Mark Ward, a TD of Dublin Mid-West, wasn’t astonished upon discovering a heavy online promotion of a ‘World Cup edition’ of nitrous oxide, colloquially known as the ‘hippy crack’ or laughing gas, in 2022. The Sinn Féin representative, who intends to put forth legalisation in the Dáil regulating the sale of this substance within the next few weeks, has long been convinced that adolescents are the prime targets of those unlawfully selling the substance as a leisure drug.
The promotion from December 2022, encouraging audience to scan the product’s QR code for a chance to win Qatar World Cup tickets, still remains active on X with a promise of an ‘assured prize’. Dr Arthur Hennessy, however, warns that the reward might end up being a neurological complication that no youngster should have to face. Nitrous oxide has a reputation for hindering Vitamin B12 production, which could potentially cause spinal cord damage. According to Dr Hennessy, the gas can also induce ataxia, a condition resulting in loss of muscle control in arms and legs.
As a consultant at the emergency department of Dublin’s St James’s Hospital, Dr. Hennessy witnessed long before the World Cup’s commencement in 2022 the rising public health concern due to protracted usage of nitrous oxide. This warning was triggered after one of two young men, so deeply affected by the substance that he could no longer walk unaided and fell often on stairs, was treated at the hospital. Disquietingly, the consultant claimed that such manifestations of prolonged usage-induced neurological damage have become more commonplace since the onset of the Covid pandemic.
Evidence of the gas’s popularity is widespread around Dublin, given the abundant discarded canisters, specifically the small bullet-type ones, turning the streets into a litteryard. Dr Hennessy insists on stricter legal measures to prevent youngsters from accessing a product that is legally employed as a sedative in labour wards, dental clinics, and even the catering realm.
Orla Grimes, a youth worker from St. Andrew’s Resource Centre on Pearse Street in Dublin, suspects that children as young as ten are experimenting with nitrous oxide. This hazardous gas, besides causing neurological damage, can induce frostbite burns so severe that they can lead to irreversible disfigurement, a reality warned about by one plastic surgeon.
An inherent appeal attracts young children to the gas, especially its balloon application – it appears as harmless fun. Kids indulge in amusement, spraying the gas on each other directly from the canister, perceiving it as a game.
During the covid lockdowns, the staff at St Andrew’s created an informational pamphlet to caution youngsters about the perils of nitrous oxide, as its popularity ostensibly surged due to cannabis scarcity. Grimes indicated the growing prevalence, mentioning a recent conversation with youngsters about collecting empty canisters to create an art piece highlighting the gas’s risks.
Notably, Plastic Surgeon Catherine de Blacam reported seven instances of frostbite burns treated within a six-month duration at Crumlin Children’s Hospital and St. James’s. Post this publication in the IMJ (Irish Medical Journal), she has noticed an increase in similar cases.
She narrated the incidents she’s encountered both at work and her personal life, observing the canisters strewn on roads while walking her children to school around Camden Street and Stephen’s Green. She also noticed colleagues acknowledging the omnipresence of such canisters in their residential areas.
She has treated injuries so severe that they necessitate skin grafts, leaving behind permanent scars. The small silver canisters, dubbed as whippets or magic bullets, are single-use, and injuries often result when the liquified, rapidly chilling nitrous oxide spills onto lips or fingers during balloon filling.
Large containers often require users to grip them between their thighs when inflating balloons. Consequently, as the gas inside these containers transitions from liquid to vapour and the temperature falls to negative 50 degrees Celsius or even lower, the users, due to the gas’s numbing effect, do not perceive this change. This can lead to severe burns, or what the layperson might refer to as third-degree burns, that penetrate the full depth of the skin and, depending on the duration of the contact, even the subcutaneous fat. Dr de Blacam detailed the implications of such injuries.
“Loss of skin, flesh and fat may result in a contour deformity in the inner thigh,” Dr de Blacam stated. This change can be significantly disfiguring, particularly for young teenage girls fond of wearing short skirts.
The IMJ report that Dr de Blacam refers to includes seven cases, one being a 19-year-old male who sought medical assistance only upon his inner thigh wounds getting infected. Following the IV antibiotic treatment, his dead skin was excised and a skin graft was carried out. Although he eventually recovered from his wounds, irreparable scars and contour deformation of the thighs remained.
Also cited was a 14-year-old girl who had sustained injuries on her inner thighs from contact with a frozen cylinder, and was diagnosed with toxic shock syndrome due to infected burn wounds. After spending 21 days for wound healing, significant scarring was noted after a six-month follow-up.
These instances of frostbite injuries are reminiscent of injuries from World War I, Dr de Blacam stated. She further mentioned that the fear of getting in trouble often delayed individuals from seeking immediate help. “Treatment is irrespective of judgement,” the doctor clarified. “Unfortunately, some wait so long for treatment that sepsis sets in and intensive care is required.”
Catherine de Blacam acknowledged that these are just youngsters looking to have a good time, albeit with regrettable consequences.
Nitrous oxide, the gas in question, though not currently controlled under the Misuse of Drugs Act 1977 of Ireland, cannot be sold for recreational use due to its psychoactive properties, as stipulated by the Criminal Justice (Psychoactive Substances) Act 2010. Its sale remains legal for medical and catering applications.
Dr Hennessy noted the difficulty in obtaining accurate prevalence data concerning nitrous oxide usage. However, a 2021 report by the European Monitoring Centre for Drugs and Drug Addiction documented that over 23% of Irish adults aged 18 and over, with a history of illicit drug consumption, admitted to nitrous oxide use. A separate 2021 study, the Planet Youth Survey, which involved 2,384 post-Junior Cert students from North County Dublin, revealed usage rates of 6.2% among boys and 5.3% among girls.
Adverse neurological effects have been linked with long-term nitrous oxide usage, including potential brain damage, as noted by Dr Martin Daly, a GP based in Co Galway who’s more concerned about the use of cocaine in his locality. However, he accepts it’s a significant issue in specific metropolitan areas. The substance’s effects include euphoria, relaxation, and occasionally, hallucination. Therefore, its unregulated use is extremely unsafe.
A spokesman for Revenue explained the Customs officers’ legal powers to seize psychoactive substances when there’s suspicion these would not be used for lawful intentions. In 2021, there were five seizures, a dramatic drop from the previous year’s 114.
The problem appears to be intensifying specifically in Dublin, Cork and Limerick. Deputy Ward, previously an addiction counsellor, advocates for a licensing system to control the distribution of the substance and targeting sellers rather than criminalising young users. His observations suggest that the substance is readily available online, primarily towards a young audience. “Large canisters can be purchased online for €15 while they cost €40 on the street,” Ward added.
Orla Grimes concurs with the urgent need for tightening legislation due to the cheap and easy availability of nitrous oxide. She stated that the existing legislation was evidently ineffective.
A representative from the Health Department stated that nitrous oxide qualifies as a psychoactive substance and a solvent under the law. Any individual vending it for human ingestion would be committing a crime, as outlined in the 2010 Criminal Justice (Psychoactive Substances Act).