By Content Producer Narbeh Minassian
Large canisters of nitrous oxide intended only for caterers appear to be driving an "exponential growth" of patients suffering from the gas' effects, experts have told ITV News.
While it has been common to see small, bullet-sized canisters of nitrous oxide - also known as laughing gas - littered across streets for years, more users now favour far larger cylinders with a significantly greater volume.
It's feared the use of nitrous oxide products such as Smartwhip or Goldwhip - cans specially-designed and legally sold to the catering industry to whip cream - appear to be at least part of the reason why hospital admissions are "through the roof" since Covid.
Laughing gas provides a short burst of euphoria, lasting no more than a few seconds, but can cause paralysis and even death if inhaled excessively.
It is now the second most used drug by 16-24 year olds in the UK, with more than half a million young people reporting taking the drug in 2019-20.
Alex Littler, 16, is one of the growing number who have fallen foul of the effects of laughing gas.
He had been at a music festival the day before, where he had inhaled nitrous oxide from balloons pumped by the smaller canisters, having only weeks prior used one filled with a Smartwhip.
Mum Cathy McCann, from Ellesmere Port in Cheshire, came home from work to find Alex still asleep, when she knew something wasn't right.
“He was still in bed so I asked what was up, he said he can’t breathe properly and has a horrible crackling on his chest,” she told ITV News.
“When I looked and I felt his chest, it was horrible. It was like pressing bubble wrap paper, I’ve never seen or heard anything like it. My fingers would sink half an inch into his chest.”
Calling the emergency services immediately, she was told to take him to hospital at once.
He was sent for a CT scan and an X-ray, but it wasn’t until doctors questioned him that Cathy discovered the reason behind her son’s condition.
“The doctor asked if he had been crushed in any way, if maybe he’d been on someone’s shoulders at the festival and fallen off,” she said.
“The doctor then said ‘I want you to be truthful, Alex, we need to know what you’ve taken.’ That’s when he came out with it. I just broke down in tears.”
Alex’s lung had been ruptured and air – including nitrous oxide – had been left trapped around his heart and shoulder blade, causing his chest to feel spongy.
While his puncture was healing quickly, doctors told Cathy her son would likely need an operation to remove the air before managing to remove the gases with an oxygen mask worn overnight.
“Until you see a person who’s lying there like that, you don’t know what them balloons do to you,” Cathy added.
“He was so lucky, it could have left him paralysed, braindead or even dead.”
Keen sportsman Alex couldn’t sit the remainder of his GCSE exams and hasn’t played football or rugby since leaving hospital.
The 16-year-old, who bought Cathy flowers to apologise for the ordeal, promised his mum he would never take nitrous oxide again.
Hospital admissions going ‘through the roof’
While Alex was only in hospital for little more than a day, more and more appear to be staying far longer and still living with the consequences.
At Sandwell and West Birmingham Hospitals Trust, toxicologist Dr Mark Pucci told ITV News there were just six admissions to his hospital between 2015 and 2020 related to the use of nitrous oxide.
Now, he says, there is one roughly every couple of weeks – with two patients admitted to his ward last week alone.
“Even when we had around one admission per year, that was felt to be frequent,” he said.
“But in the past year or so there has been an exponential growth in hospital admissions. We’re now seeing one every two weeks, as a rough estimate.”
Like Dr Pucci, neurologist David Nichol sees only the most severe cases at the same hospitals trust, with one of his patients still relying on crutches to move 18 months on from admission, despite being young and otherwise healthy.
He fears there could be far more, less severe cases who need treatment elsewhere.
“This is something I rarely saw in the past ten years, but it has gone through the roof over the past two, and it’s getting worse,” he said.
“At the beginning of the pandemic, we were seeing around two admissions every two months and now it’s almost weekly. I’m seeing patients with life-changing neurological injuries.
“And there will be others who we don’t see in primary care of other emergency departments.”
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Users typically inhale by filling a balloon with laughing gas.
