A letter from clinicians, published in The Lancet Neurology, asserts that criminalisation of nitrous oxide possession is not the answer to the concerning rise in neurological harm from nitrous oxide abuse, and calls on the UK government to prioritise legislative efforts to effectively curb the sale of nitrous oxide destined for recreational use.
The letter raises concerns over the Government’s decision to make nitrous oxide a Class C drug under the Misuse of Drugs Act 1971, rather than follow the primary recommendation in its own commissioned review by the Advisory Committee on the Misuse of Drugs (ACMD), that the legal regulation of nitrous oxide should remain under the Psychoactive Substances Act 2016.
The clinicians say that many nitrous oxide users also use other (already illegal) drugs, and are unlikely to be deterred by a Class C schedule, but the primary concern is that this legislation may cause further harm from poor engagement with healthcare services. Those suffering harm from nitrous oxide abuse are most often adolescents and young adults (some of whom are already vulnerable), and delays in presenting for medical care because of criminalisation may decrease potential reversibility of neurological damage. Any resultant long-term disability will further widen socioeconomic inequality, and propagate the poverty-disability cycle.
The letter notes that the future burden of nitrous oxide-related myeloneuropathy depends on how effectively the government is able to reduce the supply and sale of nitrous oxide for non-legitimate use, through shutting down websites selling irresponsibly, restricting sales of large containers that have no legitimate private use, and introducing mandatory health warnings on packaging.
The authors, from WIPH and Barts Health NHS Trust, conclude: ‘As clinicians, we have a duty to both react to changing patterns of disease and to proactively contribute to shape government policy that improves disease prevention. We urge healthcare workers to remain vigilant and enquire directly about possible nitrous oxide use where relevant, and call upon the UK government to prioritise legislative efforts aimed at effectively curbing the sale of nitrous oxide destined for recreational use.’
Alvar Paris, Devan Mair, Safiya Zaloum, Barbara Onen, Alastair Noyce. Nitrous oxide and its neurological harms. The Lancet Neurology 20 September 2023 22(10) page 882 ISSN 1474-4422. https://doi.org/10.1016/S1474-4422(23)00329-0.