Nitrous oxide: what if its use masks something else?
Easy to find and capable of inducing euphoria within seconds, nitrous oxide has become part of the lifestyle of some teenagers and young adults. Beyond its neurological risks, repeated use can sometimes be linked to psychological distress that has gone unnoticed. How can we distinguish between experimentation and concerning use? What warning signs should we look out for? Dr Kochman, a psychiatrist and medical coordinator at the Lautréamont Clinic in Loos (Northern France), analyses a phenomenon he regularly encounters among young people.
Nitrous oxide: from experimentation to addiction
In 2024, 5.8 per cent of French high schoolers had already experimented with nitrous oxide and 2.4 per cent had used it during the year. For Dr Kochman, the most worrying trend is the escalation in usage among some young people: "Last week, I saw a young person who told me they were taking it at least twenty times a day."
This is a far cry from the teenager who inhales from a balloon once, out of curiosity, at a party. Nitrous oxide can lead to genuine addiction, with cravings – that overwhelming urge to take the substance again. Some young people end up using it alone, every day, sometimes as soon as they wake up: “When a young person uses it first thing in the morning, on their own, it shows that they have entered a phase of addiction,” explains the specialist.
Its appeal lies in particular in the speed of its effects: a feeling of intoxication and euphoria sets in almost immediately but fades quickly, sometimes prompting repeated use.
- 14%
of young people aged 18 to 24 have tried nitrous oxide (Santé publique France)
- 3.2%
of 18–24-year-olds have used it in the past year (ANSM)
- 0.8%
of 18–64-year-olds have used it in the past year (EROPP survey)
- 25
this is the average age of users
Why is the adolescent brain vulnerable?
Despite its nickname ‘laughing gas’, nitrous oxide is far from harmless. In particular, it disrupts the functioning of vitamin B12 and can damage myelin, the sheath that surrounds nerve fibres and enables information to travel quickly. Yet adolescence is precisely the period when the brain’s myelination is actively continuing: “They’re taking nitrous oxide at the worst possible time, since adolescence is precisely a period of highly efficient myelination in our brains,” laments Dr Kochman.
Recurring memory lapses, new difficulties concentrating, an unusual drop in academic performance, tremors, dizziness, loss of balance, falls or legs giving way should serve as warning signs. Cardiovascular and vascular complications may also occur. In severe cases, hallucinations, paranoid thoughts or other psychiatric symptoms are possible.
What if, behind the nitrous oxide, there was a deeper sense of unease?
When dealing with a young person who uses the substance regularly, Dr Kochman also seeks to understand what they are seeking from it: “My first instinct is to ask myself what the young person was like before. Are they signalling a state of psychological distress?” Depression, severe anxiety, bullying at school or trauma may precede its use.
The psychiatrist cites the example of a teenager who was the victim of severe bullying at school and suffered from flashbacks and nightmares. Nitrous oxide allowed him to regain, for a few minutes, a sense of well-being: “In many cases, there is a form of ‘therapeutic’ use: I take this to forget my psychological distress,” explains the child psychiatrist.
The substance then becomes a form of self-medication, which also prompts us to look at group dynamics in a different light: “The leader who gets everyone else involved may well be the one suffering the most,” adds Dr Kochman. Problematic use is also sometimes linked to poly-substance use involving several other psychoactive substances (synthetic cannabinoids, ecstasy or ketamine).
Nitrous oxide: what warning signs should we look out for?
A teenager who admits to having tried nitrous oxide once at a party is not necessarily addicted. Frequency is not the only indicator, either. The context and purpose of use also matter: experimenting occasionally with friends when one is in good psychological health does not carry the same significance as using alone to suppress anxiety or a sense of unease.
However, an increase in the amount used, repeated use, the need to use alone or immediately upon waking, loss of control, and the onset of cognitive, neurological or psychological problems should prompt a visit to a healthcare professional. After stopping, recovery is often good, but it can take several months and some after-effects may persist.
Maintaining open communication
When a teenager admits to having used nitrous oxide, the reaction of those around them is crucial: ‘If a teenager tells you they’ve tried it, thank them for telling you. If they think they’re going to be told off or punished straight away, next time they won’t say a word. ’ The aim is not to trivialise the use but to try to understand the circumstances: how many times has the substance been taken? With whom? In what context? The subject can also be broached in advance, in the course of a casual conversation, rather than in the form of an interrogation.
If in doubt, a consultation with a GP may be helpful. They can check for any neurological disorders, assess balance and reflexes and, if necessary, prescribe blood tests, particularly to check vitamin B12 levels.
At emeis, a holistic approach to care
Once addiction has taken hold, some young people may be admitted to an emeis clinic to begin withdrawal. Depending on their needs, the care programme combines neurological assessment, vitamin B12 supplementation, psychotherapeutic support and physical activity. The teams also seek to identify the underlying causes of substance use: anxiety, depression, trauma or bullying: “The aim is for withdrawal not just to be temporary during their stay, but for the young person to leave with a genuine motivation to stop,” emphasises Dr Kochman.
An inspiring project!
In Eaubonne (near Paris, France), medical and support staff from the Clinique Mirabeau, the Jeune et Engagé association and the municipality have produced a film entitled ‘Nitrous oxide isn’t your friend!’ to warn teenagers about the serious dangers of nitrous oxide. Shown on reception screens in schools across Eaubonne and via the student app Pronote, the film is available in two formats: a short version aimed at pupils to make a lasting impression, and a longer version, focused on public health, intended for parents. This project was selected by the Tandem association – supported in particular by the AFEP – for its ‘Tour de France of inspiring projects’!