Between the flashing lights, bachelor parties, and tourists, there is a new image on St. Pauli in Hamburg: young people inhaling the contents of black balloons. They are filled with laughing gas. Consumption is simple and cheap: you fill a balloon with gas from a cartridge and inhale the gas from the balloon. The effect sets in within seconds and users feel relaxed and euphoric. The gas is particularly popular among young people. Mild hallucinations, highs, more intense feelings of happiness and fits of giggles – this is how users describe the feeling. A few minutes later everything is over. A seemingly harmless rush. The cartridges with the gas are available in different flavors such as strawberry. They are sold at kiosks or in vending machines – completely legally. However, the consumption of laughing gas as an intoxicant sometimes poses serious health risks.

Nitrous oxide is becoming increasingly popular among young people as a supposedly harmless kick at school stoves or parties, but this is prompting calls for consequences from politicians, parents and experts. The CDU is calling for a ban on the sale of nitrous oxide cartridges to minors in the Bundestag, as the “Editorial Network Germany” reports. The Lower Saxony Medical Association is also calling for a ban on sales for people under 18 years of age. Parents from Gifhorn in Lower Saxony have written an incendiary letter to Health Minister Karl Lauterbach because there, in addition to cookies and rubber toys, nitrous oxide cartridges are being sold in a snack machine near a school, as the “NDR” reported. In Wuppertal, a broad coalition of parties in the council campaigned for nitrous oxide to be anchored as an intoxicant in the Youth Protection Act and sent a resolution to the Federal Ministry for Family Affairs, as the “WDR” reported. In the Netherlands, the possession and sale of nitrous oxide has been banned since January 2023. Is the high from the cartridge really that dangerous?

Nitrous oxide is commonly known as laughing gas. The gas is colorless and has a sweet smell. It is used widely: in dentistry as a pain and anxiety-relieving medication, as a foaming agent in cream dispenser capsules, as a propellant in spray cans or in car tuning to briefly increase engine performance.

Abusing nitrous oxide for a short-term high is nothing new. Nitrous oxide has been inhaled for almost 250 years to provide a brief feeling of euphoria, relaxation, calm and detachment, reports the European Monitoring Center for Drugs and Drug Addiction (EMCDDA). But since 2010, the EMCDDA has seen an increase in nitrous oxide consumption. “We are in the middle of the third wave of the nitrous oxide hype,” the Observatory said in a November 2022 report.

It is not known how many young people in Germany inhale laughing gas for the legal high. There is no representative data for the population throughout Germany. In an online survey by over 280 addiction experts, the picture emerges that nitrous oxide consumption seems to be more of an issue in the west and north of the Republic.

Data from Frankfurt am Main provides further evidence. According to a study, the consumption of laughing gas among young people is higher than ever. 17 percent of young people in Frankfurt have already consumed laughing gas, according to the Mosyd drug study (Monitoring System Drug Trends) for the 2022 reporting year. An increase has been observed since 2016 (with the exception of the first year of the pandemic). For the study, around 1,500 students between the ages of 15 and 18 were surveyed by the Center for Drug Research at Goethe University Frankfurt.

When inhaled through the mouth or nose, nitrous oxide has an anesthetic effect after just a few seconds. Hallucinations and feelings of happiness may occur. The gas enters the lungs. It easily penetrates the cells of the nervous system. There are docking points for the messenger glutamate in the central nervous system. These are blocked by nitrous oxide. Inhibition of the messenger substance leads to changes in perception. Pain signals are also interrupted. Consumption also leads to oxygen deprivation, which can increase feelings of dizziness, lightheadedness, or disorientation.

“Something that only works for a short time cannot be that harmful – that is the misconception of many nitrous oxide users,” said Marc Pestotnik, a consultant at the Berlin Department of Addiction Prevention, to the health insurance company “Barmer”.

During consumption, the lack of oxygen in the blood can lead to unconsciousness, cardiovascular failure and brain damage. Even if the high wears off quickly, dizziness, lightheadedness or headaches can last up to 30 minutes. Frostbite can also occur if the gas comes into direct contact with the mouth or lips. The gas is cryogenic, i.e. very cold (-55 degrees). If the gas is consumed together with other drugs such as alcohol or cannabis, this can lead to young people underestimating how much nitrous oxide they have already inhaled, reports the EMCDDA.

“Deaths related to nitrous oxide are rare. Most cases involve accidental suffocation when using a mask or plastic bag over the head without adequate oxygen supply,” reports the EMCDDA.

Consuming nitrous oxide does not lead to physical dependence. However, psychological dependency can occur. Users want to experience the feeling of happiness that comes from consuming laughing gas again and again.

Alicia Haar, therapeutic director at the addiction clinic in Kronsberg, reported to “Spektrum” about nitrous oxide excesses in which young people consume 100 or even 200 balloons with nitrous oxide in a row. With such excesses or with regular consumption, the gas can have a toxic effect on the nerves. Nitrous oxide disrupts the metabolism of vitamin B12 in the body and prevents the formation of methionine, an amino acid needed to build nerve sheaths. This leads to nerve damage and even damage to the spinal cord. Those affected may complain of strange feelings in their legs. It often starts with tingling in the hands, arms, feet and legs. If further damage occurs, numbness and muscle weakness may occur, the EMCDDA informs.  

With increasing doses, psychoses can also be a consequence. 

Sources: EMCDDA, EMCDDA report, drug report Frankfurt, WDR, editorial network Germany, Barmer, Drugcom, Spektrum, city of Wuppertal, Lower Saxony Medical Association, NDR, Pronova BKK, survey of search experts