Children as young as 10 are trying nitrous oxide, frontline workers warn

Dublin Mid-West TD Mark Ward wasn’t that surprised when he spotted a “World Cup edition” of nitrous oxide, better known as laughing gas, being heavily promoted online in 2022. The Sinn Féin deputy, who is hoping within weeks to introduce legislation in the Dáil regulating the sale of the substance, also known as “hippy crack”, has long believed younger people are being targeted by those illicitly marketing the product as a recreational drug.

The December 2022 promotion, urging users to scan the QR code on the bottle to be in with a chance of winning tickets for the Qatar World Cup, is still on X with its promise: “there is always a guaranteed prize”.

That prize just might be a neurological issue no young person needs, because according to Dr Arthur Hennessy, nitrous oxide interferes with the creation of vitamin B12 and can cause damage to the spinal cord. Ataxia, where people lose control of muscles in their arms and legs, is also a risk, according to Dr Hennessy.

[ Laughing gas use and supply on the rise in Ireland, research shows ]

He is a consultant in the emergency department at St James’s Hospital in Dublin where in 2022, long before the World Cup began, medics became so alarmed at the impact of prolonged use of nitrous oxide they flagged it as an emerging public health issue.

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One of two young men who caused the alert was so badly affected he was unable to walk unassisted, and had fallen a number of times on stairs. The consultant who first started seeing the neurological damage caused by prolonged use during the Covid pandemic, says presentations are becoming more frequent all the time.

The evidence of its popularity is, he says, there for all to see throughout Dublin in the shape of discarded canisters from which the gas is decanted into balloons.

“They are everywhere. They are littering the streets particularly the small bullet-type ones,” said Dr Hennessy. He believes the law needs to be tightened up to ensure younger people cannot get their hands on a product that is legitimately used as a sedative in labour wards and dental clinics and also in catering.

Orla Grimes, a youth worker attached to St Andrew’s resource centre on Dublin’s Pearse Street believes children as young as 10 are experimenting with nitrous oxide, which as well as causing neurological damage, causes frostbite burns so severe that one plastic surgeon has warned permanent disfiguration can result.

[ Nitrous-oxide: Laughing gas hits a new high in Ireland ]

“It looks fun for young children, especially with the balloon element,” said the youth worker. “They seem to be playing with it a bit, and shooting it at each other, firing it out of the canister directly on to each other. They think it is a game.”

Staff at St Andrew’s produced an information leaflet warning younger people of the dangers of nitrous oxide around the time of the Covid lockdowns, when some addiction counsellors believe it became popular because of the unavailability of cannabis. “Its popularity has grown,” said Grimes who recently considered getting younger people to source empty canisters to create a work of art to highlight the dangers. “They told me they’d have no problem finding them. They would only have to go two metres to see them littered all over the place,” she recalled.

Plastic surgeon Catherine de Blacam recently reported on a cluster of seven frostbite burns treated over six months at Crumlin Children’s Hospital and St James’s. Since her findings were published in the Irish Medical Journal (IMJ), putting the issue under the spotlight once more, she says the cases keep coming.

“One came in yesterday where the two inner thighs were burned. We had two in the last month and in the last four months probably another five,” said the plastic surgeon who also sees evidence of the growing craze in her day-to-day life outside work.

“When I walk my kids to school I keep seeing the canisters all over the road around Camden Street and Stephen’s Green. It seems to be on the rise again. So many (colleagues) in the hospital say ‘the canisters are all over my estate’.”

The injures she has treated include frostbite burns so severe that skin grafts have been required leaving a permanent scar.

“The little silver canisters known as whippets or magic bullets are single use so the injuries we see are when the liquid nitrous oxide as it gets cold, spills on to the lips or fingers as they are filling a balloon.”

With the larger containers, the users tend to hold them in place between their thighs as they fill balloons and because of the numbing effect of the gas they are oblivious when the temperature drops to minus 50 degrees Celsius or lower as liquid turns to vapour.

“They suffer what the general public would call third-degree burns. It is a burn that goes through the whole thickness of the skin and depending on how long the contact is, through the fat, underneath your skin as well” explained Dr de Blacam.

“If you lose skin and flesh and fat you are left with a contour deformity on your inner thigh,” she added. “For young teenage girls who like to wear short skirts it is cosmetically pretty deforming.”

Among the seven case histories (one male and six female) cited in her IMJ report was a 19-year-old man who did not seek help until the wounds on his inner thigh were infected. The teenager was admitted for intravenous antibiotic and underwent debridement where the dead skin is cut away before having a skin graft. His wound did heal but he was left with “significant scarring and contour deformity of the thighs”.

They are all beautiful young people trying to have fun. But it ends badly

—  Catherine de Blacam, plastic surgeon

Another recorded case was that of a 14-year-old girl who presented two days after injury to her inner thighs from contact with a frozen cylinder. A diagnosis of toxic shock syndrome as a result of infected burn wounds was made and she had to be admitted to the intensive care unit.

It took 21 days for the young girl’s wounds to heal and “a six-month follow-up showed significant scarring”.

Dr de Blacam says the frostbite injuries younger people are experiencing “is World War one stuff”. The consultant noted many of those affected had delayed seeking help because they thought they would get into trouble.

“Obviously we treat everyone without judgment,” she said. “One delayed so long the burn got infected and she was profoundly septic and had to go to ICU.

“They are all beautiful young people trying to have fun. But it ends badly”.

Nitrous oxide is not currently a controlled drug under Ireland’s Misuse of Drugs Act 1977. It can legally be sold for catering and medical purposes but the Criminal Justice (psychoactive substances) Act 2010 makes it illegal to sell laughing gas for its psychoactive properties.

Dr Hennessy pointed out that data on its prevalence is hard to come by. But a report by the European Monitoring Centre for Drugs and Drug Addiction shows that in 2021 more than 23 per cent of Irish adults over 18 with a history of illicit drug use, had used nitrous oxide.

And a Planet Youth Survey conducted among 2,384 post Junior Cert students in schools in north county Dublin in 2021 found 6.2 per cent of young males and 5.3 per cent of young women had used it.

Long-term use can lead to well-documented severe neurological damage. That means ongoing use can cause brain damage. So it is not safe to be used in an unregulated manner

—  Martin Daly GP

Customs officers have a range of powers under legislation, to detain and seize psychoactive substances where there are reasonable grounds for believing they are not intended to be utilised for legitimate purposes, a spokesman for Revenue pointed out.

Last year there were five seizures, considerably down on the 114 in 2022.

The problem does seem to be more acute in Dublin, Cork and Limerick.

Co Galway-based GP Dr Martin Daly, who has more concerns about cocaine than laughing gas in his catchment area, agrees it is a serious issue in some urban areas.

“It can cause euphoria, relaxation and sometimes a hallucinogenic state,” he said.

“Long-term use can lead to well-documented severe neurological damage. That means ongoing use can cause brain damage. So it is not safe to be used in an unregulated manner.”

Deputy Ward, a former addiction counsellor, wants a licensing system in place to control who sells the substance.

“I do not want to criminalise the young people, who are the end users. We want to go after the people who are selling it.”

He believes most younger people access it online.

“Big canisters retail on the street at €40. You can buy them online for €15. And they market it towards young people – like when they had a special World Cup edition.”

Orla Grimes agrees that because it is so cheap and so easy to access, the legislation needs to be tightened up. “What is there at the moment is clearly not working,” she said.

A spokesman for the Department of Health said nitrous oxide falls under the definition of a psychoactive substance and a solvent and anyone selling it for human consumption would be guilty of an offence under the Criminal Justice (Psychoactive Substances Act) 2010.

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