Intended for healthcare professionals


Laughter isn’t always the best medicine

BMJ 2018; 363 doi: (Published 02 November 2018) Cite this as: BMJ 2018;363:k4579
  1. Anita Acharya, medical student1,
  2. Ian Basnett, public health director2,
  3. Charles Gutteridge, chief clinical information officer3,
  4. Alastair Noyce, senior clinical lecturer4
  1. 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Public Health Department Barts Health, Barts Health NHS Trust, London, UK
  3. 3Department of Clinical Informatics, Barts Health NHS Trust, London, UK
  4. 4Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
  1. Correspondence to: A Noyce a.noyce{at}

Recreational use of nitrous oxide is an emerging public health problem

Recreational inhalation of nitrous oxide (N2O) is under-recognised in the UK, with potentially serious health risks. Adolescents and young adults presenting with the neurological complications of repeated N2O use are seen regularly in east London emergency departments.1 Greater awareness of this emerging public health problem is needed.

Nitrous oxide is a colourless gas, with minimal odour and variable taste. Inhalation of N2O can produce a short lived, rapid onset euphoria and a dissociative effect. This is often accompanied by spontaneous laughter, hence the colloquial name “laughing gas.” Historically, N2O was inhaled as a recreational substance long before its potential use as an anaesthetic and analgesic agent was recognised.2 Importantly, N2O is always combined with oxygen in clinical settings to minimise the risk of hypoxia,3 but it is inhaled neat by recreational users.

Although the clinical use of N2O in anaesthesia has been declining in the UK and elsewhere,45 its popularity as a recreational drug has increased among adolescents and young adults.67 The 2017 Global Drug Survey …

View Full Text

Log in

Log in through your institution


* For online subscription