispensers for soda streams and whipped cream in supermarkets.
Recreational nitrous oxide use causes brief euphoria, which encourages repeated inhalation (Sedore 2023). Use of pure nitrous oxide can lower oxygen levels in the body, leading to neurological damage, psychiatric issues, or death. Recreational use of nitrous oxide has increased over the past decade (van Amsterdam et al. 2022, Nabben et al. 2021).
Chronic recreational use can cause long-term neurological damage, cardiovascular problems, and psychiatric issues like hallucinations, psychosis, delusions, paranoia, and depression (Gernez et al. 2023, Sedore 2023, Soderstrom et al. 2024). In extreme cases, chronic use can lead to degeneration of the spinal cord and permanent disability (Keddie et al. 2018, Soderstrom et al. 2024).
Nitrous oxide induced psychosis can be treated by abstinence and use of vitamin B12 supplements, and sometimes antipsychotics (Wong et al. 2014). Most symptoms improve fully, though mild neurological issues may persist.
There is limited data on nitrous oxide recreational use in MO
Nitrous oxide ranks either as the 7th or 8th most popular drug used worldwide between 2015 to 2021 (Winstock et al. 2022). Data on recreational nitrous oxide use in MO is limited. Inhalant use (including but not limited to nitrous oxide) among children in MO shows an average first-use age of 10 (Bradford et al. 2024). In the same survey, 2.4% of MO students in grades six to twelve reported having used inhalants. Out of 723 teenagers residing at the MO Division of Youth Services in 2004, 15.8% had used nitrous oxide in their lifetime (Garland et al. 2009).
MO has no laws restricting recreational nitrous oxide
Inhalants are not regulated by the federal government (21 U.S. Code § 812). However, they are regulated as analgesic by the Food and Drug Administration (21CFR § 184.1545). MO does not categorize nitrous oxide as a controlled or restricted substance (RSMo 195.017). In MO, individuals are not permitted to deliberately smell or inhale solvents, specifically toluene and nitrates, but no corresponding restriction exists for nitrous oxide or any other gases (RSMo 579.097). An exception is the city of St. Peters, MO in which use, possession, and sale of nitrous oxide are deemed guilty of an ordinance violation punishable by and in accordance with the ordinances of the city (St. Peters, MO, Municipal Code § 210.305).
Forty-five states have enacted laws to restrict the recreational use and sale of inhalants. Some states impose additional restrictions on nitrous oxide (Table 1).
Table 1. State laws restricting recreational use and sale of inhalants, including nitrous oxide.
| Regulation | Number of States | States | Includes Nitrous Oxide |
| Classify possession, inhalation, or sale of inhalants with intent to inhale as a misdemeanor | 32 | AR, AZa, CAa, CO, GAa, HI, ID, ILa, IN, KS, KY, MA, MIa, MO, MS, MT, NC, NE, NH, NM, NV, NY, OHa, OK, RIa, SC, SD, UTa, VA, WA, WV, WY | No |
| Classify possession, inhalation, or sale of inhalants with intent to inhale as a misdemeanor | 8 | LA, MD, MN, NJ, ORa, ND, PA, TX | Yes |
| Classify possession, inhalation, or sale of inhalants with intent to inhale as a felony | 2 | FL, TN | Yes |
| Imposes a fine for violating laws on inhalant possession, inhalation, or sale | 1 | CTa | Yes |
| Fine for use or possession of inhalant and require attendance of a substance use disorder program | 2 | ME, VT | No |
| Classify possession, inhalation, or sale of nitrous oxide with intent to inhale as a misdemeanor. | 10 | AZb, CAb, CAc, CTb, GAb , ILb, MIb, OHb, ORb, RIb, UTb | N/A (Have separate general inhalant laws) |
| Classify possession, inhalation, or sale of nitrous oxide but not inhalants generally with intent to inhale as a misdemeanor | 2 | IA, WI | N/A |
Note: If you or someone you know is struggling, SAMHSA’s National Helpline (1-800-662-4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service.
REFERENCES
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