Doctors in Germany are seeing more patients harmed by recreational nitrous oxide, commonly known as laughing gas. A survey of neurologists found that cases are increasing, especially in big cities like Berlin and Frankfurt. The drug can damage nerves and the spinal cord, causing weakness and numbness. Most patients improved with vitamin B12 treatment, but three-quarters relapsed when they used the drug again. The study shows that doctors need better training and clearer guidelines to help these patients, since many aren’t aware of all the health problems laughing gas can cause.

The Quick Take

  • What they studied: How often German neurologists are seeing patients hurt by recreational nitrous oxide use, what health problems it causes, and how doctors are treating it
  • Who participated: 101 neurologists answered questions about how many nitrous oxide patients they see, and 17 neurologists provided detailed information about how they diagnose and treat these patients
  • Key finding: About 60% of neurologists reported seeing occasional nitrous oxide patients, and 5% see them regularly. Cases are increasing across Germany, with more cases in cities. Most patients develop nerve and spinal cord damage, but improve with vitamin B12 treatment—though 75% get sick again if they use the drug more
  • What it means for you: If you or someone you know uses nitrous oxide recreationally, be aware it can cause serious nerve damage. If you experience weakness, numbness, or tingling, see a doctor immediately. Treatment with vitamin B12 can help, but stopping use is essential to prevent relapse

The Research Details

German neurologists were asked to complete an online survey in two parts during summer and early fall of 2024. In the first part, 101 doctors answered questions about how often they see patients harmed by nitrous oxide and whether they’ve noticed an increase in cases. In the second part, 17 doctors who treat these patients provided more detailed information about how they test for the problem and what treatments they use.

This type of survey is useful for understanding what’s happening in the real world—how many doctors are seeing a problem and what they’re doing about it. The researchers asked neurologists specifically because nitrous oxide mainly damages the nervous system, which is their area of expertise.

The survey was conducted online, making it easy for busy doctors to participate. The researchers asked about trends over time, which helps show whether the problem is getting worse or staying the same.

This study is important because Germany didn’t have good information about how widespread nitrous oxide abuse is or how it’s affecting people. By asking the doctors who treat these patients, researchers could get real-world data about the problem. This information helps public health officials understand where to focus prevention efforts and helps doctors recognize and treat the condition better.

This study has some strengths and limitations to consider. The strength is that it comes directly from neurologists who treat these patients, so the information is based on real experience. However, the number of doctors surveyed is relatively small (101 in the first phase), so the results may not represent all of Germany perfectly. The survey relies on doctors remembering and accurately reporting their cases, which could lead to underestimation or overestimation. Additionally, doctors in rural areas may have been less likely to respond, so the data might overrepresent urban areas where more cases occur.

What the Results Show

The survey revealed that nitrous oxide abuse is a growing problem in Germany. About 60% of neurologists reported seeing at least occasional cases, and 5% reported seeing cases regularly. The problem is most noticeable in major cities—Berlin and Frankfurt had the highest numbers, with some doctors reporting more than 30 cases per year. However, the concerning trend is that cases are also increasing in smaller towns and rural areas where they were previously rare.

Most neurologists treated between 1 and 10 patients per year with nitrous oxide-related problems. The damage caused by the drug was consistent: 94% of cases involved myelopathy (damage to the spinal cord), and 88% involved neuropathy (damage to nerves in the arms and legs). These conditions cause weakness, numbness, and tingling that can make it hard to walk or use your hands.

When doctors tested patients, they most commonly checked vitamin B12 levels (94% of cases) and blood cell counts (88% of cases). Doctors considered a specific test called methylmalonic acid to be the most reliable way to detect vitamin B12 deficiency caused by nitrous oxide (78% of doctors). Treatment usually involved vitamin B12 injections (88% of cases), sometimes combined with another medication called methionine (24% of cases).

The good news is that patients improved after treatment—their disability scores improved from an average of 3 to 2 on a standard scale. However, the bad news is that 75% of patients got sick again after they resumed using nitrous oxide, showing that stopping the drug is absolutely necessary for recovery.

The survey found that doctors were less aware of some other health problems caused by nitrous oxide. Only 24% of neurologists recognized hypercoagulability (increased blood clotting risk) as a complication, and only 12% were aware of skin problems. This suggests that some serious side effects may be going undiagnosed. The study also showed that doctors use different approaches to diagnosis and treatment, indicating a need for standardized guidelines that all doctors can follow.

This study adds to growing international evidence that recreational nitrous oxide use is becoming more common and causing serious health problems. Similar trends have been reported in other countries, particularly in Europe and the United States. This German study is valuable because it provides the first systematic look at the problem in Germany and shows that it’s not just a big-city issue anymore—it’s spreading to smaller communities.

Several limitations should be considered when interpreting these results. First, the survey only included neurologists, so cases treated by other types of doctors (like emergency room doctors or general practitioners) weren’t captured. Second, the response rate wasn’t very high, so the results might not represent all neurologists’ experiences. Third, the survey relied on doctors’ memories and records, which might not be completely accurate. Fourth, the study was conducted during a specific time period (summer 2024), so trends might have changed. Finally, the survey didn’t include information about why people use nitrous oxide or what factors make someone more likely to abuse it.

The Bottom Line

Based on this research, here are evidence-based recommendations: (1) If you use nitrous oxide recreationally, stop immediately—the health risks are serious and well-documented. (2) If you experience weakness, numbness, tingling, or difficulty walking, see a doctor right away and mention any nitrous oxide use. (3) Doctors should be trained to recognize nitrous oxide-related nerve damage and test for vitamin B12 deficiency. (4) Public health campaigns should educate people about the dangers of nitrous oxide, especially in areas where use is increasing. These recommendations have moderate to high confidence because they’re based on real-world medical experience, though more research is needed to optimize treatment approaches.

This research matters most to: people who use nitrous oxide recreationally or know someone who does; neurologists and other healthcare providers; public health officials developing prevention programs; and anyone experiencing unexplained weakness or numbness. This research should NOT be used to diagnose or treat yourself—always see a healthcare provider for proper evaluation.

If someone stops using nitrous oxide and receives vitamin B12 treatment, improvement can begin within weeks to months. However, nerve damage can be permanent if use continues for a long time. The study showed that patients improved significantly with treatment, but relapse was common when people resumed use, suggesting that the benefits depend entirely on stopping the drug.

Want to Apply This Research?

  • Track weekly symptoms using a simple scale: (1) numbness or tingling in hands/feet, (2) weakness or difficulty walking, (3) balance problems. Rate each 0-10 daily. This helps monitor whether symptoms are improving or worsening and provides data to share with your doctor.
  • Set a daily reminder to avoid nitrous oxide use. Use the app to log cravings when they occur and identify triggers (stress, social situations, boredom). Track vitamin B12 supplementation if prescribed. Log any new symptoms immediately so you can report them to your doctor.
  • Weekly review of symptom trends and abstinence goals. Monthly check-ins with your healthcare provider using the app data. Track vitamin B12 levels if your doctor recommends periodic testing. Set milestone celebrations for days/weeks without use to reinforce positive behavior change.

This article summarizes research about nitrous oxide’s health effects but is not medical advice. If you use nitrous oxide or experience symptoms like weakness, numbness, or tingling, consult a healthcare provider immediately. Do not attempt to diagnose or treat yourself. This research reflects German neurologists’ experiences and may not apply to all populations. Always discuss any substance use and health concerns with a qualified medical professional who can evaluate your individual situation.