The effects can be devastating, with both Dr Nichol and Dr Pucci seeing patients with spinal cord damage and an inability to walk.
Nitrous oxide can inactivate vitamin B12, which is essential for healthy nerves, Dr Pucci explains.
“Patients have symptoms including pins and needles, electric-shock-type symptoms on their hands, arms, feet and legs, while the most severe effect the spinal cord, when they can’t walk,” he said.
“They tend to be young adults that are generally fit and healthy, they don’t tend to be hardened drug users on other drugs. The average age is 22.”
What’s behind the spike?
With the recent wave of nitrous oxide highs seemingly driven by young adults between 18 and 30, some suspect social media is one potential factor behind the increase.
Searching for terms such as ‘Smartwhip’ and 'Goldwhip' on TikTok or Twitter produces videos and pictures of users fainting or sustaining other injuries.
Dr Nichol believes boredom that came about over several lockdowns led many to take up balloons, which then turned into a habit – so much so that he sees even patients who have lived the worst effects take it up again after leaving hospital.
On the other hand, a lack of awareness around the gas’ effects can lull users into a sense that they are taking up a safe drug, Dr Pucci said, which can become a “psychological addiction.”
But what many experts single out as the most significant factor is the apparent ease with which even teenagers can get hold of nitrous oxide cylinders.
Canisters ‘very easy to get hold of’
It’s that availability of canisters that worries charities like Re-Solv, which helps people suffering from solvent abuse – including those who fall ill from the use of nitrous oxide.
Stephen Ream, the charity’s director, is particularly concerned that users appear to be favouring larger canisters over smaller “whippets” and therefore inhaling a greater volume of the gas.
“We are concerned about the increased accessibility to and usage of the larger nitrous oxide canisters,” he said.
“We are now seeing reports of the use of these canisters much more often, usually alongside the smaller silver ‘whippets’ that have been the issue over recent years.
“The services that we deliver training to are also noticing increased usage of the larger canisters.”
Recently, the charity supported one young man who had been inhaling directly from the valve, rather than from a balloon, which left him with a significant blister on his lip.
“The canisters appear to be very easy to get hold of on various websites, so long as the buyer simply checks a few boxes indicating that they will be using the product for catering purposes only,” he said.
“The whippet-sized canisters help to regulate the amount a user can inhale.
“This can of course be manipulated by filling a balloon with two (or more) canisters, or by inhaling two balloons in succession, but generally speaking the amount used is regulated by the size of the canister.
“The larger canisters contain roughly 70 times the amount of nitrous oxide and a user can inhale much more of the gas in one go.”
Smartwhip and Goldwhip have been approached for comment.
So why isn’t this illegal?
Buying canisters of nitrous oxide is not illegal, nor is selling it – as long as the retailer is not selling it for recreational purposes.
Anyone selling the gas for its psychoactive effects face a maximum sentence of seven years in prison.
The buyer, however, is not breaking the law by inhaling nitrous oxide.
Southgate Police in London have highlighted a "rise in activity" in car parks around their area.
In Southend, Essex, police have been warning they will crack down on the recreational use of nitrous oxide.
Essex Police said: “We will work with partners to support the Public Spaces Protection Order in Southend.
“Under the Psychoactive Substances Act 2016 we will arrest anyone using or supplying nitrous oxide and seize and destroy any canisters.”
Home Secretary Priti Patel asked the independent Advisory Council on the Misuse of Drugs (ACMD) to review the harm of nitrous oxide in September last year and to look at potentially outlawing its possession.
“When the ACMD responds, the government will consider the advice carefully,” a spokesperson for the Home Office said.
While the law doesn't punish users, Cathy urges other parents and their children to "think twice."
"I’ve had thousands of messages of parents finding balloons in their children's pockets," she said, adding she heard from one whose child is just 13 and admitted to using the gas.
"Just think twice... it can be life-changing, it can kill you – it’s just not worth it for that little fix, a couple of seconds."
If you have been affected by the use of nitrous oxide and want to share your story, email firstname.lastname@example.org