Researchers analyzed 22 years of poison center data and found a shocking increase in people misusing nitrous oxide, commonly known as laughing gas. Cases jumped from just 28 in 2003 to 401 in 2024—a massive 1,332% increase. Most users were young adults aged 20-29, and more than half experienced serious health problems like numbness, confusion, and loss of balance. About 29% needed hospital care. The study shows that doctors often don’t recognize nitrous oxide poisoning and that people rarely receive the vitamin B12 treatment they need to prevent permanent nerve damage.

The Quick Take

  • What they studied: How many people have been poisoned by misusing nitrous oxide (laughing gas) in the United States over the past 22 years, and what health problems they experienced
  • Who participated: 1,751 people aged 13 and older who reported nitrous oxide misuse to poison centers between 2003 and 2024. Most were male (63%), and the largest group was young adults aged 20-29 years old
  • Key finding: Nitrous oxide misuse cases increased dramatically from 28 cases in 2003 to 401 cases in 2024—more than 13 times higher. Over half of these cases caused moderate to severe health problems, and nearly 3 out of 10 people needed hospital treatment
  • What it means for you: If you or someone you know uses nitrous oxide recreationally, understand that it carries real risks of serious nerve damage and brain problems. Seek medical help immediately if you experience numbness, weakness, confusion, or loss of balance. This is a growing public health concern that doctors are still learning to recognize and treat properly

The Research Details

Researchers looked back at 22 years of records from the National Poison Data System, which tracks all calls to poison centers across America. They found 3,632 cases mentioning nitrous oxide, but only included 1,751 cases where nitrous oxide was the main substance involved. They organized the information by looking at who used it, where they used it, what health problems happened, and what treatments doctors gave.

This type of study is called a retrospective analysis, which means scientists examine data that was already collected for other reasons. In this case, poison center staff had already documented each case, and researchers simply analyzed the patterns and trends over time.

The researchers tracked important details like the person’s age and gender, where the exposure happened, what symptoms developed, whether people went to the hospital, and what treatments they received. They looked for patterns across the 22-year period to see if nitrous oxide misuse was becoming more or less common.

This approach is valuable because poison centers receive calls from across the entire country, giving a broad picture of what’s happening with drug misuse. Rather than relying on a few hospital cases or news reports, researchers can see the actual trend in real-world poisonings. This helps public health officials understand emerging drug problems and plan responses before they become even bigger crises.

The study’s strength comes from using a large, established national database that captures poisoning cases from all 50 states. The researchers used consistent definitions for what counts as nitrous oxide misuse and what counts as different health effects. However, the data only includes people who called poison centers—some people with mild symptoms might not call, and some might not mention nitrous oxide. The study is descriptive rather than experimental, meaning it shows what happened but can’t prove that nitrous oxide directly caused all the health problems, though the connection is very likely

What the Results Show

The most striking finding is the explosive growth in nitrous oxide misuse cases. In 2003, poison centers received only 28 reports. By 2024, that number had grown to 401 cases—a 1,332% increase over two decades. This wasn’t a sudden spike but rather a steady, sustained climb, suggesting that nitrous oxide misuse has become an increasingly common problem.

The people affected were predominantly young. Nearly 4 out of 10 cases (37%) involved people aged 20-29 years old. About 63% were male. Most exposures happened at home (85%), suggesting people were using nitrous oxide in private settings rather than in clubs or other public places.

The health consequences were serious. More than half (55%) of the cases resulted in moderate or major health problems. The most common symptoms were numbness (12% of cases), confusion (14%), and loss of balance or coordination called ataxia (11%). These symptoms reflect damage to the nervous system from nitrous oxide’s effect on vitamin B12, which the body needs to maintain healthy nerves.

Medical care was frequently needed. About 29% of people required hospital admission, and 10% needed intensive care unit treatment—the highest level of hospital care. Despite these serious complications, vitamin B12 and folate supplements, which are the targeted treatments for nitrous oxide poisoning, were documented in only 6.3% of cases. This suggests doctors often didn’t recognize the problem or didn’t know how to treat it properly.

The study noted that new product formulations may be contributing to the rise in misuse. Flavored, high-volume nitrous oxide tanks are becoming available, which may make the drug more appealing and easier to use in larger quantities. The fact that 85% of exposures occurred in private residences suggests that nitrous oxide misuse is happening in homes and social settings rather than in traditional drug use environments, which may make it seem safer than it actually is.

While individual case reports have suggested that nitrous oxide misuse is increasing, this is the first comprehensive study to document the actual trend across the entire United States over a long time period. Previous research focused on small numbers of patients or specific hospitals. This study confirms what doctors suspected: nitrous oxide misuse is not just a rare problem but a rapidly growing public health concern that has been largely underrecognized.

The study only includes people who called poison centers, so it misses cases where people didn’t seek help or didn’t mention nitrous oxide. Some people with mild symptoms might not call at all. The data comes from poison center reports, which may not capture complete medical information about long-term outcomes. Additionally, the study can’t prove that every symptom was directly caused by nitrous oxide alone, though the pattern strongly suggests this connection. The study also doesn’t explain why nitrous oxide misuse is increasing—it only documents that it is happening

The Bottom Line

If you use nitrous oxide recreationally, stop or seek help to stop. If you experience numbness, tingling, weakness, confusion, loss of balance, or memory problems after using nitrous oxide, seek emergency medical care immediately. Tell your doctor specifically about nitrous oxide use, as they may not automatically think of it. If you’re diagnosed with nitrous oxide poisoning, ask about vitamin B12 supplementation, which can help prevent or reduce nerve damage. High confidence: Nitrous oxide carries real risks of serious, potentially permanent nerve damage.

Young adults aged 20-29 should be especially aware, as they represent the largest group of people affected. Anyone who uses nitrous oxide recreationally should understand the risks. Parents, teachers, and healthcare providers should be aware of this growing problem. Medical professionals need to improve their recognition and treatment of nitrous oxide poisoning. Public health officials should consider regulatory measures and prevention campaigns.

Nerve damage from nitrous oxide can develop quickly—some people experience symptoms after just a few uses, while others may need repeated exposure. Once symptoms appear, recovery can take weeks to months with treatment, and some nerve damage may be permanent. The longer someone uses nitrous oxide, the greater the risk of lasting problems

Want to Apply This Research?

  • If you’re trying to reduce or stop nitrous oxide use, track daily abstinence with a simple yes/no log. Note any cravings, triggers, or situations where you’re tempted to use. Also track any physical symptoms like numbness or tingling to catch early warning signs
  • Set specific goals like ‘I will not use nitrous oxide this week’ and track progress daily. Identify your triggers (certain friends, locations, times of day) and plan alternative activities for those moments. Share your goal with a trusted friend or family member who can provide support and accountability
  • Weekly check-ins to review your abstinence log and identify patterns. Monthly reflection on physical symptoms—any numbness, tingling, weakness, or cognitive changes should prompt a doctor visit. Track mood and stress levels, as these often drive substance use. Consider connecting with support groups or counseling services for long-term success

This research summary is for educational purposes only and should not replace professional medical advice. If you or someone you know has used nitrous oxide and is experiencing symptoms like numbness, weakness, confusion, or loss of balance, seek immediate medical attention. If you’re struggling with substance misuse, contact SAMHSA’s National Helpline at 1-800-662-4357 (free, confidential, 24/7). Always consult with a healthcare provider before making any health decisions based on this information.